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Low health insurance caps leave patients stranded »

Posted by: ameliog 1 month, 3 weeks ago

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Insurers set lifetime limits to keep rates low on some policies, but holders are learning that individual caps that seemed large quickly max out as health care costs soar.

Read Full Story at usatoday.com

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Comments So Far: 23

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1-2-Oscar1 month, 3 weeks ago

Rewrite the policies so that the insurer MUST provide benefits for a minimum period of time. For example, "The maximum individual benefit under this policy is $1 million, but the insured's coverage will continue in full force for a minimum of ten years."
Once you do that, the insurance companies will find that truly PERMANENT policies are in their interest.
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  TOD3961 month, 3 weeks ago
  
  So, if an insurance company sells a helthcare policy with a 1 million dollar cap, and the patient uses that 1 million up in 2 years, you want the insurance to continue to provide coverage even though they have lived up to thier end of the contract?
  If that was YOUR money, would ou do that?
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    1-2-Oscar1 month, 3 weeks ago
    
    The contract will be for a minimum number of years. What I propose would essentially force the company to to rewrite its actuarial tables to provide a minimum number of years of coverage.
    Will it cause the insurance company to lose money? Don't kid yourself, TOD396. They still know how to do the basic math, and premiums will be adjusted to provide better coverage for all.
    And it IS my money. I just want to make sure that I get a fair return for the premiums I pay.
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      TOD3961 month, 3 weeks ago
      
      "and premiums will be adjusted"
      Don't mean to rain on your parade, but that is exactly why theree is a limited policy in the first place. So that people can AFFORD the premiums. I am sure the healthcare insurance providers know how to do the math, but I wonder if you do.
      If a family of 4 is spending 15 percent of the gross monthly intake on a 1 million dollar maximum policy, and the healthcare providers now have to guarantee unlimited coverage for the 10 year term, how much of the family's gross monthly income will now be needed to make the premium payment? 50 percent or higher. So you do the math. Can you live with 35 percent fewer dollars? Most families can't. That is why there is limited coverage policies.
      
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        RichFatCat1 month, 3 weeks ago
        
        You get what you pay for. Well, with health insurance, ALMOST
        It's called "insurance" for a reason. (You want full, no cost to you, first dollar no limit coverage pre-paid medical care, get elected to Congress) Insurance is designed to prevent "catastrophic loss", not to provide constant care and attention to your runny lose, cigarette cough, or wheezing due to the fact that you are an overweight, booze sucking, pig.
        HMO's make zillions by NOT providing service and by cancelling your miserable ass if you are a high risk - just like auto insurance.
        This is business, repeat BUSINESS, to make a profit, a huge profit, not an exercise in socialism.
        Save your money in an HSA. If you use it up, tough sh!t! Or better yet, spend the money on an expensive, good health plan that might cost you a fortune, but might save you a fortune - IF you know the rules and follow them.
        Or, do what George Bush told you to do. Go to the E.R.
        
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Skeptic1 month, 3 weeks ago

Most plans that I am familiar with offer five million dollars lifetime coverage per person covered. Compare that to what your auto insurance offers and the premium paid for liability. And if you have a claim against your auto insurance for the maximum amount of coverage you own, you will probably not be renewed (different than cancelled) then try to get auto insurance at a reasonable premium.
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jumpmaster1 month, 3 weeks ago

Obese people and smokers should pay quadruple the normal premiums. Then the insurance companies could easily raise the lifetime limits for payouts.
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  saintetienne1 month, 3 weeks ago
  
  "Obese people and smokers should pay quadruple the normal premiums."
  Agreed. Maybe if people were forced to be responsible for themselves for a change, we'd see more in-shape non-smokers.
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    Will13131 month, 3 weeks ago
    
    lets don't stop there...
    lets don't cover autistic children...
    birth defects of ANY kind..
    epileptics...
    arthritics..
    absolute no mental disorders.. after all that is only in the mind.. you could control that if you wanted..
    in fact unless you are the perfect weight and height with the perfect heart rate, lets don't cover you... and then only between the ages of 15-35...
    remember when Arnold won all of those body building contests.. by the BMI (body mass index) he was MORBIDLY OBESE... so was Stallone when he played Rocky and Rambo...
    after all the strong should survive .. f the rest of you...
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      willottica1 month, 3 weeks ago
      
      There comes a point, where if you break it down to cold logic, the ill person's potential contribution to society is lower than the burden of their care.
      In a world with unlimited money, or unlimited insurance, everyone could get perfect care, as much as they need. In the real world, you do everything reasonable to try to save a life. Is it reasonable to spend 2 million dollars trying to save a life? That represents 40 years of dedicated full-time work at 50K per year. For one person. IMO, that's completely unreasonable. Doctors/Drug companies are fleecing the needy. In the old days, triage would have forced the doctors to give up long before that point was reached.
      I'm not sure that modern medicine is better. Sometimes I think that the pain to the afflicted, and the pain to the family would be much less if they were able to die easily without all the intervention that is now possible.
      I guess that makes me heartless.
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        Will13131 month, 3 weeks ago
        
        For one person. IMO, that's completely unreasonable
        ---
        probably till the person is YOU or someone YOU LOVE..
        
