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Disability and health insurance


#1

Hi Folks,

When I opened my own lab I wanted to get in on a group health
plan that was available from the Illinois Dental Laboratory
Association. I made the application and was denied on the basis
that I was too short for my weight :). I was told that if I
had 5 employees that I could join. I was a member of the
association and therefore I demanded to speak to the insurer. The
head of the association arranged a three way conversation between
him, the insurer (The Mystic Knights of the Sea Kazoo Band and
Insurance Co.) and me.

I asked the guy at the MKSKBICo. if I was a member of the
Illinois Dental Lab Association, and this was the group policy of
that association why was I being excluded? After an unbelievably
long song and dance he said nothing new. I then offered to visit
him at his office the next day with the understanding that
whoever walked out of the office got their way, and I assured him
that he would soon find out how good his medical coverage truly
was. I don’t understand why he hung up!

I ended up getting insurance through a national association for
less money with better coverage. This lasted for about 3 years.
I was paying $1500 per month. Suddenly the premiums kept going
higher and higher. We weren’t making any claims except 2 or 3
emergency room calls in about 4 years. Suddenly the premium rose
to the level that could support a third world hospital! The
$4800 per month was killing me and it took awhile to find new
insurance, and when I found it, they would only insure my wife
and 3 of my four kids for the measly sum of $1200 per month! We
lived like this for 6 months, when my wife (the educated one in
the family with a BS from Michigan State and Masters degrees in
Social work and Special Ed.) decided to go to work. She found a
position as a Social Worker with the Chicago Public Schools.
They even begged her work while she got her State School Social
Work Certificate. I am uninsurable outside of a LARGE group.
Thank God for her health insurance. It has paid out about a half
million dollars in the past 10 years just for me!

Sorry to be so long winded but I’ve been following the thread
for quite some time and it got me to thinking.

Regards,

Skip


#2

Skip: Thanks so much for your input reguarding health insurance.
You point out the basis for my rants. As I previously pointed
out, the insurance companies are in business for thier own
bennefit, not yours. Like most other forms of “legalized
gambaling” they are usualy only too happy to insure you if you
have no health record however, make one claim(or even if you
don’t) they begin to jack up the premiums to the point where you
are pre-paying your losses. Pray they don’t deny your legitamite
clam. Personaly, I refuse to live in fear and self-insure by
having the good fortune to be in good health to begin with and
taking care of myself. At 45 I can only pray that I have no
serious health problems before Medicare kicks in. I certainly
sympathize with those who have no choice and eather are fortunate
to be able to pay the horrendous premiums thru an employer or
simply do without. Appreciate everyone’s patience and I think
I’ll stop tilting windmills now;

Steve Klepinger


#3
I ended up getting insurance through a national association for
less money with better coverage.  This lasted for about 3 years. 
I was paying $1500 per month.  

This is scary. What does one have to earn to support this kind
of health insurance. For many that is a reasonable net income
per month. Been there.

As a single person I pay Cnd$102 every three months into the
Alberta Health Insurance Plan, free if one is below a certain
minimum income, and this covers all medical procedures but not
prescription medication. I may see the doc about four times a
year for colds and sniffles, but more for a jaw jaw because he
is an old friend. But that’s about it. Thank god I am healthy
except for a manageable (just becareful of what I eat) case of
Chronic Fatigue Syndrome.

My only major medical procedure was a gallstone operation years
ago which was entirely covered by our public health insurance
plan. Prescription medicine is fairly expensive here but one
does not get wiped out financially if there is a major medical
procedure. But if one requires expensive long term medication
that can be financially draining.

Kelvin Mok (klmok@shaw.wave.ca)

Home: (403) 463-4099 | Home FAX: (403) 430-7120


#4

Kelvin: Glad to hear your ringing endorsement for subsidized
health care in Canada. Unfortunalty, we in the States don’t have
that luxury. Perhaps, when all North American countries are
truly united economicly, we’ll all be free of healthcare
expenses.

