Discount Plan Sold to Woman with Congestive Heart Failure

somarco

GA Medicare Expert
5000 Post Club
36,704
Atlanta
At times like this, I wish discount medical plans were illegal, or at the least, the salesmen should be held accountable for their actions.

A lady contacted me over the weekend, desparate to talk to me about finding health insurance.

She had real health insurance until April of this year when some *** talked her into dropping it in favor of his plan that was "just like what she had, only cheaper."

The first time she tried to use it the doctors office refused to accept it and told her it was a discount plan and they did not recognize or accept those plans.

The salesman told her his plan was better since she never went to the doctor and didn't use medication, which at the time, was true.

Two months later she went to the doc, complaining of difficulty breathing. She thought she had asthma.

Turns out she has congestive heart failure. She takes 4 different medications.

Georgia doesn't have a risk pool. Her prior coverage was not HIPAA qualified. Even if it was, she had more than 63 days without coverage. She is self employed as a contract (1099) employee. We don't have 1 person groups in Georgia and she earns too much for Medicaid.

Shortly after buying this crap plan the salesman actually called back trying to sell her a dental & vision plan.

She refused, but is still paying $189 per month for a plan that does nothing for her.

We are exploring options now, including Healthy Access, a new limited benefit plan from Time. It doesn't appear that Time want's to put detailed underwriting information, or even an application, online. Does anyone have some guidance on this plan?
 
I know this is cold, however, I take it she didn't read any of the member materials that were sent to her? If it was a discount plan, the marketers are required to state that the product is not basic health insurance and not meant to replace comprehensive major medical coverage.

As to AHA, Plan A is not underwritten. Obviously, because a consumer does not get any of the hospitalization/surgical benefits with plan A.


As to the health questions, very similar to STM:

Doc


454jajxere
 
Thx, Mark.

Plan A is not available in Georgia. I finally found, after posting here, an application so I now know she won't be eligible for HA either.

Discount plans are not regulated here, as is the case in most states. I don't know if the guy was local or calling from out of state. The DOI has no jurisdiction over them. The AG will get involved if there are enough complaints.
 
I know this is cold, however, I take it she didn't read any of the member materials that were sent to her? If it was a discount plan, the marketers are required to state that the product is not basic health insurance and not meant to replace comprehensive major medical coverage.

Isn't it obvious, she trusted the agent. We obtain a licence from the state and hold ourselves out as experts in this field. A person should be able to trust that we know what are talking about, and that we honestly believe that this is in the person's best interest. It is no different than going to the doctor. If the doctor tells me I need a procedure or medication, how many people are going to second guess him?

In reality, all the disclosures in insurance and securities do more harm than good. It gives the prospect/client a false sense of security, and it gives the agent/company too much wiggle room. Both the agent and the company can always say that they fully disclosed this to the woman, but she bought it anyway. If she signed an app or a delivery receipt disclosing it is a discount plan, she is pretty much going to lose any lawsuit.
 
Thx, Mark.

Plan A is not available in Georgia. I finally found, after posting here, an application so I now know she won't be eligible for HA either.

Discount plans are not regulated here, as is the case in most states. I don't know if the guy was local or calling from out of state. The DOI has no jurisdiction over them. The AG will get involved if there are enough complaints.

I guess the only thing you can do at this point is put her on the Careington discount card. At least she will get the discounts and she won't be paying almost $200 a month for it.
 
I did put her on the Careington card. Still hoping something will turn up that is worthwhile, but not expecting much.

As for disclosures, discount plans will have them but just like insured products, no one bothers to read them. FWIW, she could have just as easily bought a Saver plan or Right Start on the same pitch that she never goes to the doc and doesn't use medication (which was true at the time).

I have been in this industry long enough to have stories of folks who have paid premiums for years and never had to use the plan. But I also have folks who ran up bills of $100k+ within weeks or months of taking out the coverage.

Sadly, there are also a few that didn't buy then their health took a turn for the worse soon after and they did not have anything to cover their bills. There are probably more in this situation than I know of.
 
This is a tough one...on the one hand the buyer must beware but I agree all the disclosures and forms the client must sign does give them a false sense of security and a statement that this coverage is just like you have now is defiantly an ommission of the differences between her true coverage and the crappy plan she bought but she will have signed something that protects the company and will make any lawsuit un-winable....The sad part is this type of crap plans leads people to think be need obamacare.

There is one more option that probably is not that realistic to her and that would be to move to a place like Maine...The policy would be GI the carrier would be able to deny claims for 1 year based on the pre-existing condition however after the one year she would be fully covered by Anthem up here.
 
Are prices in ME for GI products affordable or is it like NY/NJ?

First all health insurance in Maine is GI and all Health Insurance Prices are expensive....I guess the best way to explain it is this almost no one sells Individual Coverage here in Maine Group coverage is actually cheaper because the carrier at lest is assured that you are currently working and spreads the risk out among a group with a smattering of ages as opposed to the people actually willing to pay the price of individual coverage which costs more than my mortgage.
 
GI and affordable are mutually exclusive terms.

KY & NH had GI but then in a moment of lucidity decided to repeal it. KY probably shouldn't count because they repealed their GI provision in a year or less.

It took the folks in NH a bit longer, something like 8 years before they finally got the picture.
 
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