GI for Children

[bluemarlin08]

Just wrote a family that has a child that has health issues with RX costs of 700 per month. BC rated the boy up 300% ($300) and the family is tickled to death to get the coverage. How can a company write many of these types of cases where the cost for one family members drugs is more than the entire family's premium????

 

[AllenChicago]

I had a family of 5 approved last week where the 12 year old child was rated up 500% because she's allergic to dairy products. The parents are very ticked off at ObamaCare now. On the prior policy, there was an Anaphasic Shock exclusion rider (or something like that), which the clients were happy with, because the daughter needs no treatments.

But, even with the 500% rate-up, they're paying less money now...though their deductible is larger. Based this experience and what BlueMarlin related in the prior post, I'm getting a REALLY BAD feeling about 2014 when noone can be turned down.

What part of the ACA spells out how high a child can be rated? Until last week I thought the max was 300%.

-AC

 

[somarco]

Depends on what the DOI allows them to do.

BCBSGA used to do this here years ago. Family rate up, then they got away from it and started rating individuals on their own merit.

I have been told they have gone back to the old way of doing things.

Seems like Aetna is doing the same. Can't recall if anyone else is.

ACA doesn't regulate rates, and neither does HHS . . . even though they think they do.

Since Cigna doesn't pay commission on families where a kid is GI I really don't care what their practice is.

As Allen indicated, this is going to be a lot of fun come 2014 when you can buy a $500,000 home at a lower payment than family health insurane.

 

[YouGotMyMoney]

Depends on what the DOI allows them to do.

BCBSGA used to do this here years ago. Family rate up, then they got away from it and started rating individuals on their own merit.

I have been told they have gone back to the old way of doing things.

Seems like Aetna is doing the same. Can't recall if anyone else is.

ACA doesn't regulate rates, and neither does HHS . . . even though they think they do.

Since Cigna doesn't pay commission on families where a kid is GI I really don't care what their practice is.

As Allen indicated, this is going to be a lot of fun come 2014 when you can buy a $500,000 home at a lower payment than family health insurane.

Yes, I'll be all good though Bob...gonna invest in some Pain Management Clinics.....hell best of both worlds....mad money and free scripts...

 

[HealthGuy]

Somarco: Isn't Obama going to fix this coming sticker shock? I thought he was the smartest president ever? Surely he foresaw this coming with his health plan. This was supposed to lower the costs of health insurance. Oh my, what happened here?

 

[dgoldenz]

I was told by GR last week that there is "no limit" to what a child could be rated up. I asked if they could rate a policy to $50,000 a month if they wanted to. They responded "there is no limit to the rate up." There was no guideline on how to figure out a potential rate up for a decline-able condition either, just submit and hope for the best. Anthem is charging HIPAA rates for uninsurable kids, which isn't bad at all for a couple of their policies.

 

[somarco]

No, HealthGuy, I hate to tell you this, but Obama lied. What he didn't lie about, it was because he was ignorant.

David, interesting comment on GR. I asked 2 months ago and got no response.

Well, I did get a response. It was "we haven't decided yet".

 

[dgoldenz]

I kept getting that response before too, but I had a kid with a very rare bone disease that would need future surgery and they couldn't give me any clue as to what the rate up would be. That was the first time they actually gave me some sort of answer, even if it was as vague as possible. Anthem's SmartSense policy with a $750 deductible was $350/month for the kid, total premium $640/month for a family of 4. Would I go with that, or submit to GR and hope that it comes out better after they take a month to order a full file of medical records and review? Easy decision there for me and the family.

Oh, and Anthem pays full 15% commission on the policy even though one child is GI. They told me as long as there is one or more people underwritten, they will pay full commission.

 

[HealthGuy]

Seriously guys: Who feels like giving up trying to figure out WTF is going on with these carriers? At this point, between commissions, underwriting, plan design changes, etc...Its such a freakin' moving target. Not to mention the interpretation of this legislation. Again I say total clusterf@#k I'm not out of the game but I'm completely frustrated with the entire industry post this ridiculous legislation. Its unreal. This bill is making scrambled eggs out of our omelettes.

 

[TXINSURANCE]

How can a company write many of these types of cases where the cost for one family members drugs is more than the entire family's premium????

Because current Federal law requires these cases to be covered DAY ONE with NO pre existing waiting periods. I don't think the government cares if the big bad insurance company loses money - or maybe that is the plan???