Steve Klepinger


#5

Skip, Steve, Peter and all who are following this thread. My 24
year old son works for me in my trade shop. There are just the
two of us so I don’t qualify for a group policy. I am covered
very nicely through my husband’s job with a giant corp. We
applied for private health insurance for my son and after two
month’s of pre-paid waiting they TURNED US DOWN… How would
you like to be a 24 year old American that can’t get insurance?
They won’t say why unless his Dr. sends a request to find out.
He’s healthy for heaven sakes!! beats me!!! Patty


#6

Patty, and any others turned down by an insurance company, do
whatever you need to do to find out WHY they turned you down or
rated (surcharged) a proposed policy. This is specially important
if they’ve done any testing, even a ‘nurses’ exam. A few years
ago I didn’t bother, and missed a serious medical problem in its
early stages. So find out WHY, as young as your son is, it must
be a potentially expensive problem they foresee. The insurance
companies want your money and don’t turn away your cash easily.
Good health, efw


#7

Patty/Boni Rios… this is the country’s biggest disgrace, and
the utter terror of too many parents of kids in their 20s and 30s
– I read somewhere recently that the uninsured of that group are
now the majority of them. I’ve been through this w. three of four
daughters – only one works for a big enough company. Here are
the options available to those who follow the American dream of
wanting to work independently: register fulltime at a school;
find SOME way to join a group; marry; enter the armed forces;
go on public assistance. Or buy individual insurance which
you’ve already discovered isn’t failsafe (even if they accept,
they cut with the slightest provocation) and which can bankrupt
you. It’s not a pretty picture. In your situation,
definitely get your doctor to request the info because those
evaluating health info in these situtations are usually simply
bureaucrats, and you may be able successfully to appeal. The
chances are that your son simply fits a profile (age, sex,
zipcode, income level and occupation) that doesn’t fit their
statistics for a good “yield” for them. But you want to find
out. I’m so sorry – I’ve been there and still am. Ryr


#8

It is well worth ones time to find out why an insurance company
turns you down. There are frequently mix ups in health records,
just plain incorrect recorded and other errors which
can (tediously) be set right. I have had a similar experience,
although it was with life insurance. Both the health and life
insurance companies are accessing the same data sources.


#9
Kelvin: Glad to hear your ringing endorsement for subsidized
health care in Canada. 

Just a clarification. The Canadian Health Insursance scheme is
universal and compulsary, except for temporary visitors. These
premiums cover the Plan’s cost which is therefore self
financing, at least as far as I know since there is no public
outcry about unfair subsidies from other tax revenues. I am
just very grateful that health care costs do not occupy my
thoughts.

Kelvin Mok (klmok@shaw.wave.ca)

Home: (403) 463-4099 | Home FAX: (403) 430-7120


#10

I was contacted by a group that insures small businesses (Can’t
remember the name, but will find it if anyone is interested) when
our son first joined the business (my husband still working and
we are insured through his company). At the time we could get
full coverage of my son and daughter-in-law for about $250 a
month and they would pay directly to your doctor with a $15
co-pay. We also checked into Blue Cross Clue Shield and in South
Carolina they carry a policy for small business owners that ran
less than that a month for full coverage and was NOT an HMO.
There is insurance out there, but every state is different.

I got a call yesterday from US Health Care that said they are
now offering a policy to small business owners. Again do not
know if this is just is SC. Hope this helps someone. jb

J. Byers
http://www.csranet.com/~phoenixe
@Phoenixe


#11

Patty: Fascinating! What company was it? What does the agent
say? All I can think of is there’s something in your son’s
physical which you need to talk to his doctor about. Could be
anything though. Perhaps your agent misquoted a premium and is
trying to get out of it?? Just a few ideas. Please let us know
what you find.

Steve Klepinger


#12

I recently divorced and had to get my own health insurance. In
Florida, there is a state agency called CHPA, which is required
by law to offer group policies to self-employed small businesses.
They regulate various companies, so you have a choice of which
company, type of policy, HMO or PPO, amount of deductables, etc.
I’m very pleased so far - just 4 months. I’m a 54 yr. old female
with no employes and I pay $219 mo. for PPO with a co-pay of $10
and prescription co-pay of $5. You can reach CHPA at:

		CHPA
               P.O. Box 31214
               Tampa, Fl.  33631-3214
               1-800-469-2472

This is a very serious problem for most of us - I hope this will
help at least those of you who live in Fla. Other states may
have similar programs. Maybe the Insurance Commisioner’s office
could tell you. Good luck to all - Gini in Tampa Bay


#13

Please, for the bennefit of all our members, find and put on the
list the source of your son & daughter in law’s health insurance.
I personally would be very interested in knowing! Also the
adress and ph. # of the second source you mentioned. Many thanks;
Steve Klepinger


#14

For what it’s worth, Boni, I strongly suspect that the Insurer
would produce the basis for their declining coverage if you filed
a formal complaint with your state Insurance Commissioner. It
would be worth your while to find out what the Insurer’s
reasoning is, as it may be a misconception on the insurer’s
part, or (less likely) a medical condition which your son’s
physician has not disclosed to him, or an erroneous entry in the
medical record which is causing the problem. If there is a
misstatement in the medical record, your son has the right to
request that the physician correct the record.

