Episode 4 -- Private Health Insurance...NASE

We've finally taken the time to revisit health insurance coverage in an attempt to get away from my wife's group health insurance slavery. At this point, we're rolling the dice to see if someone will cover my wife and help us avoid using the coverage of the High Risk Pool which is mediocre at best. In our quest for decent private insurance, we stumbled onto the NASE.

The National Association for the Self-Employed provides an interesting health benefit to its members. They have negotiated a "group-like" health insurance plan with MEGA Life and Health Insurance out of Oklahoma City, Oklahoma. The only difference between a real group plan and the NASE plan is that you still have to go through underwriting for the NASE plan. Needless to say, that puts my family in an interesting predicament with my wife's medical conditions.

We found out our first bit of negative news this morning...MEGA will not cover anyone taking Coumadin. Coumadin is the "blood thinner" taken by my wife as a result of her Deep Vein Thrombosis episode 11 years ago. Doctors use Coumadin in these instances as a preventive, not as a treatment for a problem. In 11 years, my wife has had no further problems with clotting. Indeed, one could debate the necessity of taking daily Coumadin in her situation.

Here's what I'd like to know, though. Would MEGA have considered writing a policy for her if she had discontinued taking Coumadin prior to the application?

What's my point? Simple...health insurance companies encourage wreckless practices through their underwriting procedures. Have a pain? Ignore it...you don't want that Doctor's visit on your record. Need medication? Don't take it...you might be denied coverage because of it.

President Bush needs to wake up to the fact that as long as there are health insurance underwriters, the private health insurance industry will not work. I know he likes the idea of non-profit organizations pooling members to buy health insurance, but it just isn't the same as a group policy.

Amica Does a 180

In my previous article on homeowner's insurance, I noted that Amica rejected our application because of our German Shepherd. Over the past week, however, the area representative presented some of my e-mails to people higher in the organization. They told her to collect all of the information on my dogs and submit it to underwriting. In just a few hours, they had accepted our policy.

So...my apologies to Amica for underestimating them. This is the kind of behavior I expected from the company I researched a couple of years ago for my auto insurance policy.

Now if only I could get some health insurers to take a page out of Amica's book...

Homeowner's Insurance Silliness

About 4 years ago, I made the mistake of following the advice of relatives to file a claim on minor water damage in the front of our home so that we could get some money for new carpet. Farmer's subsequently doubled our yearly rate making our yearly rate higher than what they paid out once in the 6 years we've been in our house As it's renewal time, I decided to check into some alternatives to reduce our monthly payments to a reasonable level.

At American Express, I found good prices and a very odd pricing practice. They would quote and even sell you at your home's existing insured value with whatever company you currently use. Oddly enough, though, they wouldn't pay out more than the appraised value minus the value of the land. Given that there's almost a $75,000 disparity between Farmer's insured value and the appraised value of home minus property, it would seem that American Express would be collecting a lot of monthly premiums that they shouldn't collect.

Aside from the odd pricing practice, Amex would have to send our policy through underwriting because we own a Chow-mix dog. It wasn't an outright rejection, but a rejection was possible.

At Amica, I was outright rejected...not for the Chow...but for my German Shepherd. Given that I have had good experiences with Amica and already have my auto insurance with them, I offered to waive liability coverage for the dogs. No dice...they still rejected our policy.

What's humorous is that one company is scared of Chow's and the other German Shepherd's. Has any of them ever been around some of the different breeds? I doubt it because if they had, they would understand that the inherent risk is really with the owners, not the breeds. Any dog can be raised to be aggressive and dangerous just like any dog can be raised to be mild mannered and submissive.

Amica passed on a profitable customer and may have lost my auto-policy (no claims for the life of the policy). I hope they're happy.

Episode 3 - Private Health Insurance...Disputing the Riders

After further discussion with my agent, he recommended I call underwriting (customer service) at Fortis to discuss the riders placed on my policy. The subsequent phone call lasted over an hour while I spoke with two different representatives. The first representative knew very little and in fact had no real information but spoke as if I knew nothing. It felt like a textbook case of being talked down to.

