Re: Health Insurance policy targeting

[Guest guest]

Hi Anne:

We use to be with Humana when was employed by the City of Appleton.

 We did have a few minor problems and they always stated that they have doctors

on staff when I would try to explain mito to them.  I did tell them that

one day I will pop in on them with Leah so I can do a show and tell with

them.  But we don't have the issues you are dealing with and the medical

stuff.  Right now Leah has been only on MA since Brain lost his job.  So

far we haven't had any issues of what doctor she will see or what treatment

she will be getting.  But then again, Leah doesn't have many issues.  If

you need some one to help you here against Humana, I would be happy to help

you.  It isn't fair that they target you and risking the life of your child.

 When I read this all I could think of it real does come down to money.  They

are losing money by having you on their policies.  Isn't that a shame.  Yet,

in many ways they would still be paying for your insurance if you had to

go on Beckett fully.  I hope you win the fight big time.  Prove to

them they can't do this to people.  That is why they are in the business.

  There are many people who pay into insurance and don't even use it because

they are healthy.  And then there are people who use the insurance not very

wisely.  Meaning instead of having a primary care physician they go to the

ER for a minor cold or such.  I feel they are misusing their insurance policy

that way.  So I know now why insurances are having you pay $50 for an ER

visit unless you need to be admitted.  Just to cover all basis.  Keep us

informed of your process.  So far we've been lucky with MA and all our family

is on Badger Care for the moment because of 's job loss.  Hopefully

our new insurance will be ok.  Will need to read the fine print on everything

before we sign the contract.  Will have to have bring it home.  We

don't qualify for insurance until he is on the job for 30 days.  So we would

have time to look it over.  Take care and my thoughts are with you and your

family right now.  As if you don't have enough to deal with now you have

this.

Nerenhausen

mom to Leah

Anne K Juhlmann wrote:

Reading all of this stuff about Kass and

Cigna not paying for the Carnitor and it makes me think I need to write

to you all to let you know about what we are experiencing with Humana. 

My point is not to scare you necessarily (although I do think we all need

to have a fairly healthy sense of fear) but to make you aware of what is

probably going on with other medical insurers with high claim cases like

all of our children.

 

My family has been insured by Humana,

Inc, though my husband's small business employer for the last 11 years. We

have increasingly had to absorb the cost of the premium  but of course felt

it worthwhile because of the children's medical issues.  In early December

I became aware that one of the CEOs of Humana was apparently targeting our

policy for termination. Why? Because of the high cost of the boys' care. 

His actions are illegal  and unethical but unfortunately will be  hard to

definitively prove.  Several exchanges between the CEO and myself transpired

since that time - always polite. On Tuesday I filed a formal complaint with

the Office of the Insurance Commissioner.

 

If we lose our health insurance the State

of Wisconsin will be responsible for my sons' medical bills as they are

both part of the Beckett MA waiver Program. More important to me,

my Sam's very life will be at stake without access to the specialized systems

of care that Humana pays for. Sam is a vibrant, joyful first grader who

loves nothing more than to go to school and play with friends . He does

not deserve to live in Children's Hospital permanently because of Humana's

disregard for the law but he would because of a little known part of MA

law which says that care at home much be cheaper than care in the hospital.

Due to the way MA fee structures are set up - care in the hospital would

actually be cheaper in Sam's case.  Though I imagine we could eventually

find someone to champion the cause to change this - Sam would languish in

the hospital in the meantime and he would not survive that. The rate of

error is too high for someone as complex as him.

 

Our case was immediately elevated

to the expedited status and the Commissioner and his staff Director of managed

care will be handling this case.  I have been trying to impress on everyone

(hospital administration, legislatures, etc. ) that as a state we can not

afford to stand by and let this happen. Not only would it allow Humana to

pass off to the State bills that they should be paying but it would also

lead to a very dangerous precedent that could have devastating consequences

..  Small businesses like the one my husband works for and families with

chronically ill children cannot fight Fortune 200 companies like Humana. There

is no doubt that the law is on our side but unfortunately it takes a lot

of money to prove that.

This could be any of you and I urge you to watch what decisions are made

about your policy closely.  If your premium prices are rising beyond the

rate of others in your state then the company has probably taken you out

of a risk pool in order to watch your policy closely and be able to pin

point exactly where the high costs are.  If you are self employed or part

of a small business be very careful to cross every t and dot every I on

your contract.  They hold a microscope up to the high claim policies and

will pull the policy for any technicality they find. They literally have

had lawyers pouring over this policy to find something amiss and finally

found something that they had never had a problem with before.  The law

is not on their side but they are pursuing the termination anyway. I am

not trying to make you scared but I am trying to raise your awareness of

how closely your policy is watched if your child or you have high claims.

 

I will close with the last  paragraph

of my formal complaint to the OIC.

 

"While I can appreciate that this is

not a policy that anyone in their business wants, the fact remains that

Humana is engaged in is a high risk business and as such there will be times

that they are responsible for chronically ill individuals who have a high

expenditure of health care dollars.  Engaging in unethical and questionably

illegal behavior is not acceptable, nor will it lead to global health care

savings and reform.  I urge you to consider that if Humana is permitted

to target our policy and terminate it for, at best, technical issues that

have been perfectly acceptable to Humana in years past, then it will be

that much easier for Humana and other health care insurers to subsequently

target other policies with high cost claims.  On many different levels,

our country and the State of Wisconsin can ill afford allowance of such

discrimination."

 

Anne

Please contact mito-owner with any problems or questions.

 

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