Lee


#15

Hi,

I really wonder about Canadian health care. Didn’t they close
the thing down several years ago for several weeks at the end of
the fiscal year because they were broke? I also understand that
it sometimes might be months before you can get an operation if
it not life threatening or an emergency. I do know that many
Canadians come across the border for medical and dental needs.
Remember that when the government gets involved beyond laying
down the basic ground rules, it is usually an unmitigated
disaster, costs 3 times as much, and cuts the service in half.
“That government that governs least governs best!” One of my
most unfavorite lines is, “There ought be a law…” There
probably are 20 laws governing the situation that are not being
enforced because of the zillions of other laws on the books. No
one
could possibly know a tenth of them. I don’t need any more
Socialism in my life. If you think taxes are high now, look at
the taxes in Sweden, Denmark, and Germany. If the way things
have gone in the past decade and a half, continue, the
government will soon be telling you what color to paint your
house (if you are so greedy that you own one!), what brand of
underwear to wear, and what kind of art to produce. Just my $.02
worth. I hope that I didn’t ruffle to many feathers.

Regards,
Skip

Skip Meister
@Skip_Meister
N.R.A. Endowment &
Certified Instructor
in all disciplines
Certified Illinois D.N.R.
Hunter Ed, Instructor


#16

oh please. the Soviets used to say everything bad was because
of capitalism… and it’s just as much a kneejerk fallacy to call
universal health care a form of socialism. What you seem to be
against is someone else controlling your life, which I more than
understand. But if you don’t think the insurance companies now
exercise more control over your life (and what your doctor, if
you’re lucky enough to have one you can consider ‘yours’ and not
just assigned by a telephone voice, can do for you) than any
government does or can, you’ve just had a charmed life so far.
No system is going to be perfect, for sure. But I’d rather pay
Denmark’s taxes and GET something for my money than pay the ones
we do, and get the zip in return (unless I’m a military
contractor, let’s say. Or a pig farmer with a good friend in
congress…) Government employees in this country, hardly
socialists, have had universal health care for decades and
decades, without a smirch of socialism rearing its ugly (?) head.
We should all be so lucky, to say nothing of our kids, our
spouses, our employees and our neighbors. Ryr


#17

Hi,

I guess this is off topic but I couldn’t resist commenting . . .

The Canadian health care system may have it’s problems, but you
will find very very very few of us that prefer the American
system. The health care system has never been “shut down” and
sometimes you do have a waiting period, but not for several
months.

I’ve had several friends and work colleagues comment that they
would like to move to the US because they could make more money
(in high tech jobs), but the major obstacles are always the US
health care system, crime, and of course leaving friends and
family.

The constant discussion (ok, bitching and complaining) in Canada
over the Canadian health care system is more a matter of
improving it and getting rid of the waste than a desire to get
rid of it in favour of the American system. I guess it’s popular
to assume that because the Canadian system is essentially
government run that it’s more inefficient than the American
system. A number of studies made of both systems have found
that to be untrue. God knows our health care system can use
improvement, but getting rid of it certainly isn’t the solution.

My family has unfortunately had to make use of the Canadian
health care system several times (nasty things like cancer and
serious auto and work related accidents) and our experience has
been very positive . . . or as positive as anything involving
such tragic events can be.

I think that you will find that you did ruffle a number of
feathers :slight_smile:

Since I’m essentially a lurker and I won’t be back for a while,
I will take this opportunity to wish you all a very happy festive
season, and a great new year!

Rita Mikusch


#18

This is in naswer to a posting about the shortcomings of the
Canadian “socialist” health care vis-avis the US system.

No system is perfect and I can only speak from my own
experience.

To give an idea of where I come from I own my house (paid up), a
few other assets, no debts but drive a 13 year old Nissan
pickup with 400,000 plus km on it and still going strong because
I can’t afford to change vehicles that often while this one
still runs. I and many others like me would never have been able
to afford the health care the American way even if we scrimped
on other necessities of a modest middle class lifestyle. I would
remain indebted all my life. Lets say we make the ultimate
sacrifice and buy into a US style health care plan. A major
illness would have wiped us out and leave us uncovered after a
major claim when we most need it. It is alarming that even a
Hollywood notable like Chris Reeve’s benefits ran out after two
years (TV interview, 60 Minutes).

