Posted by Dr. Bob on July 16, 2002, at 10:56:34
[from http://www.dr-bob.org/babble/20020709/msgs/112416.html]
> I saw some posts over at social babble on some insurance not covering Ambien, and I just felt the need to enlighten the board to the awful truth about health insurance, especially as it relates to employer provided group plans. There is a lot more to this story than I could post on PSB, but here are the highlights.
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> Your employer may provide health insurance for employees. In order for them to get quotes for this, you have to have each person that wants to be on the group plan fill out a questionnaire with their health problems, any regular meds, etc.
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> There are so many things wrong with this I can't believe it really happens. First, are you pleased that the HR staff of your employer knows your medical history, and your medications? That seems like an invasion of privacy.
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> Also, it means that if you have a "sickly" person on your staff, everyone has to pay more out of each paycheck for their health insurance. I joked to my business partner that we should hire only very healthy athletes until after we get a good quote for cheap insurance. I was only kidding, but an unethical company could (secretly, of course) terminate employees if their medical problems were jacking up the health insurance rates.
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> But that would only work for one year, because the insurance companies do "utilization reviews" to determine the next year's premiums. They look to see how many claims were made, and how much it cost them. Then they adjust the rates for that group to be high enough for them to make money the next year. They actually look at how much each person cost.
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> If an employer asks, why have our rates for our health insurance increased 200% since last year, they (some insurance agent) can actually point out that Joe's wife is on Zyprexa, and that s*** costs big $$$. And Jane's husband needed back surgery, and god knows back patients are second only to psych patients for needing ongoing expensive care...
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> It's the same as auto insurance - if you get tickets and have wrecks, your rates go up. But in the case of an employer provided group health plan, if any one person gets sick or needs meds, EVERYONES costs go up. If the guy in the next cube is a smoker, and gets cancer, next year you won't be able to afford your company health insurance.
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> Your employer can dodge this practice, called "profiling", by switching health insurance companies each year, but that's a huge hassle to people.
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> Because the cost of the company provided plan was so high a few years ago, we almost decided we could no longer afford it.
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> So my wife and I tried to get self pay health insurance. First they told us $600 per month per person, but only if we "got off" certain meds. Then they came back and said that due to our medical history, they could not offer us health insurance, at any price, as private individuals. The only chance of us getting insurance was through a group plan, where our high utilization could be offset by someone else's low utilization.
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> But the group health insurance costs so much that the business can barely afford to pay its part, and the employees can barely afford to pay their part.
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> So I am now in a position where I may end up on the street corner holding a cardboard sign that says “Will Work for Health Insurance”.
poster:Dr. Bob
thread:26359
URL: http://www.dr-bob.org/babble/social/20020714/msgs/26545.html