About Shopping Around for Health Insurance

December 11, 2009

There is a helpful article in the New York Times today, “Steps to Take Before Cobra Subsidy Ends”, which lays out some tips or suggestions to maintain your coverage while Congress debates on whether or not to extend the subsidy. It points out that your COBRA payments will go up, and that it is better to pay the full amount than let it lapse.

That’s good advice. Letting your insurance lapse creates a new set of issues that are next to impossible to avoid or untangle. There is a grace period, usually not more than 90 days, which is about three months. Remember, though, that applying for an individual or family health plan can take 30-40 days to process, and applying does not guarantee you will be given coverage.

And it is the lack of guarantee that gives me pause when I read:

time to shop around for health insurance alternatives that may be more affordable.Check ehealthinsurance.com and healthplanone.com for general pricing information from carriers that provide individual policies in your area.

You may find a plan that is perfect for you (and your family) at an affordable price, apply and get denied. The denial puts you right back at square one. And that is a frustrating, demoralizing place to be.

To avoid, or at least improve your chances of getting coverage, apply to more than one plan that you like and/or find a respectable health insurance broker. Or check out organizations like MediaBistro, the Freelancers Union, the National Association for the Self-Employed or something similar that offers health insurance to members. They have often brokered good deals for members already, much like your former employer. And if you’re a lawyer, try the American Bar Association.

When it comes to health insurance, there is something to be said about being part of a large group. MediaBistro, Freelancers Union, NASE, ABA and others put you back in a group, and sometimes that can lead to more than just health insurance coverage.

Take the time now to investigate your options and get the ball rolling on applications. It will make a difference.


Lessons for Getting Individual Health Insurance Coverage

December 9, 2009

This blog has become a little less about open source for lawyers and legal professionals, in the strictest sense, and more about my own struggles as a laid off individual turned entrepreneur. I have been applying the philosophy of open source to this blog, and on all fronts, it remains a WorkInProgress. One thing about blogging is that you can easily shift it to apply to any given situation, such as unemployment and the myriad of challenges people don’t tell you about, let alone offer any kind of guidance on how to overcome them, other than to simply press on.

One of those challenges is obtaining health care coverage. You may recall my previous post on denial of coverage, and the absurdity of “pre-existing conditions.” I had about given up, holding onto a thin thread of hope that the government would pass health care reform that, among other things, might stream line the application process. I find it difficult to believe that 30 million or so Americans will be given health coverage without a simplified health insurance application process. Silly me. Congress is not interested in bringing down the cost of health care by streamlining the ridiculous application process. It’d rather demand the adoption of electronic medical records, which is a good idea but will not solve the problem.

Congress is still haggling over health care reform. Sure, the House has passed its bill and the Senate seems intent to pass its own before the year is over, but the two still have to be reconciled and then that rather innocuous word, “implementation,” must occur. No one seems to know how long that will take.

So for those of you who find yourself staring at the end of your COBRA coverage, or are otherwise on the hunt for health insurance but have struck out much like myself, I offer some advice that helped me obtain coverage:

  1. Do not apply for an individual plan, or a health plan, with whatever health insurance company you currently have through COBRA
  2. Find a good health insurance broker, either through a family member, family friend or other trusted source
  3. Apply for coverage under whatever state program is offered

Find a Different Insurance Company

The logic that switching from COBRA to an individual plan with the same insurance company  will be easy and simplify things is poor logic. I learned this one the hard way, so let me explain.

When you apply for an individual plan, or a different plan than the one you had through your employer or COBRA, you effectively become a new “customer.” However, you are a new “customer” with a history, so the insurance company has a wealth of information it can sift through to find any reason, however mild, to deny coverage. The forms requesting permission to obtain medical records is merely a formality, in case there is a challenge. You are better off applying for a plan with a different insurance company.

Do some research, especially since plans vary widely by state. Check consumer watch websites, too. Though few people have anything good to say about health insurance companies, you’ll get an idea of what people have to say, which is likely to be more honest than what you find on the corporate websites. Also talk to family, friends and others about their health insurance coverage. Had I done so, I would not have applied for an individual plan with the same company I had for the past 4 years. I wasn’t a fan of it, to be sure. The best health insurance plan I ever had was with a Taiwanese container shipping company, and which I fully understand I may never get again. But, at the time, it seemed better to go with the devil I knew than venture out into the unknown. That was foolish. So even though it may be a hassle, and it will all start to sound the same, shop around.

And shopping around brings me to point #2: find a good health insurance broker.

Find a Good Health Insurance Broker

I’m was skeptical about using an insurance broker. I looked into it briefly, and found information for and against but not enough to persuade me to find one. I was a bit stumped on how to find a good one, too. If I call them up, they’ll give me some song and dance sales pitch. I’m not interested in a sales pitch. I’m interested in results. And who is to say the broker won’t cut and run when the deal is done?

So I continued on my way, working my way through various applications and applying for coverage through the state as well.

