Looking for health insurance - Page 2

**cat lover** · #11 (**permalink**) 05-22-2006, 10:15 AM

Quote:

Originally Posted by Insurancelady

I am a state licensed health and life agent and I am familiar with some of the plans you've mentioned in your post.

Thank you for all your information; hopefully it will help someone. I can't get any insurance at all because of health conditions and in my state they aren't allowed to exclude conditions; they either have to cover all or not cover you at all. The plan I had was self funded so was not covered by insurance commission and therefore when they did not pay claims I got taken. So they were collecting $500.00 per month and didn't pay anything big. They covered meds, but that was all and I didn't find out till after a surgery! Happened to everyone who had that coverage. Attorney generals office in state money was sent to has it, but it won't help any of us that were taken. And many of us were in the same boat, no coverage because no one will cover us. So yes you telling everyone to read everything carefully is great, but even that doesn't always help. Thanks anyway!

Insurancelady · #12 (**permalink**) 05-28-2006, 12:29 AM

I am so sorry about your health problems. I know how difficult it can be today to get insurance if there are prior health issues. It is true that insurance companies do not have to accept people with pre-existing conditions especially for individual plans. However group plans are more lenient as they are subject to certain state laws regarding group insurance that individual insurance is not. Insurance underwriting guidelines are very tough today and get tougher each year. As an agent I am often the bearer of bad news when I have to tell someone they will not be accepted due to certain pre-existing conditions. Now some conditions are accepted but most insurance companies want to see a year or more of successful treatment such as in high blood pressure. If you have been on the same meds at least a year and your blood pressure is under control most companies will accept that person. Companies are looking for a history of a year or more of successful treatment for certain conditions. If it's under a year, it will be a decline or a possibly a rider excluding the illness completely. It does sound like you were taken by the company you had and it sounds like it may have been more of a discount plan vs. major medical insurance. This is something else I see on the rip off site I volunteer for. Unfortunately people do not realize they've been taken until they go to use the plan they have and then find out it doesn't cover anything at all. As health discount/savings plans are not insurance they are not regulated by the Dept. of insurance and the states are helpless to do anything for the victims of these scams. However I would report any of these companies to the attorney general's office in your state and the federal trade commission. Often a discount/saving plan will refer to it as self funded and possibly connected with an association and therefore they do not need a state license. If they sell these plans as INSURANCE they always need a license for both the company and agent selling the plan. No exceptions but they lie to people all the time and people get hurt by them. Most real insurance plans sold on the internet have gaps in them, co-insurance, or added fees for services that people will not realize until they go to use the policy. Without an agent to explain the benefits and more importantly the EXCLUSIONS most people do not understand what they have. Health insurance policys are complicated and unless you deal with them everyday and understand what all the terms mean, it is confusing to the general public. I tear apart policys constantly looking for gaps and hidden exclusions for people. If they pass my inspection I guarantee you they are good ones! For someone with pre-existing conditions I would suggest the following. Check out your state Blue Cross plans as they may take a pre-existing but not cover it for a year. This will be allowed by law in most states on an individual policy. Second if you are self employed in some way contact your local chamber of commerce or if you are somehow in construction or some field that deals with houses such as real estate or home design contact your local builders association. Both these associations will usually offer a group policy for their association and you may be accepted and covered under a group plan if you join either of these associations. Keep in mind there will be a membership fee for either association but at least you may be able to get insurance. If you get a job that offers group insurance you would be covered under that also although they may still exclude a pre-existing condition for a year. In other words generally speaking a group plan must insure people but they can still usually exclude pre-existing for at least a year or whatever your state mandates. That's what your state insurance dept. was telling you. Individual plans don't have to cover you at all, group will. Chamber of commerces almost always offer insurance thru Blue Cross. You are right if people don't read or understand a policy it is too late and it is so quick and easy to buy insurance online with just a click and a credit card today it is really impossible to to catch everybody before it's too late. Phone salespeople prey on the innocent and sell them worthless discount health plans as real insurance ripping people off everyday. All I can do is hope to save a few people on this board from making a mistake before they buy a plan that will not do what they think it will. Some people do only look at the bottom line price on a premium and think it's a great deal especially on the internet sites but instead of buying it online, I would tell them to write down the name of the company and the plan name and then call the company and ask for the number of an agent so the policy can be explained to them by a professional before they buy it. There really should be no difference in price from an internet site vs. purchasing from an agent as the internet sites get paid for selling the insurance also. Then there should be no surprises when a person goes to use the insurance. Plus it gives the person time to check out the company and agent with their state insurance dept. to be sure they are both licensed in the state before buying so that's added protection for the consumer. Doctor's and hospital's are a good souce of where to get quality insurance also as they are the ones that have to accept it so they can provide some names for people to call also. Many major hospital's such as the Mayo clinic in Florida or Columbia Pres. in NYC will post the insurance plans they accept right on their websites. I wish you the best and I hope you find a good plan that is right for you in the future.