The second representative actually had the information used during underwriting. As it turns out, even though underwriting knew of the EMG and MRI, they based all of their decisions on the Doctor's notes from the appointment where he ordered the EMG and MRI. So, not only did they know about the tests because I told them, but the Doctor's records should have also shown the EMG and MRI being ordered.

So, the riders have been explained, but my experience with the customer service representatives has helped me decide not to accept the insurance. Here are a few statements the representatives made during the call:

• In response to me asking about a higher premium to get surgery or even just complications of surgery for Otitis Media (ear infections) covered..."We're not going to solve all of the insurance industry problems right here on the phone today."
  
  
• In response to me asking what information the first representative was looking at in telling me they didn't have records that underwriting had clearly told me they would order..."I know nothing." This isn't a joke...that's what she said. I then asked to speak to somebody that did know something, and she transferred me. I figured she'd hang up.
  
  
• In response to me asking why I would trust their claims department given their attitude on the phone..."That's a decision you'll have to make."
  
  
• In response to me asking if he thought there was a problem with their research based on not retrieving the EMG and MRI results that they knew about..."No."
  
  

Needless to say, I wasn't too impressed. Admittedly, I was combative on the phone, but I do that intentionally to see how they react. Dealing with ISPs, I've often found that if sales can't be polite, technical support will be a nightmare. I'm guessing that if customer service for health insurance is poor when you're trying to GIVE THEM MONEY, it could only be worse when you're trying to take money.

The next step is to look into Blue Cross Blue Shield. Unfortunately, they do not offer an HSA and as such, our medical expenses would not be tax deductible. Don't believe the crackpot accountants they have on TV shows that tell you all of your health care costs are deductible. In truth, only the amount of expenses that exceed 7.5% of your adjusted gross income are deductible.

It's interesting to note that Miscellaneous itemized deductions have a floor of 2%. Given that a lot of Miscellaneous deductions are fraudulent, it really makes you wonder about the logic of our elected representatives. Removing all taxes from the healthcare system would go a long way toward reducing the burden on all Americans.

Episode 2 -- Private Health Insurance...The Offer

It finally came after another e-mail to my insurance agent this morning. This was the offer that would free my wife from her work-for-insurance situation...just $100/month. BUT...there's some fine print. For myself:

• 2 year rider excluding any illness, disease or physical disorder of the wrists including, but not limited to, Carpal Tunnel Syndrome.
  
  
• 3 year rider excluding any injury, illness, disease, or physical disorder of the spine, its muscles, ligaments, joints, discs, nerves and spinal cord.
  

And for my 1 year old son:

• 1 year rider excluding esophagitis, reflux esophagitis, heartburn, indigestion, gastroesophageal reflux disease, duodenitis or hiatal hernia, including but not limited to any diagnostic procedures, treatment, surgery or complications thereof.
  
  
• 2 year rider excluding Otitis Media, including any diagnostic procedures treatment, surgery or complications thereof.
  

So let's look at each of these exclusions individually related to our medical history. Both of my exclusions deal with a precautionary visit to the Doctor regarding numbness in my arms while sleeping. As it was, I had let the problem go on for about half a year without visiting a Doctor and finally went because the episodes were so severe that I couldn't move the arm from the shoulder down, and it was taking 5-10 minutes to get feeling back in the arm.

The orthapaedist ordered X-Rays, an EMG, and an MRI. As a side note, I have never met a more arrogant Doctor. The X-Rays showed basically nothing. The Doctor was a little concerned about the position of one vertebrae which prompted the MRI. My profession, computer programming, led him to order the EMG.

The MRI was a piece of cake and resulted in a statement from the reviewing physician of "Negative cervical spine MRI." Of course, the EMG, that was a different story. I can imagine a lot of people live with the pain of carpal tunnel syndrome instead of completing one of these tests. Basically, the test consists of electric shock to the nerves in your arms and hands and stabbing the muscles with needles.

