I've had health insurance through work for over a year now. But I've been afraid to use it because I'm afraid my rates will go up.

Can your health insurance provider raise your rates or drop you for something like perscription meds or therapy sessions?

11/1/2010 12:55:14 PM

the only time i could see that being a possibility is if they have reason to believe that you are abusing the system.

otherwise, isnt that the purpose of having insurance?

go get your meds, and if the therapy is provider approved, start it as well

11/1/2010 12:57:20 PM

I didn't think an employer-sponsored health-insurance plan could drop you...

11/1/2010 1:00:05 PM

I guess it depends on the company, but I thought most places it was a pretty set price for everyone for whatever combination of benefits and dependents you opted in for/pay your share of?

If rates go up, it is because they are going up across the board for all employees because of things like the health care reform, or rising costs of health care in general, not just for you.

Utilize what you pay for...

[Edited on November 1, 2010 at 1:02 PM. Reason : .]

11/1/2010 1:01:42 PM

Okay.

I was just worried from when I was a contractor and was self insured. They raised my rates every 6 months then and I never even set foot in a doctors office.

11/1/2010 1:10:08 PM

Use it if you need it. Health insurance isn't like home owner's insurance in this regard. HO insurance tends to go up if you use it

That sounded kinda dirty...

11/1/2010 2:14:20 PM

Quote :

"Can your health insurance provider raise your rates or drop you for something like perscription meds or therapy sessions?"

No, but if this is a pre-existing condition they can deny you coverage now.

But I would call before you go to see anyone to determine (first and foremost) if they are in your network. Then you have to find out if you need pre-authorization to see someone. After that, you
must also determine if there is a cap on the number of sessions you see, and if your copay applies to these sessions or not.

11/1/2010 3:58:34 PM

I thought Obama was making insurance free?

11/2/2010 12:49:10 AM

^did you hear that on fox news?

11/2/2010 1:08:41 AM

^^r000000000000fl

the second thing taken off the table right away was single-payer
(the first was re-importation from Canada)

11/2/2010 1:19:38 AM

Your company picks the rate. It may change each year depending on how your company negotiates w/ the plan each year. The important thing for you to pay attention to are the Copays/Coinsurances, Deductible and Out-of-Pocket Maximums.

11/2/2010 1:25:28 AM

What if you had a condition under one insurance plan, then you change employers. Could you be denied coverage under your new employer's plan?

11/2/2010 9:58:46 AM

^ You just have to show you didn't have a lapse in insurance coverage for more than 63 days, I'm pretty sure


Pikey, they can't drop you for those things.... but, if you say you've wanted therapy for a while or something they might be able to count it as a pre-existing condition. But as of January, pretty sure they won't be able to count that against people anymore

11/2/2010 10:01:51 AM

Well crap, I've definitely had a longer than 63 day lapse in coverage. Stupid economy Stupid health insurance system

11/2/2010 10:10:52 AM

Tell me about it. If the payroll lady had turned in my BCBS paperwork the day she f'ing told me she did, I would have exactly 63 days btwn insurance and would have had no problem... but no, she turned it in 3 days late and didn't tell me. Fucked me over.


Oh I forgot to mention - I think if you had your previous coverage for at least a year then you don't have to go with the 63 days thing

11/2/2010 10:13:01 AM

Okay, so technically, I just got coverage in April '10. I did not have coverage prior to that.

But you are saying that if I switch employers, my new provider can drop me for pre existing conditions?

11/2/2010 10:25:41 AM

Quote :

"Oh I forgot to mention - I think if you had your previous coverage for at least a year then you don't have to go with the 63 days thing"

Believe insurance companies credit the length of time you previously had insurance when determining if/how long you'd be subject to pre-existing conditions. If you've been without insurance for over 63 days, you're pretty much sol'd. If you previously had insurance continuously for 12 months or greater and you haven't lapsed for over 63 days, that time is counted toward the 12 months that most places require. So if you only had 9 months of previous coverage and hadn't lapsed, you'd be subject to 3 months for pre-existing conditions. Some also have clauses where you're good as long as you haven't been treated for the condition in the previous 6 months or so.

11/2/2010 10:26:39 AM

For me I've had continuous coverage since I was a kid until this past August. Where does that leave me

11/2/2010 11:00:27 AM

I doubt they care if you had prior coverage since you were born if you've had a lapse of longer than 63 days.

11/2/2010 11:06:31 AM

^3 Yeah that's what I was trying to say

^4 I wasn't saying they can drop you, just that they won't cover you... meaning the insurance company... listen to pttyndal

11/2/2010 11:08:29 AM

Yeah it's such freaking bs. I miss having gubnet healthcare

11/2/2010 11:10:22 AM

Yeah, I got lucky that the gubment subsidized the majority of the cobra premium or I would've been screwed when I got laid off in March. Just started a new job and didn't want to pay an extra month of cobra so I cancelled it as of 9/31. Luckily the new insurance goes into effect in a week or so.