What our socialist health care plan does is to allow us to see a
doctor for the usual colds and sniffles, cuts and bruises which
are what most health problems are without having to worry about
that impacting on our premiums or continued eligibility into a
health care plan. Everyone is automatically enrolled into the
Plan no matter how many health or job related exposure
liabilities one has. There is no prequalification. I can move
from one province to another and get accepted into a similar
health plan without a break in coverage. No need to hunt down a
provider or worry about costs.

And when we do get a whopper of a medical emergency such as a
serious accident, a heart attack or some other disaster for
which immediate medical attention is required there is no wait,
no surprises and no special treatment on the basis of your bank
account. Everyone gets the best services available from the
staff on duty at the time of the emergency. This coverage is
country wide, meaning that my provincial plan will pay for my
emergencythat happened in another province or when out of the
country. I will never get turned away at any hospital because
they couldn’t find my health insurance papers. I don’t get
wiped out financially.

And how many of you on HMOs restrict the size of your family
because of health care costs?

To be sure this is no Cadillac service either. If you have a
serious illness which took a long time to develop which cannot
be fixed overnight even by the most advanced medical technology:
cancer, a heart disease, kidney failure, emphysema, genetic
disorders and the like: there is a long waiting list to get to
the operating table. And if you are elderly where major surgery
is not likely to add much to your life expectations you don’t
get preference to the front of the queue. But everyone gets
there eventually. Your HMOs do very much the same cost benefit
assesments and HMOs are more likely than us to restrict or deny
procedures on lost causes and even cut off coverage.

Our coverage is lifelong and universal. Although there won’t be
any herioc efforts to prolong your life you won’t lose medical
access either or have your premiums jacked up.

Because having the monetary means does not allow a Canadian to
jump the queue they are what you are seeing in the rise in
Canadians going Stateside for medical treatment. If you fear
that something is going to kill you before you get to the
operating table and you have the money, why not go someplace
that will let you pay to get ahead. Money is no good if you are
no longer around to spend it. No quarrel there. But if you
look at the implicit morality of the issue, only the rich get
treatment. The ordinary and the poor have no say. And if you
look from the puiblic health point of view that expenditure
adds very little to the health expectations of the patient. A
year, perhaps two. That same money can treat dozens of lesser
but treatable illnesses to maintain a healthy populace.

With that I am entering into a very contentious debate of
personal health versus public heatlth which will take much more
arguments than time or my knowledge will allow. We have to live
with whatever health systems our countries inherited. Over at
least four US presidential administrations health care costs and
ascessibility had been a serious election issue and the
President and Hilary Clinton’s proposal was as close as the US
got to reform. That went nowhere.

As for Canadians, we have our complaints about our system but
the chief beef is that we are not spending enough, mainly from
those who want immediate and the latest medical procedure when
they have an excuse to draw on the system (doesn’t cost them an
extra cent to demand the best); and from those with vested
interests in generating higher expenditures - to maintain union
jobs and more benefits for example. That talk about the system
running out of money is negotiating tactics to rein in public
health care costs as at no time were essential medical
facilities closed (political sucide). There are planned and
ongoing public hospital closures for sure and practices such as
weeklong stays after a normal birth delivery are no longer
allowed. Stays after major operations have also been curtailed,
cost cutting practices which your HMOs rigorously enforce.
Unless you are a private paying patient like rich Candians in
which case they will max out the stay and your checkbook.

As I mentioned above, we have to live with whatever health
system we inherited. All I can say is that just as you feel so
strongly about your free enterprise medical system, we will
fight to keep ours and proud of it. What I do care most about
from a personal point of view is that payments into our health
care plan and accessibility do not occupy any of my everyday
concerns and I shall receive as good care as anyone else.

That peace of mind no money can buy.

Kelvin Mok (klmok@shaw.wave.ca)

Home: (403) 463-4099 | Home FAX: (403) 430-7120


#19

I’ve been listening to this discussion with a growing sense of
horror. Here in New York our state law requires insurance
companies to accept patients - regardless of their medical
history. Companies no longer have the ability to drop clients
who interfere with the profit margin. That has led, no doubt, to
other problems…for instance the cases where companies have
denied expensive medication/treatment; but at least we are
guaranteed the right to purchase insurance coverage.

Pete


#20

And while we’re on the subject…it’s a little bit ironic that
some of our representatives in Washington who are the harshest
critics of universal health service have all their health care
subsidized by the government…at the same time as they
fanatically support the private insurance companies who
contributed lavishly to their campaigns. Talk about
hypocrisy…