I had a little difficulty finding a good image for this sort of "grandfathering"

As I have explained beginning here, in the process of trying to move from Kentucky to Maryland, I was horrified when I received information in the mail from CareFirst  (the Blue Cross company that operates in Maryland) telling me that the health insurance policy they would give me with Blue Cross Blue Shield’s guaranteed transfer program had a maximum lifetime benefit of $250,000.  I contacted CareFirst by phone and was told that the information was accurate and allowable because it was what is called a grandfathered policy (see below for the definition of this kind of policy) and not subject to the new health care rules.  That however is not true in the case of lifetime limits. Here is the official government explanation (emphasis mine):

• Under the new law, lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed on or after September 23, 2010.
• The new law restricts and phases out the annual dollar limits that all job-related plans, and those individual health insurance plansissued after March 23, 2010, can put on most covered health benefits. Specifically, the law says that none of these plans can set an annual dollar limit lower than:
  • $750,000—for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011.
  • $1.25 million—for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012.
  • $2 million—for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014.
• No annual dollar limits are allowed on most covered benefits beginning on January 1, 2014.

Some Important Details

• Be aware that plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not “essential.”
• If the new rules apply to your plan, they will affect you as soon as you begin a new plan year or policy year on or after September 23, 2010. (For example, if your policy has a calendar plan year, the new rules would apply to your coverage beginning January 1, 2011).
• If you have a “grandfathered” individual health insurance policy, your health plan is not required to follow the new rules on annual limits. (A grandfathered individual health insurance policy is a plan that you bought for yourself or your family; that you did not receive through your employer; and that was issued on or before March 23, 2010). If you’re not sure whether your plan is grandfathered, ask your insurance company.
• The ban on lifetime dollar limits for most covered benefits applies to every health plan—whether you buy coverage for yourself or your family, or you receive coverage through your employer.
• Some plans may be eligible for a waiver from the rules concerning annual dollar limits, if complying with the limit would mean a significant decrease in your benefits coverage or a significant increase in your premiums.

If that wording is not clear enough, this wording from a 2010 Health and Human Services fact sheet certainly is:

All health plans – whether or not they are grandfathered plans – must provide certain benefits to their customers for plan years starting on or after September 23, 2010 including:

No lifetime limits on coverage for all plans;

So grandfathered or not, given that CareFirst is issuing me this plan in 2011, a plan with a $250,000 lifetime limit was not legal.  I sent a query to the Maryland Insurance Administration regarding this and lo and behold, CareFirst sent me an Amendment to the policy that gets rid of the limit.  They couldn’t find any record of anyone at CareFirst telling me that there was a $250,000 limit.  Really?  Maybe they don’t actually record all those conversations for training purposes.  And who do they think sent me the policy information sans amendment in the first place that triggered complaints being filed in two states and with numerous elected officials not to mention the launch of this blog?

There is however another huge flaw in the policy they are offering me–according to the plan description, there is no cap on out of pocket expenses which obviously could add up to a huge chunk of change with a serious health event.  As far as I can tell, it is the only policy they offer that does not have a cap (but I’m not eligible for those plans because I have so-called pre-existing conditions).  In this case, the clause may be legal under the “grandfather” definition, but it sure isn’t right and a reprehensible change  to make to someone’s coverage simply because they moved, which I have pointed out to the Maryland Insurance Administration, which gives itself 90 days to respond to complaints, so sit back and relax, we’re going to be here awhile.  If in fact they are allowed to do that, it would be tantamount to a blatant effort to get me to transfer to the Maryland high risk plan (MHIP) when I become eligible (you have to live in Maryland for 6 months which I am still a few months shy of).  It would be a cushy deal for CareFirst which administers MHIP–so they get their fees for administering my health insurance, but none of the risk.