My test took around 2 hours as the Doctor wanted to be very thorough given the unusual nature of my symptoms. He even went so far as to check my neck (not part of the normal routine). I don't know if you've ever had a needle inserted into the back of your neck, but it's not the most comfortable thing in the world. The fun part about the needles in the EMG, though, is that the Doctor moves it slightly inward 3 times after the initial stick. Big fun if you ask me...

Anyway, I ended up with the same result as the MRI...normal study. In fact, the Doctor told me during the test that he'd never done such a test where the nerves fired as well as mine did.

The Doctors explained my symptoms as a combination of injury and bad sleeping position.

So, I took a precautionary visit to the Doctor, ruled out any problems, and the insurance company penalized me for it.

With respect to my son, he had some minor reflux problems in his first 3 months of life, but since then, he's been fine. At the time of the insurance application, he had been through a rough period with ear infections, but the Doctors were not (and still are not) talking about tubes. Both of these are things that a lots of babies experience and the majority outgrow.

I don't mind the exclusion about carpal tunnel. I know from the EMG that it will be a long time before I have to deal with it, but excluding everything related to my spine. That's a bit scary. With respect to my son, again, I'm fine without having a safety net for reflux issues, but otitis media? I have no idea how much tubes would cost and what kind of complications could go along with them. Granted, there's a very low chance that he'll have tubes, but it's an issue that has to be addressed due to the exclusion.

The problem here is the mindset of the insurance company. For each patient, they want to make money (in the private market) regardless of what happens to your health along the way. As a result, they try to find the most likely near-term problems and exclude them from coverage.

How is insurance "insurance" when they only cover things that you don't have? It's great that I can have cancer coverage, but what good does insurance do me if, by some off chance, I have a problem with my spinal cord? I thought the whole idea behind insurance was sharing risk across a larger group. When did the insurance companies decide that each and every patient had to be profitable?

Something in the health insurance market has to change in this country...this system is hopelessly broken. Being far, far right in the political spectrum, I refuse to believe that means socialized medicine. Maybe I just need to start my own insurance company...

Episode 1 -- Private Health Insurance

Sticking to my daily routine, I arrived at work around 8 am after dropping my son off at daycare. The anticipation of finding an answer to my family's health insurance quandry left me breathless as I jogged up the stairs to the second floor. Plugging the laptop into the wall, I knew it would be a few minutes until Mozilla would be running, but I waited anyway. Watching the cryptic messages scroll by on my Linux laptop as it booted seemed to take forever. That stupid PCI hotplug ought to be faster.

Finally, a login prompt. I was just a username, password, and a few commands away from checking my e-mail.

With Mozilla finally on the screen, it was just a matter of minutes before I would see that my son and I were approved for private health insurance under a Health Savings Account (HSA) program with Fortis. On the ADSL line at work, it wouldn't take long to download the usual 500 or so messages, half of which are spam, to my local machine. Even though the Bayesian spam filter in Mozilla is slowly falling apart, it still picks up about 70% of my spam saving me tons of time sorting through garbage.

I double-clicked to open the first e-mail to start reading. After deleting a few spam and reading some server status reports from our FreeBSD machines at the colo facility, the Mozilla window closed.

Huh? Where was my insurance offer?

Knowing that it could have fallen into the Junk folder as a false positive, I started the arduous task of cleaning out my junk mail. After several thousand messages (it had been a while since the last housekeeping adventure), I still had nothing.

"Well...forget hi-tech, I'll just call," I thought to myself.

The independent agent, Mark, answered the phone quickly and politely. As he told me about the questions they had about a visit to the Doctor earlier this year and how they ordered medical records, all my hopes of finding a health insurance alternative had been crushed.

Apparently, you have to be HEALTHY to qualify for HEALTH INSURANCE. And not just healthy, you better not have been toa Doctor for anything beyond a routine physical EVER.

Does that make any sense?

I'm applying for an HSA policy with a $5,000 deductible. Never, in my life, have I had expenses in excess of $5,000...not even the year I had gall bladder surgery.

Ridiculous...