[Digest Post] Group medical insurance

Try the Chicago Artists Coalition and the SAS, Society of American

http://www.membernetusa.com/sas/ is the link to the insurance page
www.silversmithing.com for their home page.

Elaine Luther Chicago area, Illinois, USA Certified PMC Instructor

And please, if you feel strongly about health insurance, write or
call your legislators and let them know this is important to you.
There are 40 million people in this country who don't have health
insurance, and the number is growing with the economy in the

Thank you, Susan! This country spends more, per capita, than any
other on healthcare, and yet we have 40 million people with no health
care coverage, and many, many more, particularly the self-employed,
who are under-in sured and who will face ruin if they have a
catastrophic illness. Those i mbeciles in Washington, DC who loudly
proclaim that we have the best heal thcare system in the world should
talk to some of the 40 million with no coverage-- damn near anything
is better than no coverage at all! Access to basic health care
should be recognised as a human right, just as import ant as access
to food, water and shelter.

Those who are self-employed in this country face a particularly ugly
situation with healthcare, unless they are able to access a true
group policy 2E Individual health insurance is a confidence
game.Under invidual policies,you are effectively a risk pool of 1,
so if you are diagnosed with a ny ailments of even minor severity,
your premiums will increase as much a s 100% at renewal time, which
may well force you to drop your coverage. I t is also common for such
individual policies to be “underwritten on the back end.” This means
that you will be issued a policy fairly routinely, and your premiums
accepted, until you seek treatment for a serious medical condition.
At that time, your file will be pended, effectively stopping payment
to your healthcare providers, while your application for coverage is
reviewed, and your medical history (often going back five years
prior to your application) is investigated minutely for any
discrepancy which would allow the insurer to apply any of the “three
Rs”: retroactive rescission of coverage, retroactive rate increase
or a rider excluding coverage of the medical condition.Failing that,
the insurer will seek to establish that your current illness is
connected with, complicated by, or arose out of a pre-existing
condition. Even if the insurer uncovers no discre pancy, they
effectively block payment to your healthcare providers with these
tactics while the investigation is in progress, and I have personall
y observed several such underwriting investigations which took more
than a year to resolve. The insured in these cases is often forced
to both pay the premiums for their policy and pay their healthcare
providers out of pocket, and many cannot bear the financial burden.

(I’m not making this stuff up, and I didn’t just read it somewhere-
I am ashamed to say that I once worked for a Third Party
Administrator who em ployed all of these dirty tricks.)

Our system of healthcare financing does not just need to be
overhauled-- it needs to be discarded, and replaced by something
better and altogether different. I have been involved in healthcare
reimbursement for roughly 20 years, and in my experience the
Medicare and Medicaid models, where the coverage is spelled out
under governmental regulation, and where carrie rs administer payment
under governmental supervision, with government fun ds, result in the
vast majority of cases in prompt payment for medically necessary
care, with maximum protection of the rights of the patient, and with
the minimum administrative cost. From where I sit, single payor,
governmentally funded healthcare looks pretty good.

Perhaps those Orchid members in other industrialized nations could
give us feedback on their healthcare systems and how they work?

Lee Einer

Hi Suzanne,

What the situation is depends heavily on what state you live in.
Each state sets its own rules and regulations governing when an
insurer can turn you down, how much they can charge you, and
whether they can exclude pre-existing conditions

I don’t if I have any medical condition that would cause a company
to turn me down; I’ve never gotten that far! My experience when
looking into insurance offered by different professional groups was
that, as soon as I entered my Massachusetts zip code, I got a
message saying that their products are not offered in my state at
this time. As you were preparing your article, did you get any
insights into why none of these groups operate in Massachusetts?


Perhaps those Orchid members in other industrialized nations could
give us feedback on their healthcare systems and how they work? 

The UK, of course, has, since the 1940s, had a state-funded National
Health Service where any UK resident can get all the health care they
need for free. This is marvellous and is just funded from general
taxation but, in recent years, there has been a push from government
to encourage people to take out private healthcare insurance policies
and to seek care in the private sector. The result of this is that
many doctors now spend more time with ‘private’ patients and the NHS
hospital waiting lists for non-emergency treatment are very long.
There is a way around it as we recently found with my wife’s knee
replacement surgery - pay 100UKP to see a specialist privately and he
then slips you into the NHS waiting list above those who cannot
afford to pay for his provate consultation! In our case a 3-year
waiting list was magically reduced to 3 weeks!! In my opinion the
whole system of private healthcare stinks and a system of state
funding and treatment based on need not wealth should be available
for all.

Best wishes, Ian Ian W. Wright Sheffield, UK

Health Insurance Knowing this is a sore subject for many, I thought I
should let you know what I’ve found, perhaps it will help you. I’ve
spent many years without health insurance due to expense, and the
fact that once you get on, it seems that the premiums would increase
tremendously each year causing me to cancel.

A local agent called me this past summer and told me he thought he
had a coverage he thought I’d be interested in. The company’s name
is National Health Insurance Company. What made them stand out in
my eyes was that along with major medical, they offer outpatient
riders. So for instance you could get major medical with a $5000.00
deductable, and attach a outpatient rider for say $500.00
deductable. The riders covers essentially all outpatient care
although they may have a limit on some, such a chiropractic, but at
least they cover it, which many don’t. I believe at this point they
cover around 46 of the states, so for those of you that have been
looking you could check this out to see if it meets your needs. I’ve
no clue whether the riders are available in all states, hope so.
They’re based in Texas, and # is 800-237-1900. No affiliation, just
offering what I’ve found. Good luck! Lisa We’ve had our first rainy
day in Southern Oregon, we sure needed it, now my garlic can grow!!!
– Lisa Hawthorne @Lisa_Hawthorne