Meanwhile back in Kentucky…

After I initiated the policy transfer between the two Blue Cross’ and found out that the new policy was not what I had been led to believe would be available, I contacted my agent in Louisville who had sent me the misleading information about insurance in the DC metro area to begin with (documented in my first post)  and told her it had put me in quite a bind. She told me that one option, if I maintained dual residency in Kentucky is a plan that they offer that is a national plan designed for people who might be working somewhere else temporarily or be retired with homes in two states or similar situations. It is called Blue Card and looks like what every insurance policy should look like (all 100 plus pages of it)—namely, insurance, regardless of where you live.

At her suggestion, I sent Anthem a letter asking to stop the transfer which they granted.  However they forgot to tell me they had stopped the transfer and apparently also forgot to tell their own Grievances and Appeals department which, in responding to the complaint I had filed with the Kentucky Department of Insurance, said that while they “empathized” with me, as far as they were concerned, I had moved and was no longer a customer.  I only found out from the letter that my insurance agent sent to the Kentucky Department of Insurance explaining that it had been stopped.  Since the Grievance and Appeals letter was dated after the letter from my agent, I assumed that was the last word and that maintaining dual residency and keep the better insurance available from Anthem in Kentucky was not an option.  But I assumed wrong.  When I called Anthem to make sure they would not deduct my premium from my checking account for the upcoming month, when the transfer was supposed to happen, it seems that I am still a customer and the transfer was stopped.  And presumably no one has told CareFirst which has already billed me for my new insurance!  Confused?  I sure am.

The thing that that I keep coming back to is that none of this should ever have happened.  Moving your insurance should be no more complicated than the change of address form you fill out to forward your mail and.  Instead, it has proven to be an epic farce of Frank Zappa proportions.

Just in case this wasn’t consuming enough of my time or stressing me out to the max as it was however, CareFirst decided to up the ante and issue me insurance cards for two different plans and send me bills for the same.  On top of that I got a very strange call from them last week asking if I’d moved to a different county in Maryland which I assured them I hadn’t.  The upshot is that while there aren’t all that many Lucinda Marshalls in the world, one of the other ones also lives in Maryland and apparently didn’t pay some insurance premiums somewhere along the line.  Somehow I have a feeling that is going to come back to bite more than once.

Evening update:  After I wrote this post I wandered out to get the mail which included a large envelope from CareFirst with a huge booklet describing the benefits of a plan that is much, much better than the paltry one they have offered me.  So I called CareFirst again to ask what gives and after umpteen requests to their robo-secretary, I finally got put through to someone who didn’t think it was the right booklet.  I told her I didn’t either but that it was pretty mean to send me info on a plan they are saying I can’t have so could I please speak to the dude who signed the letter that came with the booklet.  Well no I couldn’t because they don’t have phones in that department.  Right and I have some swampland for sale so taking another stab at it, I asked for a supervisor.  After enough hold time to get the dinner dishes done, I spoke to another very nice person who said she couldn’t put me through to that department either but that she could make an inquiry and that she would call me in the morning to tell me what she learned.  She even gave our conversation its very own case number.  Stay tuned.

And this morning:  The supervisor called back to say that they had sent me the wrong booklet and they would send me the right one for my paltry plan soon.  Really CareFirst?  Rubbing salt in the wound that you won’t provide health coverage for?  I don’t know the other Lucinda or where she’s gone to, but I sure covet her insurance.

Afternoon mail call:  Yet another duplicate bill from CareFirst.  Ezra Klein wrote a piece for The Washington Post in 2009 that pegged health insurance administrative costs in the private market at 30%.  If my mail is any indication, I can see how that eye-popping number is easily obtained.

And in the say what department:

While sorting through the ridiculous pile of paper that has accumulated since this began, I came across this envelope.  Given the who knows how many times I’ve been reminded that each Blue Cross is separate, it seems a wee tad ironic that the Maryland Blue Cross is processing their paperwork in Kentucky.  Are they taking advantage of cheaper labor or is there some sort of Blue Cross processing center there used by multiple Blue Cross’?  Curious to say the least.

