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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?

To: Cogito who wrote (134802)	3/25/2010 12:51:26 PM
From: Sam	Read Replies (1) \| Respond to of 543020

It is notable that the insurers don't see any need to drop people for problems on their applications before they get sick. They're willing to accept the premiums from such people for as long as they are still adding to the plus side of the ledger Yes, they are very efficient at collecting premiums. Someone I knew worked for BCBS for three years before becoming an actuary. He sat in a large room with many other people, all of whom were dedicated to finding reasons not to pay claims. That was their sole job. Not that ferreting out fraud isn't important, and plenty of federal and individual company resources should be devoted to that. But--looking for reasons to deny individual claims isn't ferreting out fraud. Fraud that is worth finding is something that individual providers commit, not individual claimants. Providers' fraud is where the really big bucks are, as it happens over and over again.

To: Cogito who wrote (134802)	3/25/2010 1:46:17 PM
From: Katelew	Read Replies (1) \| Respond to of 543020

What I meant is that insurers are prevented by law from dropping people after they get sick just because they got sick. I think this is the public perception. There are very clear laws in place, in most states I would think, that force insurers to honor their contractual agreements. This is true for all insurers....auto, property and casualty, and life policies all have clear statements concerning what they will pay for and what they won't. It's a given that all insurers want to minimize the amount they pay out on claims. Thus it's incumbent on the buyer of a policy to really study out what their policy will do for them in the event of a car accident, an illness, or damage to their homes and other property. This really is a task, though, I admit, and I don't think the typical policyholder works very hard at it. I think a lot of people assume their policies will cover more than they actually do. My point here is simply that I suspect this is an overstated problem. If one has a comprehensive policy from a large insurance company, the benefits that are listed in that policy will be honored. You weren't dropped after your own cancer surfaced, were you? I've personally never known anyone who had the kind of problems with their health insurance that are being claimed. Probably there have been such problems somewhere, but I just haven't personally known of them. Everyone I know complains about the cost of their policies, but that's all I've noticed. With one exception. This past years, a woman who helps me with cleaning now and then, was having claims refused following her husband falling off a ladder. I offered to help her try to figure out her policy. The problem was that it was a policy from some small insurance company, and they had bought it just because it was cheaper than what was available at the time from the bigger, household name companies. It just had lower and stricter limits on what it was going to pay for a situation that required on-going treatment like her husband needed. Right there in black and white were the limits of the coverage....very sad. But please don't think I have a love affair with the health insurers. I was for single-payer or public option all the way. The fact the country is now being delivered into the hands of all the insurers and HMOs and PPOs is somewhat horrifying. We'll just have to hope for the best.