6 ms·

I had the same unfortunate experience that in angers me to even think about it. - I leave my last employer on July 21, 2017 - My old employer rols me off syst

by weka 9y ago

I had the same unfortunate experience that in angers me to even think about it. - I leave my last employer on July 21, 2017 - My old employer rols me off system on last day of July 2017 - On June 2017, they switch HR providers from TriNET to Namely and now the payment processor is Discovery Benefits and the Dental/Vision are now in Guardian. (So it went from Aetna to Aetna/Guardian and two other companies). Since my wife is high-risk and I have thyroid issues, our best bet was COBRA ($1,000 / mo) because the new startup I joined did not offer group health coverage. What followed next was this: - The HR person who was handling my COBRA papers left during all of this. Switched jobs. - Thanksgiving break - Weeks of "the system will update this weekend with your information." - "They were suppose to process your dental, but they never did" My wife and I tried using our new AETNA IDs once we had gotten them and they still told us that it did not work. I had to have an expensive thyroid blood test pushed back. Multiple dentist appointments postponed. Everything. FINALLY, once I got my SSN and ID for my coverage on AETNA, I had to pay back premiums all the way back to August 2017 just to keep using my coverage. So that's $4,000 USD for services I could not essentially render. $4000 of my hard-earned money. Gone. For nothing -- basically. They had the gall to tell me (AETNA did) "Sir, if you paid for anything out of pocket during the time of your retroactive coverage, we can pay you back any cost you incurred." The whole reason we get insurance is to avoid those high prices. I'm so spent. I'm not an angry man but these health insurance companies really drove it home for me. I feel taken advantaged of and it really stinks.