I had a doctor’s appointment today and there was an elderly gentleman in the waiting room and the receptionist had given him a number of forms to fill out. He protested saying he was a long term patient and had already filled out forms. But no, these were new forms, so he would have to fill out all his information again. He struggled with it for a few minutes and went back and told her he just couldn’t fill it in. Later when I went to fill a prescription, I was in line behind an older woman with a cane who was struggling to understand why her regular prescription had just gone up in price and how she was going to pay for her medicine and her groceries. My heart went out to both of them. As I said on the show, none of this should be necessary, when we need medical care, we should just be able to get it without jumping hoops or going broke.

My interview begins at the 50 minute mark and runs about 18 minutes, but I highly recommend listening to the whole show, lots of good information.

Other guests on the show include health insurance industry whistleblower Wendell Potter, Vanessa Beck of Healthcare Now and Mad As Hell Doctors.

The show will air at 7pm EDT. I’ll be interviewed beginning at 7:45.

A big thank you to Ashley Peddicord at Sen. Ben Cardin’s office for her lengthy and informed reply to my letter and her offer to contact both the Maryland Insurance Administration and CareFirst for me.  We’ll see what comes of that, but it is great that Sen. Cardin’s office is willing to step up to the plate.

Sen. Barbara Mikulski’s office also forwarded my letter to the Maryland Insurance Administration but said they couldn’t do any more because this is a state, not a national matter.  Gee Senator, I beg to disagree, healthcare should be a national issue like it is in every other so-called developed country and if Congress hadn’t so totally wimped out on healthcare reform,  I wouldn’t be in this position.

I’ve also gotten letters from the Maryland Insurance Commission and the Department of Insurance in Kentucky saying that they are investigating.  I will follow up with both next week, assuming Hurricane Irene doesn’t knock us off the grid.

I have yet to hear from Congressman John Yarmuth’s office or Congressman Chris Van Hollen or from Blue Cross Blue Shield.

Early next week I’ll have more on the national insurance plan offered in Kentucky that I wish I’d known about before this sorry adventure began.

As I reported earlier, the Maryland conversion policy was almost no insurance at all so one of the options I wanted to explore was what kind of policy CareFirst (the Blue Cross company that serves the Washington, DC metro area, including the Virginia and Maryland suburbs) would offer me if I lived in the District instead of in Maryland. I asked CareFirst to send me the information and when it arrived it was a stunner.  We are talking about maybe a 15 mile difference in location and the same company.  But the policies were radically different, which CareFirst attributes to insurance laws which vary by location.

If you live in Maryland, there is a $250 deductible and  for most things, you pay 25%, the plan pays 75% up to a very unrealistic lifetime maximum of $250,000 (most plans have a $1,000,000 maximum or no limit).  There is no cap on out-of-pocket expenses.  Premium for a 55 year old woman? $443.22, less than my Kentucky policy but for a lot less coverage and substantial risk.

But hop on the Metro and move into the District and wowswers–the guaranteed conversion plan there has a $750 deductible, pays 80% instead of 75% and there is a $3500 cap on out of pocket expenses for an individual.  There was nothing that I saw about a lifetime maximum.  Sounds good so far, but there is a catch and it is a big one–the premium.  Are you sitting down? $1448.  Per month.  Aside from CEO’s of health insurance companies, not too many people can afford that.

For comparison’s sake, it is worth comparing these plans to the Federal Pre-existing Condition Pool, which incomprehensibly also varies from state to state.  In Maryland, the premium is as high as $354/month with a $1500 deductible and an out of pocket limit of $1500.

In the District of Columbia, the Federal Pre-existing Condition Pool is a bit more complicated with premiums as high as $436 and,

In addition to your monthly premium, you will pay other costs. In 2011, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

The kicker with the federal plans however is that in order to qualify,

• You must be a citizen or national of the United States or lawfully present in the United States.
• You must have been uninsured for at least the last six months before you apply.
• You must have a pre-existing condition or have been denied coverage because of your health condition.

