NWR: Anyone work in health insurance? (sort of vent and long)

Carebear62584 · December 2011

So I know this is totally NWR but I'm really bothered by my health insurance and feel like I am getting scammed. I know the laws may be different in each state, but if anyone knows anything about this I would appreciate the feedback. Sorry if this gets confusing.

In August 2010 I had to go on my own insurance because I was too old for my parents to carry me. I was paying $198/month. (I haven't had a permanent job to get benefits from an employer)

In June 2011 there was a glitch in the system and my insurance never got paid (it was on their end and I wasn't penalized).

In July 2011 they took out my original $198 for June + $237 for July. So somehow my premium went up. I think I remember getting a notice at some time.

I paid the $237 all along and didn't say anything. Fast forward to yesterday when I got an e-mail saying my insurance premium will increase in January. Thinking this JUST happened, I went online to check to see what they would quote me now. The online price is $204. When I called they told me that $237 was the absolute lowest rate for my plan and they couldn't really explain why it was lower online. I tried to research it to see if there was some difference and didn't get anywhere and when I tried to call back last night they were closed.

So I called back today asking what the difference was in these plans. The guy told me there is no difference, that it's the same exact plan, same deductable, everything. So I said I wanted to pay $208 ($204 now but will go up in Jan when it is effective). He said no problem and e-mailed me the paperwork.

When I asked why I've been paying so much when I only paid $198 before and will only be paying $208 in Jan he told me that they came out with new plans so they closed my account to put me on my new plan. Can they actually do that? I didn't authorize them to close my account and reopen it for the same exact plan at a higher rate. I understand that premiums go up, but he flat out told me my account was closed and reopened under a new plan. So I asked him if I could get back all that money I was overpaying and he told me that they can't backpay anything. Not knowing what to do next, I kind of said ok, thanks for helping and hung up.

Does this sound illegal to anyone else? Somehow it's okay for them to close and reopen my account at a higher premium without permission yet to get the online quoted price I have to call and change it. Just seems like nobody has the same story. Should I call the state insurance commission?

kathleenkmm · December 2011

I think it's worth a call to the state insurance commission - it's supposed to be their job to help consumers with things like this and they'll know more about your state's laws than we will.

chelseakopperud · December 2011

it is illegal. unless you cancel your plan, they have to honor old plans. call for sure.

doeie04 · December 2011

I don't know anything about the laws and such. I wanted to mention that if you don't use your health insurance much, it may be better to save the $200 into an account (maybe a flex account) and save yourself some money. Just a thought.

DIsclaimer~ If you have medical issues, like me (I have asthma and allergies) it probably is totally worth the $200+ you pay every month. Actually, I think I could pay less than that a month and cover my bills.....

MissAmeliaPond · December 2011

I know I'm late to the party, but I feel compelled to say something.

I work for an HR company/health insurance broker. I hate to break the news, but yes it is perfectly legal for your provider to discontinue certain plans and map you to a similar one, even if it's not exactly the same. However, they should have sent you a notice telling you this was going to happen, and give you the option to choose a different plan if you like. Sadly, even if they weren't moving you to a different plan, the premiums increase anywhere from 3-11% every year. You would normally see this increase at your renewal. So, since you began your plan in August 2010, you could have seen an increase in August 2011. In California, customers are not mapped to the new plans until their plan year expires (in your case, this would be August 2012), so I'm not sure if they're telling you that your new plan will start in January, but I don't think this is right. Unless the laws are different where you live. Here, old plans are honored until they expire. I would think this should be the same for you.

So, what I think you should do is call the insurance provider (again) and ask to speak to a supervisor. These lackeys in customer service often don't know what's going on, especially with new plans, trust me. FIRST, I think you should clear up this premium increase issue. $198 to $237 could be considered a normal rate for a renewal. However, I'm confused as to why this happened in July and not August 2011. I really really think you should get this cleared up with a supervisor at the insurance carrier. If your rate didn't actually increase to that amount, and they aren't willing to credit you or refund you, then you should call the insurance commission with all your bills from the past year and explain the discrepancy. But do check your bills and notices you may have received over the past year.

Second, also check your mail/email for notices regarding plan discontinuations and being moved to new plans. They may have sent you a notice telling you about them. In this case, they would have told you that if you take no action, your plan will be automatically renewed to an equivalent plan. By receiving this notice and taking no action, you were consenting to let them do this. If you did NOT receive this notice, then you have a right to complain about it.

Sorry this was a super long response, but you should try to clear these issues up with the insurance company (and someone who is a manager or supervisor) and check your notices before trying to contact the insurance commission. Also when you call the company, make sure they have the proper address or email address for you, depending on how you receive your statements.

I hope this helps! Good luck!

Amynutrition · December 2011

I saw call your state to see what the regulations are that pertain to your situation.

My FI works in benefits consulting. Health Insurance premiums are going up like crazy everywhere because the government requires them to cover tons of stuff (and most states by LAW cannot offer a minimum, preventative, cheap plan to persons with no ongoing medical issues). The fact that health insurance companies have to cover children upto age 26 (by law) made costs go up like crazy because they're covering more individuals for longer and that care isn't covered in the parents premiums in most cases.

Also, insurance companies are worried that future government regulations (like all women have to get free birth control) will be even more costly to them so they are raising premiums now to cover themselves because they don't know what the new laws will be.

NWR: Anyone work in health insurance? (sort of vent and long)

Re: NWR: Anyone work in health insurance? (sort of vent and long)

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