rsync 9y ago
"The whole reason we get insurance is to avoid those high prices." But only for unpredictable, irregular events. Anything else is uninsurable. If someone sells you "insurance" for wellness checkups[1], regular, scheduled screenings ... or tires on your car ... you can be absolutely assured that they are taking from you as much, or more, in premiums than the cost of those services. What you are looking for is socialized, state sponsored medical care. There is no problem in looking for that and I make no value judgement here on that. The first step would be to stop mischaracterizing this as "insurance". It's not. It can't be. [1] Yes, certainly wellness checkups and things like them can be enormously economically beneficial for the provider since they spend up front preventative dollars instead of emergency, acute dollars later but it still doesn't change the fact that those are not underwriteable as they are regular, on-going expenses - very much like the tires on your car.
- bostonpete 9y ago
  Your comment seems to overlook the fact that insurance companies negotiate better rates on many (most?) services than an individual would get going at it alone. From that perspective, I think it's reasonable to say that in our current system, insurance can allow you to essentially avoid high prices even for things that are predictable/regular.
  - lotsofpulp 9y ago
    That is because providers can't refuse healthcare to someone that needs it and can't afford it, so those costs get inflated just to be able to get a fraction of it. As rsync says, it's still not insurance, it's just the ability to be part of a group large enough to negotiate pricing, and has enough credibility for providers to trust them to be able to pay.
    - jdpedrie 9y ago
      AFAIK that only applies to hospital emergency rooms. Your local doctor certainly can refuse service if you can't pay the bill.
      - lotsofpulp 9y ago
        Yes, of course. I meant to convey that for the providers that can't refuse, like hospitals or ambulances, sticker prices not realistic because the provider is having to gamble on which portion of the people they treat can and cannot pay, and how much, so they inflate their prices extremely high. And also to negotiate with insurers.
  - ChuckMcM 9y ago
    This is not clear, in that "concierge doctors" or cash only doctors to some, seem to have rates that are lower than what the insurance companies claim they are billed for a service. That would suggest they are lousy negotiators.
    - 9y ago
fred256 9y ago
That's the way COBRA works though: you have 2 months to elect it, but if/when you do, you have to pay premiums starting from the moment you lost your original coverage (and have retroactive coverage).
- specialist 9y ago
  It's all about that first postmark, when you start the paperwork.
- weka 9y ago
  Yep. And I elected ASAP. One of the first things I did starting new job. But the I continuously got the "we have you down for this provider" when my COBRA admin told me that that provider could no longer give me coverage. I needed to AETNA to file me under a new provider. Then I called AETNA and they still said "so and so" is listed as my provider. I told them to change it. "It's gonna be at least a week to update your information, sir." Call back next week, "sir, you are still listed on 'so and so' provider." It was exhausting.
- wolfgang42 9y ago
  The way COBRA works is that they can just start giving you coverage whenever they feel like finally getting their act together?
  - sjg007 9y ago
    No, Cobra rules are all defined in Federal law. The OP could have gotten care at the time and asked the doctors to defer billing until the insurance resolved (or just submitted to the insurance company anyway and followed up later). If the doctor/hospital balks you can show them your Cobra paperwork to confirm it. But yes you have to pay the premiums.
    - weka 9y ago
      In retrospect this is probably what I should have done. edit: but the thing was, I trust them to give me good advice. The HR providers. I figured, well if they haven't said anything about deferred payments, it might not be applicable to my situation so I never brought it up...
ethagnawl 9y ago
As someone who's on the same path as you were -- and has similar needs -- this is very concerning. Have you been able to find a workable alternative or are you still stuck with AETNA?
- weka 9y ago
  Stuck with Aetna as they have lowest rates. Blue Cross was $200 per month more.
dkonofalski 9y ago
This echoes my experience during the mortgage crash so much it gave me flashbacks. - Bank of America messes up my loan because the person doing my paperwork was a newbie. No biggie, right? - Branch manager offers to fix the issue and prioritize it so that we can close in time. - Branch manager is unable to fix it in time so offers to pay our closing costs and re-finance the loan afterwards. - Branch manager leaves the company after our loan is completed. - Don't qualify for re-fi because we owe more than the house is worth. - Don't qualify for loan modification because we've never been late on our payments. - Reported to FHA. Got in touch with local news station. Immediate response from BofA's Office of the President. - Rep from Office of the President that was "assisting" quits 2 weeks later. - Get another rep and they start a "forced" loan modification. Assign me another, lower rep and promise follow-up in 2 weeks. - Repeat ad nauseum until I literally can't even and decide to foreclose because it's such a cluster. Your last few sentences really strike a chord here. I totally feel for you.
- sizzle 9y ago
  How has foreclosure been? Hard to get new loans? Hope you bounce back.
  - dkonofalski 9y ago
    Already have, thanks. Actually bought another house after the 3 year mark when I was eligible for an FHA loan. Luckily, my credit score is pretty excellent. This was back in the early 2000's just before the actual market crash. It was insane to me that banks were willing to work with people that bought houses they couldn't afford but that they wouldn't work with me on a loan modification because I wasn't delinquent.
- weka 9y ago
  That sucks. I hope you bounce back... I don't understand why it should take days to "update" a system. Now, I now next to nothing about how their current system works but information updated should not take so long. The insurance industry needs a technological overhaul but I doubt it will happen.
specialist 9y ago
I encourage you to contact your state's insurance commissioner. Further, in my state, they admin the COBRA program. In my experience, the state has been very supportive, helpful. Whereas the insurers and payers will do very little to help.
dv_dt 9y ago
People feel that politics are tedious, but this is exactly the reason to pay attention. Look farther than your case and systematically review overall national stats of healthcare costs in the US vs other nations. We pay the most of any developed nation, double on average other developed nations, almost triple the best run healthcare of other nations. We not only pay much much more, people die sooner and go bankrupt more under this system for completely preventable reasons. Edit: And great that there might be a new value conscious private competitor out there - but I'd note that all those other developed nations that are individually, collectively, and vastly outperforming our health system all have some form of government control on drug and procedure prices. And a single private company would be very hard pressed to replicate the negotiation leverage of a government. I'd also note that I'd trust JPMorgan about nil to be concerned about customer value over company profits. Other nations have a health system, and at the end of the day we have a health market.
- indemnity 9y ago
  One of the nastiest things in the failed TPP from my perspective were provisions to make illegal a government agency in my country that successfully keeps costs of medication down by forcing competition and negotiating strongly. The numbers are small by world standards but I guess the drug companies are paranoid of this idea catching on in, say the US. I’m sure it will be regarded as communism, but hey, it makes the market actually work for us here. https://en.wikipedia.org/wiki/Pharmac https://en.wikipedia.org/wiki/Pharmac
  - dv_dt 9y ago
    I think it would have been incredibly foolish and costly for your government to sign onto that provision. It's funny that the arguments seem about single or multi or hybrid public private billing arrangements here - but if you look across the national stats, all of those arrangements perform better - because a root cause that I think there are in those nations, a regulation of cost by medical experts in that nation vs efficacy of various drugs and/or procedures. The dream that somehow laymen off the street can shop for medical care like shopping for a pair of socks and that would balance the market in price or knowledge of derived value is really naive in my eyes.
neltnerb 9y ago
I've also had lots of weird and frustrating insurance and doctor issues, but am surprised COBRA was your best bet or that your wife being high-risk was relevant. In the current system your preconditions shouldn't be a factor in the price. I am also high-risk and have always found that the Obamacare market had prices close to or lower than the unsubsidized cost of an employer provided plan. The most frustrating for me is that the doctors can't even guess how much their facility will charge for the treatment they decide is necessary, much less how much the bill will be after insurance gets their cut. It is a major barrier for me to get MRIs and blood tests. Especially blood tests, which seem to range in cost from practically free to thousands of dollars for a single blood test panel. It's infuriating, and no matter how closely I read the insurance fine print I still cannot guess what the hospital and insurance plan negotiated ahead of time. Kaiser was way better, at least there the incentives were aligned to sane billing procedures.