The first and third points seem reasonable, but requiring that you be without insurance for six months is absurd and causes unnecessary financial hardship and risk to public health.  When you have met the other two conditions, you should be immediately eligible.  There is no other country on earth that would require you to go without health insurance before you could qualify for it and that we, the richest country in the world should do so is beyond belief.

Fortunately for me, there is also a Maryland State pool where six months of state residency is required, but there is no requirement that you be uninsured before qualifying.

I am still trying to determine the best option for myself and will write more about that later. But as I was sorting through the possible scenarios, I wanted to point to the total absurdity that insurance plans should vary so drastically in one metropolitan area.  It is well past time for a federal single payer plan that makes health care expenses equitable, regardless of where you live or work or how healthy you are.

And finally, while Blue Cross guarantees you coverage if you move, that does not mean it will be adequate or affordable or even remotely like the coverage you had before you moved.  The result is that for people like me with pre-existing conditions, Blue Cross is effectively making it so you may have to go without coverage for 6 months because you can’t afford $1448 premiums (or if you live in a state like Maryland, have very minimal and inadequate insurance until you have lived here for six months)and then force you into one of the high risk pools.  Just because you moved.  But somehow I don’t think insurance CEO’s or the elected officials they’ve financed are losing sleep about this.

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Addenda:  Health insurance for all of us is under siege, whether you have an individual policy, obtain coverage through your company or have Medicare or are uninsured, etc.  Here is an important piece about what is happening to workers at Kaiser Permanente, which ironically is a health insurance provider.  The author compares what is happening there with what is happening at Verizon. She makes the point that we need to stand together, a point that should be true regardless of how you get coverage.  A lot less attention has been paid to those of us in the individual market than those who get coverage via employment or Medicare.  We need solidarity regardless of how we obtain health care coverage.

(Cross-posted from my personal blog, Reclaiming Medusa)

The following is the letter I am sending to the appropriate elected officials in Kentucky and Maryland as well as both states’ insurance regulatory agencies and Blue Cross Blue Shield as well as health insurance reform advocates.  It documents the infuriating, scary, time-consuming and unconscionable experience I have had trying to move from one state to another without losing adequate health insurance.  When I receive responses, I will post them as well.

Dear _________,

I recently moved from Louisville, Kentucky to the Washington, DC area to better facilitate my work as a political activist and writer.  For a long time, I was afraid to make this move because of the risk of losing my health insurance, an individual policy through Anthem Blue Cross Blue Shield. Due to several health problems, I was afraid I would not be able to obtain insurance elsewhere.  Yes, there are now high risk pools but the Federal pools require that you be uninsured for six months before you qualify and obviously that would be a substantial risk if you have a major illness or accident during that period.

Then I found out that Blue Cross has an arrangement called an intra-association transfer group conversion which means that the Blue Cross company wherever you live has to offer you an insurance plan that does not require going through underwriting although it may have less benefits and cost more.  Armed with that information, I wanted to find out what coverage might be available to me depending on if I lived in the District or in a suburb in Maryland or Virginia.  Even though I’m a writer with more than passable research skills, I could not get anyone at CareFirst, the Blue Cross company for the DC metro area to give me that information.  The Sales Department wouldn’t talk to me because they only handle policies that go through underwriting and Customer Service said they couldn’t give it to me until I actually transferred my policy.

After multiple conversations and a lot of hold time, I finally called my agent in Louisville, who had always been quite good about answering my questions.  She sent me information about an HMO plan that CareFirst offered in DC that had open enrollment, no underwriting and better benefits and lower cost than the policy I had in Kentucky. I was ecstatic and relieved that I could move without jeopardizing my healthcare or financial well-being. At no point did she tell me that this was only available in DC and not in the surrounding suburbs in Maryland and Virginia or that the plan was not always open to new members.

After finding a house to rent in Rockville, MD, I was finally able to move.  When I transferred my insurance however, I got a major shock.  The policy my Anthem agent had told me about was only available in the District.  In Maryland, the policy offered me cost much more for a lot less coverage.  The terrifying part of the policy is that it has a $250,000 maximum benefit.  If you have a major disease or accident, that would be grossly inadequate. 

