<p>Also, the state insurance commissioner is asking the companies to allow all these policies to be continued for one more year.</p>
<p>Good luck, GP. I hope you can keep your plan as promised.</p>
<p>So it’s now all the plans for a year, not just BS for 3 months? That will give time for the suit to work through the courts.</p>
<p>Tatin, BS has agreed to the March 31 extension, not one year. The commissioner wants a 12 month extension. Not sure where this is going?</p>
<p>I’m just not sure what the deal is? </p>
<p>Ours was cancelled, but I think it was over caps? We had a cap that was really high. I mean, if I needed that much, I’d rather be dead. But… You have to remember that if you got sick, the insurance companies used to just kick you off the policy.</p>
<p>This was a real thing they did. All the time. People forget. There is a reason the majority of Americans wanted change. Maybe not this exact change, but change.</p>
<p>So, you want to go back to a capped plan? Fine. Since it’s only for one year, who cares? it’s not really capped. They cant really kick you off insurance, etc…</p>
<p>For me, the annoying thing would be if I had no coverage AND I couldn’t sign up and ended up uncovered for a period of time and something happened.</p>
<p>In the end, the old insurance business is over. They have a favorable situation right now, but it won’t stay this way. It’ll even out. The kids will start to get a better deal if they vote more.</p>
<p>But, they ought to let people stay on their old plan for a year just because nobody can get signed up right now with the computer situation.</p>
<p>GP, I am not a lawyer but I can pretend. :)</p>
<p>Your case is weaker than the case mentioned in the LA Times.</p>
<p>You got value for your switch. The plan you have now is not grandfathered and you were never promised you could keep it.</p>
<p>As I read the story in the LA Times, actual grandfathered plans were cancelled and policy holders were pushed to more expensive plans. </p>
<p>You are not going to want me on the jury. :)</p>
<p>dstark, where did it say that grandfathered plans were cancelled?</p>
<p>It said they were pressured to give up their grandfathered plans in 2011. It didn’t say how they were pressured.</p>
<p>A large premium increase and the fact that they were closing the plan I was transferring to could be considered as a form of pressure.</p>
<p>Ok…I see what you are saying…</p>
<p>Sorry… You wouldnt want me on the jury and the same with this couple…</p>
<p>[Anthem</a> Blue Cross is sued over policy cancellations - latimes.com](<a href=“Anthem Blue Cross is sued over policy cancellations”>Anthem Blue Cross is sued over policy cancellations)</p>
<p>Anthem told me not to change out of my grandfathered plan.</p>
<p>GP, I was part of a class-action against Blue Shield once-- on behalf of my daughter. Here is what happened: As you know, in the past premium levels were set by health ratings, so that the healthiest customers had the lowest premiums. I had separate individual policies for each of my kids as well as myself, and we all were entitled to the lowest rates. However, at one point I changed my daughter’s plan within BS, probably to change the level of deductible. Many months later, when looking at a rate sheet, I realized that we were NOT being charged the lowest rate, but instead were being charged a rate that was stepped up a level. I called up Blue Shield and asked why, they said that it was a “mistake”, and moved us to the lower rate. They did not offer to refund money for previous months. </p>
<p>About 2 years down the line I get notice of a class action over that issue – I signed on, and then maybe 6 months or a year later, I got a small refund check as part of the settlement of the class action. Nothing close to total amount that I should have been owed if you had done the math. </p>
<p>On the other hand, I am sure the class action lawyers made a lot of money.</p>
<p>Class actions are a very effective tool that can be used to curb bad practices of a corporation. They are NOT an effective way to get compensation on an individual level-- essentially in most cases you will only get a small fraction of what you think you are owed.</p>
<p>I have probably said way too much about this on a public forum. I may have crossed the line about what I should be disclosing on a forum like this.</p>
<p>"busdriver, I’m reading the statute I posted in #3610 as saying that if a treatment counts as an essential health benefit, and if you are sent out of network because the in-network providers don’t treat that condition, you have to be charged for it just as if it was an in-network procedure.</p>
<p>So if you needed a kidney transplant, and you had to go out of network because your plan didn’t have any transplant surgeons, you would have to pay the same as you would have had to pay if it was in-network. Do you read the statute in a different way?"</p>
<p>It’s rather confusing to me. What does it mean that in-network providers can’t treat the condition, and you have to go out of network? Is that just in the state, the county, the area? What about if your kid is out of state, and the nearest network provider is 100 miles away? Well, he could stay in network, and drive 100 miles. So would they cover it at the in network cost if he went locally, because there are no local providers? I guess it’s all in the fine print, and if it’s not specifically defined, they could interpret it any way that is favorable to the insurance company.</p>
<p>calmom, that’s interesting that BS made that mistake. When I saw this law firm was suing Anthem, my immediate reaction was why not BS. They are equally deserving. :)</p>
<p>dstark, I can’t believe you would rule in favor of AN insurance company. I am going to attribute your momentary lapse of judgement to a couple of stressful days dealing with Anthem. Maybe you’re the victim of the Stockholm syndrome, having positive feelings toward the enemy? :)</p>
<p>To GP – more about a lawsuit / damages / etc.</p>
<p>There are two things that you can get in a lawsuit: money damages or injunctive relief.</p>