by weka 9y ago

rsync 9y ago

"The whole reason we get insurance is to avoid those high prices." But only for unpredictable, irregular events. Anything else is uninsurable. If someone sells you "insurance" for wellness checkups[1], regular, scheduled screenings ... or tires on your car ... you can be absolutely assured that they are taking from you as much, or more, in premiums than the cost of those services. What you are looking for is socialized, state sponsored medical care. There is no problem in looking for that and I make no value judgement here on that. The first step would be to stop mischaracterizing this as "insurance". It's not. It can't be. [1] Yes, certainly wellness checkups and things like them can be enormously economically beneficial for the provider since they spend up front preventative dollars instead of emergency, acute dollars later but it still doesn't change the fact that those are not underwriteable as they are regular, on-going expenses - very much like the tires on your car.

bostonpete 9y ago
Your comment seems to overlook the fact that insurance companies negotiate better rates on many (most?) services than an individual would get going at it alone. From that perspective, I think it's reasonable to say that in our current system, insurance can allow you to essentially avoid high prices even for things that are predictable/regular.
- lotsofpulp 9y ago
  That is because providers can't refuse healthcare to someone that needs it and can't afford it, so those costs get inflated just to be able to get a fraction of it. As rsync says, it's still not insurance, it's just the ability to be part of a group large enough to negotiate pricing, and has enough credibility for providers to trust them to be able to pay.
  - jdpedrie 9y ago
    AFAIK that only applies to hospital emergency rooms. Your local doctor certainly can refuse service if you can't pay the bill.
    - lotsofpulp 9y ago
      Yes, of course. I meant to convey that for the providers that can't refuse, like hospitals or ambulances, sticker prices not realistic because the provider is having to gamble on which portion of the people they treat can and cannot pay, and how much, so they inflate their prices extremely high. And also to negotiate with insurers.
- ChuckMcM 9y ago
  This is not clear, in that "concierge doctors" or cash only doctors to some, seem to have rates that are lower than what the insurance companies claim they are billed for a service. That would suggest they are lousy negotiators.
  - 9y ago

fred256 9y ago

That's the way COBRA works though: you have 2 months to elect it, but if/when you do, you have to pay premiums starting from the moment you lost your original coverage (and have retroactive coverage).

specialist 9y ago
It's all about that first postmark, when you start the paperwork.
weka 9y ago
Yep. And I elected ASAP. One of the first things I did starting new job. But the I continuously got the "we have you down for this provider" when my COBRA admin told me that that provider could no longer give me coverage. I needed to AETNA to file me under a new provider. Then I called AETNA and they still said "so and so" is listed as my provider. I told them to change it. "It's gonna be at least a week to update your information, sir." Call back next week, "sir, you are still listed on 'so and so' provider." It was exhausting.
wolfgang42 9y ago
The way COBRA works is that they can just start giving you coverage whenever they feel like finally getting their act together?
- sjg007 9y ago
  No, Cobra rules are all defined in Federal law. The OP could have gotten care at the time and asked the doctors to defer billing until the insurance resolved (or just submitted to the insurance company anyway and followed up later). If the doctor/hospital balks you can show them your Cobra paperwork to confirm it. But yes you have to pay the premiums.
  - weka 9y ago
    In retrospect this is probably what I should have done. edit: but the thing was, I trust them to give me good advice. The HR providers. I figured, well if they haven't said anything about deferred payments, it might not be applicable to my situation so I never brought it up...

ethagnawl 9y ago

As someone who's on the same path as you were -- and has similar needs -- this is very concerning. Have you been able to find a workable alternative or are you still stuck with AETNA?

