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<p>GP, I’m asking what you imagine the premium and the deductible would be for a plan that was exactly the same as the $60K plan, but with a deductible. And you’d better give two numbers that add up to something bigger than $60K; otherwise I will laugh at you.</p>
<p>I just have to say this again…</p>
<p>“I dont see how this story is good for Humana or Anthem. Anthem offers a family a policy for $11,000 a month knowing they have policies that can insure this family for $1,500 a month or so.”</p>
<p>WOW!!!</p>
<p>I was in the individual market for 22 years. The last year I paid $679 a month for a plan for two people with a $5,200 deductible and the same out-of-pocket maximum. In 22 years I went through underwriting only twice. The last time was about ten years ago when I switched from Anthem to Blue Shield. Stop with the hyperbole.</p>
<p>I dont hype anything. </p>
<p>I joke around but I dont bs. My word is good.</p>
<p>Check out what Anthem did to that woman. Just check it out.</p>
<p>I checked out the rates Anthem charges in va on ehealth. Maybe a silver plan for 4 could cost up to 2,000.</p>
<p>What a RIP off!!!</p>
<p>GP, are you asserting that this family had a $60K/year insurance plan because for some reason they thought it was a good idea to pay $60K per year for insurance, rather than because they couldn’t get insurance for any cheaper because one family member had had cancer for eight years and required expensive treatments and they were stuck in this uber-expensive plan?</p>
<p>You have to consider the out-of-pocket maximum when determining the premium for a plan. In some plans the out-of-premium can be considerably higher than the deductible. Also, in a family plan the family deductible can be twice or more than the deductible for an individual in the plan. Believe me, if you buy a plan with zero deductible and zero out-of-pocket maximum for a family of four, it is going to cost a lot of money. </p>
<p>I don’t know what was going on with this woman and her family last year and neither do you. So stop guessing or doing what dstark is doing: quoting a hyper-partisan columnist from the LA Times while assuming a scenario that he has no idea happened. I guess dstark finally found an example of a good journalist worthy of the school he attended. LOL</p>
<p>in case you missed my previous post, how come I was not screwed since I had my family in the individual market for 22 years. There were years when we had significant medical expenses. My kid played football in high school and college. The insurance company wasn’t happy during those years.</p>
<p>GP, I know you have to consider the out-of-pocket max. What o-o-p max do you imagine this family could have had? Even if they had $20K out-of-pocket, that’s still a $40K/year premium. (That is, if, instead of paying $60K, they could have gotten a similar policy with $20K oop and less than $40K premium, they would have done it unless they were idiots.)</p>
<p>That is, I’m trying to understand how you think these people could have spent less than $60K per year. If they could have, why didn’t they? If they couldn’t have-- if $60K per year was what they had to spend, every year-- why would we want to return to the situation where people with cancer had to spend $60K per year on health care? And what were people who got cancer but who couldn’t afford $60K supposed to do?</p>
<p>:)</p>
<p>GP, I posted what the father in law supposedly said. </p>
<p>You better hope this guy was misquoted. If he wasnt, you are arguing with CF and Las Ma while Anthem just proved CF and Las Ma’s point. :)</p>
<p>"“Blackwood didn’t respond to my request for more details, but I did reach his father, Robert, a family physician. He wasn’t sure of the reason for the cancellation either, but did say that the old plan cost $5,000 a month in premiums to cover four family members. When it was canceled, BC/BS offered a substitute plan with a monthly premium of $11,000, which Dr. Blackwood quite properly concluded was out of line.”</p>
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<p>And so would you, if you were Anthem! They don’t want this customer. Anthem is required to sell that $1500/month policy to the family, but they’re certainly not required to go out of their way to offer a policy to a customer they know would be money-losing.</p>
<p>Sorry CF, I can’t follow your example. Not sure what you are talking about. </p>
<p>I am going to reiterate what I said before. You guys are continually making me knock down these straw man arguments. Who cares what the heck happened last year except for the fact she had coverage for her illness and her son was much happier than he is now without coverage for the drugs she needs. To say that Obamacare is not responsible is laughable. I guess it is just incredible coincidence this happened at the same time we have this earth-shattering change in the law. Sure.</p>
<p>I guess the hundreds of examples of people with catastrophic illnesses which have been cited in this thread over the last few months who have lost their doctors, drugs or hospitals are all coincidence. </p>
<p>CF, Of course, Anthem did not want that woman.</p>
<p>This time…ACA is around. And thanks to the WSJ op ex piece which got the ball rolling, we get to see what Anthem did. 
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<p>I have a low opinion of Anthem for many reasons, but I don’t blame them for offering this family the $11K/month policy.</p>
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Anthem might have been offering the policy with the most generous prescription drug benefits.</p>
<p>One part missing from the analysis is that under ACA, the family has the option to split coverage. I think it’s fair to assume that a family that can afford $5000 a month for insurance probably does not qualify for subsidies. But if the other 3 family members were relatively healthy, then perhaps they could have chosen to have 3 family members on a less expensive ACA plan, and simply keep the old plan for the mother with cancer. If the premiums cost $11000 for 4 people, that probably would have been about $4000 at most for the cancer patient alone. Splitting the policies would have increased the total out of pocket for the family – but it is an option that does’t seem to have been explored. </p>
<p>I don’t know. I still can’t figure out how someone who works as an office manager in a medical office wouldn’t know how to check drug formularies, or wouldn’t have a very good idea as to which insurance companies were more or less likely to balk at paying claims. I find it hard to believe that someone in that position, knowing the cost of the drug she relied on, would accept “you’ll have to sign up to find out” as an answer. </p>
<p>Not at all, GP. I think both in the old days when denying coverage to sick people, and now when trying to put the squeeze to hospitals and doctors, insurers were and are actuated by their own monetary interest. It’s just that now their own monetary interest aligns with what I take to be desirable, namely lowering medical costs.</p>
<p>If I found Humana has Sandostatin on the ‘needs prior auth’ list, yes, you’d think a medical family would be informed. And demand assurances at a higher level. And, it has been on Humana’s auth list since at least Jan 2012. Granted, they were under stress and son implies mom did the bulk of the calling. But, if your life depends on a med, how do you settle for blind assurances? (Not to mention, how do you imply Mom had to go this on her own?) Something’s missing here. </p>
<p>Also, what I saw is that Sandostatin was tier 3 under Anthem, “highest co-pay.” I only know what that would mean under my current and former policies. But it’s one more bit that points to the fact the family should have known the risks in assuming. You’re dealing with a life saving, high cost drug, given twice/month.</p>
<p>You guys are continually making me knock down these straw man arguments. Go for it. </p>
<p>Btw, no one said wise, sagacious or saintly. </p>
<p>wow: don’t y’all sleep at night? 
I-) </p>
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<p>Ouch. I thought ALL of my stuff was good. 
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<p>Not if you post something GP likes!</p>
<p>^^Yeah, but then I’m eligible for an award!</p>