Monday I wrote about the friend who was having a great deal of difficulty getting a straight answer from Anthem Blue Cross of California about her options after they raised premiums on her current policy 20%. Their current tactics are part of
September 21, 2010

Monday I wrote about the friend who was having a great deal of difficulty getting a straight answer from Anthem Blue Cross of California about her options after they raised premiums on her current policy 20%. Their current tactics are part of their larger war and temper tantrum about having to cover people with pre-existing conditions because for insurers, it has always been about pre-existing conditions. All of the other issues aren't a big deal, but they wanted the right to discriminate against insureds, and the Affordable Care Act robs them of that right. Not soon enough, unfortunately.

The audio file must be heard to be believed. In it, the representative spends a full ten minutes trying to talk this customer out of switching to another policy that would be regulated under the Affordable Care Act. He begins with this bizarro threat:

What that means to you specifically is if you make a change after March 23rd, you'll be subject to a [?] requirement [unintelligible] and more specifically - you'll be stepping outside of one underwritten pool of people that were upgraded due to pre-existing health conditions -- and you would be stepping outside into a non-regulated, non-grandfather classed plan.

More specifically, what will be in that pool that you'll be in? You may be very healthy but you will be a healthy fish, so to speak or a healthy person -- you'll be put in the pool of other persons that are in there and insurance is just a pool of people that come together to indemnify a particular [unintelligible].

So when you move from one pool to another and in that pool you have 18-year olds, cancer, diabetes, stroke, heart attacks, brain aneurysms, doesn't matter what it is they could not afford the insurance at that point in time. So now, in that pool is I could afford the premium that I couldn't afford before. The 18-year old. But now you're stepping in there and guess who's helping them pay their premiums?

The only changes to risk pools at this point are: a) covering children under age 19 without regard to pre-existing conditions; and b) allowing children to remain on parents' policies until they're age 26. But to hear this guy talk, you'd think every kid on the planet is one of those dirty, dirty fish with cancer, diabetes, heart disease and well, all sorts of possibilities.

The customer persists. She returns to her original question about what plans she is eligible to switch to without underwriting requirements. The representative also persists in his relentless crusade for her to remain on her grandfathered plan, which has just gone up 20%. After reminding her that she will be abandoning her perfectly good grandfathered contract for that dirty pool with just anyone in it, he tells her that premiums will go up on a quarterly basis and quotes amounts.

In the process, he appears to confuse premium increases for age changes with some kind of scheduled quarterly increase. The full transcript is at the end of this post with the details, but frankly, it's just wrong information. Insurers under CURRENT law are not permitted to make quarterly rate increases, much less under the Affordable Care Act. Yet, he persists with his insistence that yes, premium rates will go up each quarter. In fact, those rate quotes are for part-year insureds -- those who buy insurance mid-year rather than in September.

The more the customer persists with her original question, the more frenzied his anti-health reform spiel gets. At about eight minutes in, we get this:

A: So instead of annual increases, it's going to be April --

Rep: We're going to --

A: Quarterly increase in the premiums?

Rep: Every three months, that's what the rates are looking like.

A: This increase I've got now is 20%. Are you telling me it could be going up 20% every quarter?

Rep: I can tell you right now that what I'm looking at for me as a healthy male age 51 on a $3500 deductible plan is going from this much to $441.00 and I'll be 52 between July and October, and October it's going to be $793.00.

A: That's October, 2011?

Rep: mmhmm, just because I went just one age bracket up, but even in July it's $743.00, for a healthy male, $3500 deductible, PPO share.

A: Um, well --

Rep: But you're no longer grandfathered or I would no longer be grandfathered. I'm going into a plan after March 23rd, subject to being in the swimming pool or the pool with other people that are insured that have pre-existing health conditions, that were higher risk in the underwriting before March 23rd, but now after March 23rd, they're not subject to the same underwriting critiquing, because you're going from a plan that was with ABC Anthem Blue Cross and you, and just jumping into a plan that is overseen and imposed by the federal government and on every single state in the union, on every single department of insurance in every single state.

They're regulating, and making sure that every single insurance company that writes insurance in a state must comply with the federal health care reform bill, and that's being phased in. A big portion of it's going to be in January.

Got that? This Anthem rep is telling the customer (who happens to be more savvy than the average customer) that because she has opted out of the grandfathered (less beneficial) plan, the plan isn't overseen by the state but is subject to that bad, mean federal government.

Only, he's wrong. Every contract for health insurance post-Affordable Care Act must be reviewed and approved by state Insurance Departments and part of their review will be to ensure that the provisions of the Act are included. There is no higher-level federal review. We wish such a thing existed, but part of the plan was always to leave the reviews and approvals to the states rather than putting it in the hands of the federal government.

This is a major, huge big deal. The White House and Sebelius should be all over this. Every Democrat running for office should be on a soapbox taking laser-like aim at what they are doing, because they are misrepresenting the impact of the changes made by health care reform, they are threatening customers with rate increases, and they are using pressure tactics to keep customers in plans that do not incorporate ACA provisions. Further, they are fomenting fear and confusion in order to support the right wing's promise to repeal the act entirely.

Make no mistake, this is a war, and it's a war over whether they can discriminate or not.

[Full transcript - PDF]

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