weka 9y ago
Stuck with Aetna as they have lowest rates. Blue Cross was $200 per month more.

dkonofalski 9y ago

This echoes my experience during the mortgage crash so much it gave me flashbacks. - Bank of America messes up my loan because the person doing my paperwork was a newbie. No biggie, right? - Branch manager offers to fix the issue and prioritize it so that we can close in time. - Branch manager is unable to fix it in time so offers to pay our closing costs and re-finance the loan afterwards. - Branch manager leaves the company after our loan is completed. - Don't qualify for re-fi because we owe more than the house is worth. - Don't qualify for loan modification because we've never been late on our payments. - Reported to FHA. Got in touch with local news station. Immediate response from BofA's Office of the President. - Rep from Office of the President that was "assisting" quits 2 weeks later. - Get another rep and they start a "forced" loan modification. Assign me another, lower rep and promise follow-up in 2 weeks. - Repeat ad nauseum until I literally can't even and decide to foreclose because it's such a cluster. Your last few sentences really strike a chord here. I totally feel for you.

sizzle 9y ago
How has foreclosure been? Hard to get new loans? Hope you bounce back.
- dkonofalski 9y ago
  Already have, thanks. Actually bought another house after the 3 year mark when I was eligible for an FHA loan. Luckily, my credit score is pretty excellent. This was back in the early 2000's just before the actual market crash. It was insane to me that banks were willing to work with people that bought houses they couldn't afford but that they wouldn't work with me on a loan modification because I wasn't delinquent.
weka 9y ago
That sucks. I hope you bounce back... I don't understand why it should take days to "update" a system. Now, I now next to nothing about how their current system works but information updated should not take so long. The insurance industry needs a technological overhaul but I doubt it will happen.

specialist 9y ago

I encourage you to contact your state's insurance commissioner. Further, in my state, they admin the COBRA program. In my experience, the state has been very supportive, helpful. Whereas the insurers and payers will do very little to help.

dv_dt 9y ago

People feel that politics are tedious, but this is exactly the reason to pay attention. Look farther than your case and systematically review overall national stats of healthcare costs in the US vs other nations. We pay the most of any developed nation, double on average other developed nations, almost triple the best run healthcare of other nations. We not only pay much much more, people die sooner and go bankrupt more under this system for completely preventable reasons. Edit: And great that there might be a new value conscious private competitor out there - but I'd note that all those other developed nations that are individually, collectively, and vastly outperforming our health system all have some form of government control on drug and procedure prices. And a single private company would be very hard pressed to replicate the negotiation leverage of a government. I'd also note that I'd trust JPMorgan about nil to be concerned about customer value over company profits. Other nations have a health system, and at the end of the day we have a health market.

indemnity 9y ago
One of the nastiest things in the failed TPP from my perspective were provisions to make illegal a government agency in my country that successfully keeps costs of medication down by forcing competition and negotiating strongly. The numbers are small by world standards but I guess the drug companies are paranoid of this idea catching on in, say the US. I’m sure it will be regarded as communism, but hey, it makes the market actually work for us here. https://en.wikipedia.org/wiki/Pharmac https://en.wikipedia.org/wiki/Pharmac
- dv_dt 9y ago
  I think it would have been incredibly foolish and costly for your government to sign onto that provision. It's funny that the arguments seem about single or multi or hybrid public private billing arrangements here - but if you look across the national stats, all of those arrangements perform better - because a root cause that I think there are in those nations, a regulation of cost by medical experts in that nation vs efficacy of various drugs and/or procedures. The dream that somehow laymen off the street can shop for medical care like shopping for a pair of socks and that would balance the market in price or knowledge of derived value is really naive in my eyes.

neltnerb 9y ago

I've also had lots of weird and frustrating insurance and doctor issues, but am surprised COBRA was your best bet or that your wife being high-risk was relevant. In the current system your preconditions shouldn't be a factor in the price. I am also high-risk and have always found that the Obamacare market had prices close to or lower than the unsubsidized cost of an employer provided plan. The most frustrating for me is that the doctors can't even guess how much their facility will charge for the treatment they decide is necessary, much less how much the bill will be after insurance gets their cut. It is a major barrier for me to get MRIs and blood tests. Especially blood tests, which seem to range in cost from practically free to thousands of dollars for a single blood test panel. It's infuriating, and no matter how closely I read the insurance fine print I still cannot guess what the hospital and insurance plan negotiated ahead of time. Kaiser was way better, at least there the incentives were aligned to sane billing procedures.