The questionnaires were endless, asking for every little medical detail. I discovered that if you were still covered, they only asked for information going back five years. When I applied after my coverage had expired, meaning I was not covered, they asked for information going back 10 years. It was starting to make more sense to wait for Congress to get its act together and pass some semblance of health care reform, or apply for the state plan.

Then I got an email from my uncle, who recommended an insurance broker whom he had used before, and recommended to others. I thought it a kind gesture, but didn’t think much of it. I was starting to question whether I really needed health insurance at all. There was no pressing need. Except that accidents happen, and I cannot shake the logic that the point of insurance is to guard against accidents. And the accident that always pops into my head is the “bus incident” that wasn’t as bad as it could have been, but who is to say the next accident, sans-bus or otherwise, will turn out that way?

So I called the broker, explained my situation which he said was common these days. That was surprising, but what was surprising was the application process. The number of questions was considerably diminished, and when I was contacted for more information, it was via phone. There wasn’t a separate mountain of permission forms to sign; just a series of questions to further enlighten the new insurance company. However, there was a difference in tone.

When I had called up my now former insurance company to switch to an individual plan, the woman on the phone was cheery and confident that I’d be approved. Nothing raised red flags, which at the time struck me as odd and later was infuriating. Clearly my former insurance company needs to change its in-take process as red flags should have stopped my application cold.

The tone was quite different with this broker application process. The representative asked similar questions, requested clarification of claims but did it in a manner that seemed to imply a genuine desire to help, or a deep understanding of insurance company processes and how best to present information to achieve an objective. Granted, that may or may not be true, I really have no way of knowing. But I do know that the approach was decidedly different, the response much faster and the overall experience less frustrating.

Still, there was no guarantee, so I decided to cover all the bases and submit my application or the state plan.

Apply for State Health Insurance

State health insurance is no less bureaucratic than private health insurance, and it is much more expensive, at least in Illinois. However, they’re rules are a little less strict, so more people can be covered. It was the least desirable, but with options dwindling, I bit the bullet and sent in my application. Apparently I forgot to answer one question. It had to do with whether or not my parents have health insurance and whether or not I am eligible to be covered under their plan. Since I am over the eligibility age of their plan, I didn’t think the question applied to me. Even the phone call I got about the question said I was over the age, but I still had to answer it anyway.

And then there was this interesting little piece.

Under “employment,” I said was “self employed” since, well, I am. Turns out that you have to send in a letter, on your “corporate letter head,”stating that you do not offer yourself health insurance coverage. Sounds silly to me. If I provided health insurance, why would I be applying for state coverage? After some thought, though, I can understand. Budgets are tight all around so they want to provide coverage to those that absolutely cannot get it anywhere else.

I was working on fulfilling a couple other requirements to complete my state application when I receive a surprise email: my health insurance application had been accepted and I had been granted coverage. That was followed by an email from the insurance broker, confirming my health coverage. So I stopped my state health insurance application.

Final Thought(s)

There is no doubt that the health insurance industry is a mess, and I’m skeptical that any reform out of Washington will address it in any meaningful manner. Of course, that is predicated on the assumption that health care reform passes.

So if you find yourself staring at the COBRA finish line, and still want health insurance, I suggest finding a broker through a family member, friend or other trusted source, and applying for state health insurance in the mean time, if your state offers a health insurance plan. Speaking from experience, it is a relief to have some coverage. One less thing to worry about as the “what ifs” shrink, and create space for other, happier things.

Demand Openness from Health Insurance Industry

November 6, 2009

One of the things I liked about Obama’s campaign was his seemingly relentless pursuit of opening government up to the people. It wasn’t hard to sell that point. It’s clear that under Bush, the people were kept in the dark so some light was more than needed with a new president.

Obama has made strides in his efforts to bring “transparency” to government by bringing in smart tech people and creating sites like data.gov. Though not perfect, it is a step in the right direction. People have more access to raw government data than before, which helps educate the public. We should count our blessings we not only elected a leader who believes in an educated public, but also takes such visible steps to help educate the public.

As health care continues to dominate headlines and debates both in Congress, at local hang outs and even around the dinner table, one thing is missing: health care transparency.

Open standards for electronic medical records: OK. Coverage for more Americans: on the table. Eliminating “pre-existing” conditions as grounds for denial: on the table. Giving Americans more choice/control over their health care: on the table.

Except how can we make informed choices without access to the data that determines those choices? How can we make informed decisions on anything related to health care if the data remains obscured by government and health insurance bureaucracy?

Simple answer: we can’t. But, as we’ve all come to realize, any issue around health care is anything but simple.

A start would be to provide standard definitions for “pre-existing” conditions and for what constitutes a “history,” and make those definitions universal. If one incident, even if not repeated, constitutes a “history,” then say so. If the “pre-existing” condition list is so expansive as to include any trip to the doctor that resulted in “recommended treatment,” even for the common cold, then say so.