<p>With money damages you are compensated only for actual loss. If you claim that you were misled when you opted to change policies for a lower premium, then you are essentially asserting that you want to be restored to the position that you would have held if you had continued to stay with the policy for with the higher premium. So on the money end of things, you would have to subtract out the value of the difference in premium costs for all the months since you changed policies. </p>
<p>BS will raise its rates on its grandfathered policies at the first of the year or whenever the policy renewal is. They always do. (The average has been about 9% a year, but it will likely be higher in 2014 - I think 15% is a conservative estimate, 25% quite possible). So being restored to the position you were in might give you the right to keep a policy at an increased premium rate.</p>
<p>Now maybe you are willing to pay that premium out of the hope that Cedars Sinai and UCLA med will remain in your network. I say “hope”, because there is absolutely nothing that prevents BS from dropping those hospitals from their existing, “grandfathered” networks either. Nothing at all. </p>
<p>So you could get your wish: a higher premium, paid for grandfathered policy that is not much different from the ACA policy (except that it has a lower deductible, lower max OOP for in-network care, and significantly higher max OOP for out-of-network care). You may be very happy because now you and your wife can see the doctors at Cedars Sinai for in-network rates. And then a month later you get a notice from BS announcing that effective on such-and-such date, Cedars Sinai will no longer be part of the BS network. </p>
<p>I know that you are frustrated with the ACA changes – you have made that very clear. But I think that you are mistaken to assume that there is a way to go back and lock in an entitlement to what you had. These changes are a sign of things to come: either the rates on those old grandfathered plans will go sky-high over the next few years, or the insurance company will feel the pressure to make cuts to economize. Since they can’t cut the benefits and maintain grandfathered status, they may very well look to trimming their network… Although the sky-high premium thing might be attractive to them as well. </p>
<p>If you do the math, you’ll see that future sky-high premiums on grandfathered plans on the individual market is a virtual certainty. Right away, about a third of the people in those plans will drop out because they will be entitled to generous subsidies on the exchange. It’s not possible for new young people to come in, so there will be an aging and dwindling risk pool going forward, and many will be there precisely because they want the privilege of getting care from the more expensive facilities that have been dropped from the exchange plans. So insurance company payouts will go up, and that will be translated into higher premiums.</p>
<p>Calmom, you may be right, but right now I like my plan much better than the one I am looking at. If all those bad things happen down the road, then I guess I will be transferring to an ACA plan.</p>
<p>Gp…Post 3654… :).</p>
<p>
That makes no sense, because its based on an assumption that (a) it will be impossible to sign up all the way through March 31, and (b) that using the internet is the only way to sign up. </p>
<p>Many of the state exchanges are working seamlessly. I have some issues with the site design of the Covered California portal – I’m a very sophisticated internet user, but find navigation hard to fathom there. But the sign up process went pretty smoothly, and every time I have phoned the 800 number, I’ve gotten through very quickly. Plus the same insurance agent I had with my old plan would be able to sign me up through the exchange if I hadn’t already done so myself. </p>
<p>It makes sense to me that there would be an extension to preserve coverage in areas where there are true impediments to signing up, but a slow and sometimes buggy web site coupled with a lot of media hype isn’t the same thing. </p>
<p>You might be right that an extension is in order, but I don’t think that’s a decision that should be deferred until the end of January. </p>
<p>It doesn’t really impact many of the “cancellation” notices because those seem to be more of a matter of people being rolled onto new and sometimes more expensive policies with the same insurance companies. (The people are covered by policy X, and if they do nothing in response to the insurance company letter, they will be covered by policy Y for $$$ instead.) For those who are not subsidy eligible, there is no harm done-- they are often being put on the same policy at the same price as they would get on the exchange.</p>
<p>GP, I think you are going to be transferring in any case, just maybe in April rather than January. At least the thing about the networks should be clearer by that point. </p>
<p>Blue Shield doesn’t have the legal power to change the ACA rules – that is, it can’t let you shift back to a grandfathered plan or keep your non-grandfathered plan absent a court order or some other sort of government action. Class-action lawsuits aren’t effective for short-term injunctive relief (to stop a company from doing something, or compel some sort of action) because they are very cumbersome – it will take months just to get that sort of lawsuit in gear. The basic legal argument of the Anthem class that they were tricked or pressured into dropping grandfather status sounds like primarily a claim for money damages – so that’s the sort of thing where the litigation will drag on for a couple of years, and then everyone in the class will get a check in the mail for $60 or something, and that will be it.</p>
<p>haven’t read all of this, but in case this is good information for anyone, there is now a site which gives the basics on prices in the states using the gov site. So if you just want an overview on a given state’s plans, they’re all listed here:</p>
<p>[url=<a href=“http://www.thehealthsherpa.com/]HealthSherpa[/url”>http://www.thehealthsherpa.com/]HealthSherpa[/url</a>]</p>