Small-business owner: Nobody wants to sell me medical insurance

Tue, 08/11/2009 - 2:52pm
By: Letters to the ...

The purpose of this letter is to address the shortcomings of the various responses to the healthcare debate now going on. It is also an act of penance in order to pay for my own misguided attack on the proposals in Congress designed to improve the healthcare delivery system in America. In short, as a lifelong Republican, I have done a 180 on this issue. Please let me explain.

The healthcare system in America today discriminates in an almost criminal fashion against the small businessperson and the self-employed, i.e., folks like me. Before you turn the page, consider these facts.

I am in my late 50s and consider both myself and my wife very healthy. We had to pay a major insurance company $1,050 per month for policy that has a $5,000 deductible on each of us. That means every time we go to the doctor for a physical or anything, the first $5,000 comes out of our pocket.

I believe in the free market system, so I decided to change policies. Also, since I am in the building business I am finding it nearly impossible to continue this coverage. To be blunt, business is terrible and I cannot afford these high premiums.

To my surprise, nobody seems to want to sell me any medical insurance. One representative of a major insurance company told me that frankly they simply do not want any new 50-plus-year-old clients. Another company turned me down due to my taking pills for blood pressure, even though it is under control.

My only resort to lower my premiums was to change to a policy with an even higher deductible of $8,500 per year per person.

But that is only the beginning of this nightmare. I had a procedure done this year and since I pay for the first $8,500, I got the full bill. The doctor made me pay for the procedure up front. That put a big dent in my credit card.

Then to make matters worse, after I got the results, I got another bill saying I owed even more money than they first projected.

What was interesting is that by mistake, they sent me the bill of another patient along with mine. The other man had the same procedure as I did yet his charges were, as I recall about half what I was charged.

When I called to ask why he paid so much less than me for the same procedure, I was told that his company had an insurance policy that had negotiated a lower rate than I am charged. I did not know going to the doctor now also requires intense negotiation skills.

So here I am, a self-employed small businessman. I pay more for my medical insurance than those who work for large companies or the government. And then, I get to pay more for the treatments I get when I go to the doctor.

To add fuel to the fire, I saw on TV the other night how our military doctors are treating not only our soldiers in Iraq and Afghanistan, but also the local civilians and even enemy wounded. Great, my government cares more about medical care for the citizens of Iraq than here!

Since nobody in my party has voiced a solution other than medical savings plans, which I own and consider virtually worthless, here is my answer to this issue.

I pattern this program after our state car insurance laws. First, require everyone to buy an insurance policy.

Second, do not let the insurance companies turn anyone down.

Third, do not let the hospitals charge a different price to different folks based on their carriers.

Fourth, let people in one state buy coverage in another.

My solution is not perfect but it sure beats the heck out of nothing and nothing is all we have gotten out of Washington so far.

Steve Enterkin

Fayetteville, Ga.

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Submitted by CuriousBob on Sat, 08/15/2009 - 7:08am.

Steve--I understand and have experienced some of the same issues you have seen. My situation is slightly different in that I have insurance from my Large Corporate employer. Let me point out that I am retired from this employer and I receive the healthcare benefit as part of my retirement package. My employer is a self-insurer. They rate my benefit with a value of $11k when compared in the cafeteria of plans that are offered. My plan is a PPO.

My plan has a $2200/person deductible and a $5000 out of pocket for major medical. This deductible and out of pocket have steadily increased from less than half of these numbers in about 6-8 years.

I was recently examined by a doctor(back in April) and he determined that I had breathing difficulties due to some issues with my nose. He recommended a repair of my nose-Rhinoplasty. Yes, a nose job. Normally, Rhinoplasty is considered cosmetic so, explanation as to reasoning for the surgery had to be submitted to the insurance company. Even with the explanation and proper coding-the insurance company denied the pre-approval request. The doctor resubmitted and ultimately it was approved. The caveat to the whole process is that by the time the approval came through(June 10), my benefit year had rolled over(June 1) and I now had my $5000 out of pocket to pay if I wanted this surgery. It took two months for them to approve a procedure that should have been approved in the beginning.

Of course, I cannot prove it--but, it certainly appears to be stalling tactics so that the insurer could avoid paying the bulk of the cost!

We need reform to stop these practices, as well!

grassroots's picture
Submitted by grassroots on Wed, 08/12/2009 - 11:57am.

Try Kaiser. I've had them for 25 years. Never paid more than a $10 copay and I have had excellent care. Got both children through life saving procedures and have always been treated the same in every state they're in. Thumbs up. Probably high for 50 year old but no charges for x-rays, lab, rehab, etc. I'm 60 myself.

Submitted by Bonkers on Sat, 08/15/2009 - 7:40am.

What does it cost per year and who pays it?

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