Private Health Insurance Questions

June 28, 2008 6:56 PM

Are some health insurance companies better than others?

Due to my partner quitting his job, we are now looking for new coverage. Although COBRA will presumably an option, I anticipate it will be fairly expensive, so I've been looking at various cheap private plans out there. Although my partner and I are reasonably healthy people, we've had various minor fractures, illnesses, and procedures between us. I'm well aware that there are at least some health insurance companies will reject applicants for the most of minor of prior health issues (for example, I was rejected by Blue Cross 3 years ago for genital warts that ocurred over 5 years ago). I'm wary of ommitting health details in the application, however, because of the health insruance companies' other favorite habit of recission. So with this in mind, I have a couple questions:

1. Are some health insurance companies less picky than others about prior health conditions/accidents than others?

2. Are some health companies less likely to try to retroactively cancel your policy than others?

3. Do I have a chance applying for Blue Cross again, now that over 5 years have passed since I was (successfully) treated for the condition they rejected me for a few years ago?

Thanks a lot. This is in northern California, BTW.

posted by mahamandarava to health & fitness (7 comments total)

I suggest you get COBRA coverage while you apply for other coverage; otherwise your COBRA option period may expire and then you may get rejected by other insurance companies.
posted by zia at 7:02 PM on June 28, 2008

The advantage to Cobra is the fact that you remain on the group plan and pre-existing conditions are not an issue. In addition, the premium for group coverage is often cheaper than the cost of an individual plan.

In terms of "retroactively" cancelling the policy, I believe that this can only happen if you are not honest on the application regarding your health history.

This is a judgement call, if neither of you have any documented pre-existing conditions it would make sense for you to price other coverage, but, I would predict that in an apples to apples comparison it will be cheaper to go the COBRA route.

Bottom line with health care, you get what you pay for.

/from the perspective of an employer who negotiates health plans.
posted by HuronBob at 7:07 PM on June 28, 2008

I just went through this last month. I went from Blue Shield with my employer to Blue Shield solo.

The COBRA deal was $500+ a month IIRC. Blue Shield (California) PPO with $1700 annual deductible and $1700 out-of-pocket cap is ~$200/mo (with some dental coverage too).

The screening process was some small degree of hassle, they wanted to know my last doctor visit and stuff.
posted by yort at 8:20 PM on June 28, 2008

Yes, some companies are much worse than others (but insurance companies are all pretty evil). It all depends on the network of doctors they use. For example, in Illinois, it is hard to find many good doctors on United Healthcare. Why? because it is a pain for doctors to be on this and similar networks--they are difficult to work with and doctors end up spending way too much time having to chase after money they are owed. So if you get an insurance policy without a good selection of doctors/providers, it won't do you much good. Find out which of the companies you are considering have the doctors you use on their panel. As far as "retroactively canceling your policy", I think they can only do this if they feel there was some fraud involved on your part, such as not reporting pre-existing conditions when you applied. In terms of BCBS accepting your application after denying coverage for you 5 years ago, it all depends on what the pre-existing condition was. Amazingly, I have seen them turn down people for mitral valve prolapse, previous psychotherapy, and psychiatric medicines. Here is the trick........if you ARE rejected, get your doctor to write a letter requesting the reason for your rejection (if they won't give it directly to you which they might not). Then go back and try to negotiate a policy with a rider that exempts the condition they are concerned about. They often do this. Remember, though, that because of ERISA laws, they can only reject you or put a rider on based on pre-existing conditions when you are applying for non-group insurance. If you go from one group policy to another with no lapse between, they cannot even subject you to a pre-existing condition waiting period if it is a group policy. Let's just hope that Obama gets elected and keeps his campaign promise of making sure everyone who wants insurance can get it. Good Luck!
posted by Lylo at 10:58 PM on June 28, 2008

Just avoid any policy or company associated with MEGA insurance. They allow balance-billing by providers, which can easily result in sky-high medical bills.
posted by Thorzdad at 3:08 AM on June 29, 2008

In all likelihood, COBRA is your best bet. For the same quality of coverage (amount of coverage, deductibles, exclusions, network, etc.) group is always cheaper than individual. The only way an individual premium will be lower than your COBRA is if the quality is worse -- probably much worse. Having a history of claims can only make it worse.

However, you still may be able to come out ahead with private if there are certain aspects of the group plan you can give up. Maternity coverage is very expensive; group plans almost always cover it but private plans sometimes exclude it, and there's a big premium benefit from that. If your group plan had very low deductibles and co-payments (which is common at union employers and employers who pay lower wages) the COBRA premium may be badly inflated by the cost of that generosity, and you can come out ahead if you have the savings to bear higher deductibles and co-payments.
posted by MattD at 4:36 AM on June 29, 2008

My company just switched from Blue Cross (GA) to Humana (GA) and I can't stress how horrible Humana has been from the get go. If you have any existing medications that you feel work for you, it is a good idea to check and see whatever company you do switch to, doesn't require these medications to be pre-authorized by their mysterious medical board (which can involve weeks of going back and forth with your doctor and them and if you are out of something you take daily you are screwed). Ultimately, they will suggest you "try an alternative they recommend", which seems to me should be illegal... Just something to look out for in your quest. Good luck, as you know, there is a lot of simply crooked stuff out there.
posted by priested at 7:09 AM on June 29, 2008