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        willottica1 month, 3 weeks ago
        
        Not disagreeing. You'd do anything in your power to save the person you love. For how many of us is spending millions of dollars really in our power?
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nikkibabe1 month, 3 weeks ago

My father who takes medications for diabetes, high blood pressure and cholesterol gets all of his 90 day supplies from India. He pays a total of $52.47 with no insurance. These are made by Bristol Myers, Merck & Pfizer in India.
The cost of the same medicines in US without insurance is $422.50 also made Bristol Myers, Merck & Pfizer in US.
The reason being, in India prescription drugs are treated as public health requirement and the prices are fixed by the Government with a 150% markup over cost for the drug companies.
Can US Congress hold a hearing and ask the drug companies what is their markup after cost in US? I guess not. The lobbyists are more powerful.
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1-2-Oscar1 month, 3 weeks ago

Drug pricing is really a separate issue, and deserves its own discussion. There is no doubt that the pharmaceutical companies enjoy, under government-enforced patent protections, the ability to charge virtually ANY price they choose for the medicines that millions of people need to to live. We pay because there is no alternative to paying.
It is no mistake that, prior to the recent spurt in oil prices, Phizer was the most profitable company in the world, and it still ranks at or near the very top if you calculate profits as a percentage of sales.
We are being fleeced, and our government is helping them do it to us.
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  Charlson1 month, 3 weeks ago
  
  The government refuses to negotiate better prices for drugs with pharmaceutical companies and accept whatever the companies say because as you've said, the fleecing is double decked, and coming from both our government and the pharmaceuticals.
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nikkibabe1 month, 3 weeks ago

It is really questionable as the markup allowed by the Indian government is actually after adding up manufacturing cost, Duties, Taxes, Distribution.
Rest of the expense to the companies will be in sales & marketing which is really reaching out to the doctors. In India, it is illegal to advertise prescription drugs in public media and restricted to doctor detailing and professional medical journals.
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blksentra21 month, 3 weeks ago

It gets frustrating with health insurance policies these days. I was diagnosed with end renal failure a couple years ago and now being that I have to go through dialysis 3 times a week, it is impossible to work a full-time job to cover the cost that insurance doesn't cover.
I would have never thought it was so difficult just to stay alive when you have such an illness. And me being only 28 years old, it's very very frustrating.
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  truthiness1 month, 3 weeks ago
  
  you may be interested in getting an online degree (from a real university) that trains you in work you can do from home.. e.g. web design, IT help, grant writing, freelance indexing, etc
  just a thought.
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truthiness1 month, 3 weeks ago

I used to work as an EMT. we spent a week every year training on the details of paperwork (not how to fill the form out, that is easy, but the nuances) b/c the insurance companies AND medicare have depts dedicated to find clerical errors which will justify denying the claim.
how much of your health care costs go to paying for that dept? or the ad dept? or the sales dept? which not only includes personnel, but paper and staples, etc.
then there is the cost of the executive salaries. then the cost of the profit margin to pay the stock dividends. all from your insurance premiums.
how much less would insurance cost if we required all insurance companies to be non-profit orgs?
or how about a single non-profit org for the country, the way utilities are for a city/county/etc. ? (before you mention utility investments those are bonds not stocks which function differently)
there are many better ways to do this. health care is infrastructure.

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jumpmaster1 month, 3 weeks ago

Non-profit. Hmmm, that sounds so noble.
Hey, let's buy a new MRI machine. It costs a million dollars. Ooops. Can't do it. We got no money cause we got no profit.
Sorry, no MRI for you.
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  truthiness1 month, 3 weeks ago
  
  you don't really know what non profit org means.
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    jumpmaster1 month, 3 weeks ago
    
    Yes I do. It means no taxes.
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      truthiness1 month, 3 weeks ago
      
      it means no dividends to pay out. no profit margin to strive for. b/c any capital above margin goes back into the org. the lack of profit motive beyond staying afloat, mean the focus is on mission, not driving up sales through marketing and sales people and finding ways to avoid paying people.
      it means actually viewing itself as a service org.
      without stockholders to answer to, or bottom lines to be concerned about beyond staying in the black, the org focuses on serving its clientele.
      ex: the red cross execs make six figures, but there mission is well served. if they were paying money to stockholders, would they be able to help so many people?
      UNICEF. United Way. ACS. etc.. they are able to provide quality service and pay people to do quality work and stay on mission, b/c they are not a profit motive org.
      you cannot serve money and do good works at the same time.
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