Quote :

"Important Notice About Your Pre-Existing Condition Limitation This plan imposes a pre-existing condition exclusion for all employees and their dependents applying after the group’s original effective date with BCBSNC (all references to “you” are meant to refer to both the employee and their dependents). This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within a six-month period. Generally, this six-month period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the six- month period ends on the day before the waiting period begins. The pre-existing condition exclusion does not apply to pregnancy nor to children added as a result of a court order or to a child who is enrolled in the plan within 30 days of birth, adoption, or placement for adoption or foster care. Eligible children (newborns, adoptive children and foster children) are not subject to this exclusion period when enrolled more than 30 days after one of the events listed above if your coverage type or the premiums owed are not affected by adding the child. When applicable, this exclusion may last up to 12 months from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior “creditable coverage”. Most prior health coverage is creditable coverage and can be used to reduce the pre-existing condition exclusion if you have not experienced a break in coverage of at least 63 days. To reduce the 12-month exclusion period by your creditable coverage, you should give BCBSNC a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, BCBSNC will help you obtain one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage."

11/2/2010 11:26:55 AM

If you are a employee I don't think they can drop you. I mean you would have to have some serious serious stuff, -and I have never heard of a employee being dropped b/c of pre-existing condtions.

11/2/2010 11:45:43 AM

speaking of health insurance...

just got a bill today for $300.

My wife went to an in-network physician for a physical, got the lab work done at the same office, and they sent it to a contracted company to do the lab analysis (which happens all the time...common practice from what I understood). Now the insurance company is saying that even though the lab was contracted through an in-network physician's office and the lab samples were taken at the same office, they aren't covering the lab work because it was analyzed at an out-of-network lab?

Seems like BS to me. My wife called the insurance company and I called them as well today and we both got the same answer where they basically said 'tough luck.' I couldn't find anywhere in our documents where it says anything about that under the lab work sections.

Guess I need to do a little more digging...

11/2/2010 11:50:39 AM

Contact the Department of Insurance. The Insurance company will back down real quick.

11/2/2010 11:53:46 AM

haha i'm sure. I've had no problems with them in the past. I'll try the doctor's office and the lab center later as well to make sure there wasn't some mix up there. For example, perhaps since the invoice it was submitted directly from the lab it was labeled out-of-network whereas if the doctor's office submitted the invoice it would be covered with the co-pay (like my benefits package says it should be).

but yes, if I don't get anywhere after that I'll look into other methods

It's just annoying because it's a pretty standard physical here. I've never had any trouble getting all of my stuff covered on my annual physical and my wife didn't have any problems last here when she got hers done (diff doctor then).

[Edited on November 2, 2010 at 11:59 AM. Reason : .]

11/2/2010 11:57:23 AM

good luck, I usually can't even get away cheap with the lab stuff since it is done with lab corp.
they will rack you up with a high bill!

11/2/2010 12:00:22 PM

anyone else's insurance going up again this year? i just got an email saying insurance rates are going up again. i went and did some research - our copays are increasing (again) and what is taken out monthly from my paycheck is going up (again).

11/2/2010 12:21:13 PM

^^ thanks. i guess i've gotten lucky in the past. Just seems really screwy to me /shrug

^ I bet 99% of companies are raising them this year. My company has generally been really good about keeping costs low and not passing on increases but even we are going up a little this year. Our co-pays are staying the same but the total cost per month for my wife and I is increasing $40 this year.

11/2/2010 12:30:40 PM

well ours went up last year because we changed providers. my company said they were saving us money by making the switch but now this year they're raising it again and blaming it on the healthcare reform (dependents can be on someone's insurance up to 26 years of age now). i don't know if it's true or not or maybe i misread the information.

[Edited on November 2, 2010 at 12:43 PM. Reason : edit]

11/2/2010 12:43:40 PM

I think a lot of insurance companies and self-insured corporations are going to jack up rates and hide behind the healthcare reform bill as the cause.

While I definitely think the bill will have the opposite effect of what's intended, companies will exploit it as much as possible to increase revenues and to give the finger to the feds.

[Edited on November 2, 2010 at 12:48 PM. Reason : .]

11/2/2010 12:48:12 PM

ugh anything to make a buck right

cost of living is going to kill me

[Edited on November 2, 2010 at 12:54 PM. Reason : $$$]

11/2/2010 12:53:43 PM

Cass, the company I used to work for raised rates when an employee accumulated hundreds of thousands of dollars from sudden health problems... she was in the hospital for a very long time so they raised it for everyone

11/2/2010 1:09:43 PM

Pikey you'll be fine. I've cost my health insurance company well over $60,000 the last 3 years and nothing's happened.