**cat lover** · #13 (**permalink**) 05-28-2006, 06:22 PM

I appreciate all your information and hopefully someone here will benefit from it. No I do not work as I had to quit work in 2000 to care for my husband. He was ina bad accident and suffered a brain injury and two crushed legs. He recovered as well as he could, but still suffers from the problems the accident caused and cannot be left alone. I am keeping him at home. We have good days, bad days, and sometimes that even turns in to just hours of both. So I am stuck with no insurance and just slipped between the cracks on that issue. Believe me I have checked into every aspect of possible coverage, but it just won't happen for me.
What I had was not a discount plan and the attorney genral's office in two states have it so..., but like I said before it is to late to help me. Thanks again!

Insurancelady · #14 (**permalink**) 05-28-2006, 08:49 PM

Hi, I am very sorry to hear about your husband's accident. I do understand your situation to a certain extent as I am the legal guardian of my mother and I care for her in my home. She has mild dementia and is mentally incomptetent at this point and no one can tell me if it will progress or not. There was a 2005 Commonweath Fund report that stated approx. 16 million U.S. residents are presently caregivers for sick or disabled family members and approx. 45 percent of the caregivers have one or more chronic health conditions themselves and have difficulty either obtaining insurance or being able to afford it. As my business is at my home I am very fortunate as I have always been self employed which allows me to still work from home and be able to care for my mother at the same time. However most Americans must give up employment so they can be at home to care for a family member. Because of this many Americans have lost group health insurance benefits that they would normally have if they were able to be employed or they have lost an income to afford an indvidual plan. The study suggests that because of this situation, it would be a benefit if caregivers could either be covered by medicare or be allowed to buy into medicare for affordable health care coverage. This is a wonderful suggestion but so far it has fallen on deaf ears in our goverment. If a person with a disability had to be cared for in a facility vs. being at home with a caregiver the costs would be astronomical and as no one could afford long term care the goverment would have to pick up the tab. To cover the costs of a caregiver's health insurance or to allow them to buy into at a discounted rate would benefit the goverment as it is small change to what they'd have to pay if no one was willing to be a caregiver at home. There are many disabled Americans in this country who do not have anyone to care for them or sadly do not have anyone willing to care for them or to be able to afford to care of them and they often become ward's of the state and the goverment ends up footing the bill. The goverment does at least realize this fact. I'm sure you have checked every source for health insurance but you may find these site useful as well and many people have gotten help from them. www.usdoj.gov is the Americans with Disabilities website and contains alot of useful information. www.aoa.gov is the website you can find The National Family Caregivers Support Program and you will find it by clicking on Elders and Family. This site has a wealth on information and links just for a caregiver. Your county should also have a dept. of social services you may check out also. www.aarp.org also offers several insurance products for people from age 50-64. When I was appointed legal guardian of my mother I was handed a 20 page booklet that was suppose to tell me everything I would need. It was completely useless. There are so many programs available out there for people and NO ONE comes knocking on your door to tell you about them. They make you go looking for them and I could write an entire book on the programs I found. There are county, state and federal programs available for many things but most people have no clue they exist. There are programs also available thru the V.A. if someone was in the military and some of those programs are for the spouse as well including medical coverage. Most counties have a community developement program that grants money to people to make repairs on a home they own. You must keep the home a certain number of years such as 7 and if you sell it before then you simply pay the money back as there are never any payments or interest to make but if you do keep the home for the required length of time the loan becomes a grant and is considered paid. Not all programs are for the low income, many are also for middle income and disabled. A good friend of mine who is disabled with M.D. and a real estate agent was able to get a brand new roof thru this program. If you haven't already checked out these programs it is worth doing so. You may even stumble across health insurance by checking into programs such as these. Like I said no one offered me this information and it took a year of research and I was amazed at the things that are available. This is an area where our tax dollars go but no one tells us about it! There are always forms to fill out but it's worth it if you or your spouse are entitled to any benefits that may help you.

**cat lover** · #15 (**permalink**) 05-29-2006, 03:30 AM

Thank you again! I will check into those two links you gave,maybe there is something there that will help with some things. Yes, you would think our government would help the people that is standing up and caring for their own. I just couldn't live with myself by having him in a nursing home. At this point he does much better here at home. There are times he appears just fine, but the dementia shows itself on a daily basis sometimes worse than other times. He has given up driving a long time ago by himself. On good days he will drive in town (we live in s small rural area) as long as I am in the truck with him, but not by himself any longer. The day he went to town on his own several years ago and didn't know how to get home was the last time he drove by himself. I am lucky in the fact even though his personality changed he is usually very acceptable of things. I just try to keep our life as "normal" as I can and just "deal" with the way it is now. No use in doing it any other way and we both be miserable. Thank you again and hope you are enjoying FamilyCorner. It is a great place. Be sure and visit FC's sister site;MomsMenu; itis all about food. Thanks again!