By leaving such things undefined, or rather leaving it up to insurance companies to define, creates wide-spread confusion and denial of coverage in one state but approval in another. People will be more likely to gravitate towards the states where they are more likely to get coverage, sucking states dominated by money-hungry insurance companies dry. Loss of population leads to loss of tax revenue. Loss of population means companies have a smaller pool to help shore up their work force, so they will look to move where there are people. Small businesses will gravitate towards states that are more kind to them. An imbalance will be created that will only exacerbate existing budget falls.

Requiring health care companies to show where exactly premium dollars are spent is another starting point. How much goes towards claims? How much goes towards advertising? Payroll? They are run like companies, so all the money goes somewhere. It comes out of our pocket and goes into someone else’s, and we should be allowed to know who.

So if the government is truly set on health care reform, and truly wants Americans to be able to make their own health care decisions, then demand insurance companies become more transparent than the government. Clearly no one can rely on studies conducted by groups, even if the groups claim to be “neutral.” Americans must be given access to the very information used to decided whether or not they can receive coverage, whether or not a particular procedure or visit is covered and whether or not their health is really that important.

Health care reform may force insurance companies to cover more people than they’d like (despite their claims that they will have access to a broader base, which they already do but choose to deny), but until Americans are given more than a cursory view of how the system works, health care reform won’t do much good in the long run.

Health Coverage Frustration

October 26, 2009

OK. I’ve done my best to stave off a rant on health care coverage, especially since I’m sick and tired of hearing people, ahem, politicians, health insurance companies and the like, put forth the same arguments for and against health care reform. They all take a rather narrow-minded view of health insurance reform, and are completely ignoring something basic: the health insurance application process.

If you want everyone to have coverage, then you must simplify the application process. Case in point: me.

Just to recap: I got laid off in April 2008, making me ineligible for extended benefits, or what I’ve referred to as inadvertently being ahead of the pack. Knowing my COBRA insurance would run out after 18 months, the maximum length of time for coverage, and would not be extended under new legislation since I was laid off well before the masses, I applied for individual coverage. I’m a fairly health individual, take 0 prescription drugs but like to have a plan in case of the unexpected, especially after getting hit by a CTA bus. I came away from that unscathed, but with a profound sense that accidents happen (the bus hit me, not the other way round) and I may not always be as fortunate.

I did some initial research, and I found that I still liked my current carrier and that an individual plan would save me roughly $300 a month over COBRA. I momentarily kicked myself for not switching earlier, but there had been the chance of gainful employment that brings with it health insurance coverage. Plus, it is the 3rd time I’ve had this particular health insurance carrier so my records are already with them. In triplicate, actually, which I find rather silly but didn’t know exactly how ridiculous this was until I applied for individual coverage.

Logic dictates that since I am already insured by said carrier, indeed have been insured by said carrier, switching from an employer to an individual plan should not be equivalent to walking through a mine field shackled and blind folded. They have my information, they have my records, they have what is needed. When I called to inquire about switching, I asked if they can just transfer my records from an employer account to the individual account I wanted to set up. The person laughed. Nope. Doesn’t work that way. I have to re-apply and re-submit my medical records. All of them.

Now keep in mind I am not changing carriers; I am using the same carrier. They have my records. The records have to be submitted for claims, and there have been a few claims since I have been insured by said carrier. Bottom line: they have the records.

Apparently, though, no division communicates with any other division. They cannot simply move my records from the “employer” division to the “individual” division, and then check for discrepancies and make records requests for incomplete information. No. I have to go through a completely separate, wonderfully detailed application process. The majority of the questions, by the way, would have been answered if they had been able to move my records. And they clearly have access to my claims history because they read it back to me over the phone, and inquired about each one. My answered verified what they had on their screen.

So this is where my frustration has started to…OK…has boiled over. If they can pull up my claim information, why can’t they then review my records? Why is it that I had to sign 4 records releases? 4! And here we are, more than a month later, and I am still waiting for the underwriter to approve or deny my application.

Yes. That’s right. Approve or Deny. Without employer coverage, there is the possibility of being denied coverage. If I’m denied coverage, I’d hate to see what happens to people who have submitted 0 claims and also take 0 prescriptions.

That’s not what annoys me, though. What annoys me is the silos. How on earth can there be any kind of meaningful health care reform if health care insurance companies cannot even share information within their own walls? And if they can’t even do that, how can they possibly field requests for information from out-of-state hospitals? Seriously. What happens if I am in a serious accident or have to be hospitalized in Arizona, Florida, Maine or *gulp* overseas? If it takes more than a month simply to request records and “process” an application, how long does it take to send my information to a hospital somewhere else?

I talked about this whole medical records transfer issue in a previous post on electronic medical record portability, but this lack of internal communication makes me think the problem runs much deeper than anyone, myself, Congress, anyone, originally conceived.

My point, though, is that if health care coverage is to be granted to everyone, then Congress must force the health care insurance industry to simplify its process. So if a person like me, who is KEEPING THE SAME INSURANCE CARRIER, applies for individual coverage, the process should happen much more quickly than if I were to change carriers.

Otherwise, shelve health care reform and focus on creating jobs as that will be the only way the rest of us will be able to obtain health care coverage.