11/2/2010 1:22:14 PM

^^ that happened at my last company one of my coworkers got super sick and developed a lot of health problems which raised all the rates.

maybe i'm to blame for the raise in our health insurance costs. i have spent quite a bit of time at my endocrinologist's office and they've drawn quite a bit of blood from me in the last few months

11/2/2010 1:26:53 PM

hmm well maybe I'll be okay since I technically haven't been treated for shit in over 4 years.

I still think it's bs that you can be denied coverage though. I wish we had a system like Australia's.

11/2/2010 2:30:28 PM

Quote :

"I think a lot of insurance companies and self-insured corporations are going to jack up rates and hide behind the healthcare reform bill as the cause."

we'll have to keep an eye on health insurance quarterly financial statements to get a sense of whether their actual costs are increasing proportional to the increased revenue

11/2/2010 2:43:35 PM

Or they'll charge you out your ass for it. BCBS wanted to charge me ~$350 bucks/month for one of their mid-range Blue Advantage plans because they saw medication for migraines and epilepsy on my record eventhough I haven't had a seizure or been treated for them since 04.

11/2/2010 2:46:04 PM

Yeah that's what I'm concerned about and it's bullshit imo. I guess that's what can be expected when health insurance is a way to make profits

11/2/2010 2:52:03 PM

I'm a Type I diabetic and I pay the same rates as my coworkers.

Employer health plan is FTW. Your rates only go up based on what the company decides to charge every person.

Don't be afraid to use it, just don't go abusing it and getting vicodin to get high on or something. It's there for your health, and if you don't use it it's not like your rates are going to go down. They'll go up slightly each year no matter what you do.

11/2/2010 7:23:59 PM

20% increases a year is more than a "little bit."

11/2/2010 8:24:11 PM

^^ yeah. The $350 quote was from when I was looking around for alternatives to getting Cobra. Hell, that was more than the full, unsubsidized price for the cobra plan I was on. The company I'm with now just has a regular High Deductible plan with Blue Cross but they contribute about 90% of the deductible to an HSA which isn't bad as I'll never come close to using it all anyways.

[Edited on November 2, 2010 at 8:49 PM. Reason : ]

11/2/2010 8:40:38 PM

Quote :

"What if you had a condition under one insurance plan, then you change employers. Could you be denied coverage under your new employer's plan?"

You get a letter of credible coverage sent from your old insurance to your new insurance showing you didn't have a lapse in coverage. Now if there was a lapse, your new insurance may ask you to wait a period of time for covered services under your pre-existing conditions.

I had a lady at my old job, who went from full-time to part-time. She got off birth control in order to try and get pregnant, but she got pregnant on her first try. She decided to be full-time again to cover the baby, but had to wait 90 days to get coverage and then was told the pregnancy was a pre-existing condition. (which it was)

11/2/2010 8:44:52 PM

I heard the republicans are going to make it where only rich people can get insurance.

11/3/2010 1:36:19 AM

my wife's new job has killer health insurance, mine is okay but i still have some out of pocket expense

is there any reason why i shouldn't just cancel mine and get solely on my wife's plan?

5/12/2017 5:56:24 PM

Quote :

"my wife's new job has killer health insurance, mine is okay but i still have some out of pocket expense is there any reason why i shouldn't just cancel mine and get solely on my wife's plan?"

Several of my friends and their spouses pick which employer provides the best plan and do family coverage from that one employer like you are thinking.

5/12/2017 7:05:29 PM

Ditto to what ^ said. But also, it is usually fairly cheap if all you're covering is yourself through your employer. Some companies cover the employee completely. Where it gets expensive is if they cover anything on the family cost. So if my wife had the better insurance, we would definitely have the whole family on hers but I would also keep myself on at my work as it would literally only be a few bucks a month. And in the small chance something large/tragic happens to me, it could help out.

[Edited on May 13, 2017 at 12:26 AM. Reason : .]

5/13/2017 12:25:17 AM

I have to pay about $300 per month for mine, I'm just having trouble evaluating if it's worth it

5/13/2017 3:45:24 AM

You'd probably be better of dropping your insurance and putting that $300 in an HSA.

5/13/2017 9:28:51 AM

yeah that's what i'm thinking, i'm just having trouble figuring out the factors to run out the numbers. last year i had some unexpected medical costs, but plugging in the prior few years the coinsurance isn't worth it from what i can tell.

5/14/2017 12:05:03 PM