While this policy is completely different than my old policy and written by a different company, apparently it does not have to comply with the new healthcare rules on lifetime limits.  Getting a more comprehensive policy from CareFirst  will require underwriting and when I discussed this with a customer service representative at CareFirst, I was told that because of my health, I would be denied.  What I find incredible is that I’ve been repeatedly told that because each Blue Cross is a different company, they don’t have to offer the same coverage as my old Blue Cross company did but they still can get away with offering me a ridiculously low minimum because the policy is considered to be grandfathered, not a new policy.  It is outrageous that they can get away with this.

As I understand it, once I have lived in Maryland for six months, I will qualify for the Maryland state high risk pool as long as I apply for an underwritten policy and am denied or if the policy I’m offered is more expensive than what Maryland offers in the pool which would certainly be the case with the policy that CareFirst has given me. If however I were to have a catastrophic health event before that, once the CareFirst policy was used up, my medical care could bankrupt me.

What I find the most disturbing is that the misleading information that I was given by my Anthem agent has, at least in the short run, substantially raised my health care costs.  Had I known that while CareFirst administers Blue Cross plans in the entire DC area, the plans vary substantially, I would have made sure to take that into account before choosing exactly where to live.

It is appalling that, for people who buy their own insurance on the individual market at great expense (and this impacts women the most since they are less likely to work for companies that offer health insurance), insurance companies can decide whether you can move without jeopardizing your healthcare and financial well-being.  Given my health history, it would not surprise me at all if Anthem deliberately misled me about what would be available to me to get me off their policy.

After finding out that the group conversion policy offered by CareFirst in Maryland was seriously deficient, I spent a great deal of time on the phone trying to find out what my best course of action was.  Even though they would be involve huge cost, the options as I understand it include:

1. Break the lease on the house I am renting and move into the District.  The fly in that ointment is that sometimes the Open Enrollment HMO that CareFirst offers there closes to new enrollment.  CareFirst is sending me information about the group conversion plan they offer in DC so I can compare that to the Maryland policy (information I was not able to get before I moved).  If it is better, I may consider doing this, although the expense would be huge.
2. Apply for an underwritten policy and if rejected, which I’ve been told will likely happen, apply to the pool after I’ve lived here six months. It is however abhorrent that the simple act of moving effectively forces people into the high risk pool.  There is a lot of talk about the individual mandate that would require people to buy insurance.  Given the way insurance companies are treating people now should make it quite obvious that this is not going to be a good idea.
3.  Maintain a residence in Kentucky with a second home in Maryland.  Had I know that I would not be given adequate insurance here, this would have been the best option even though it wasn’t really what I wanted to do and would be expensive.  Revisiting that route however would be a substantial hassle and expense at this point and given the double digit increases and continual decrease in coverage that I’ve gotten from Anthem over the years, there is no guarantee that this would be a good idea.
4. Marry someone with great family health insurance benefits.
5. Find a job with health care benefits even though I’ve been self-employed for almost 30 years.
6. Move to another country.

I have not yet determined the best course of action; fully understanding the options takes a lot of time.  In a bizarre side note, when I called the Maryland high risk pool helpline, the woman I spoke to said that she saw that I had just spoken to someone else in her office a little while ago.  When I said that no, I had spoken to someone at CareFirst, she told me the office they worked for answered questions for both.  After asking her a few questions about the Maryland program I asked her something about the CareFirst policy.  She told me she couldn’t answer that while on the Maryland phone but if I called her at her CareFirst extension, then she could answer the question.  Given that CareFirst has de facto made it quite clear that they have no plans to sell me an adequate insurance policy, it would seem to me that there is a major conflict of interest here.

On a personal basis, I am angry and scared.  Because I work for myself and foot my own insurance bill, and because I have health problems should not be an excuse for being totally screwed because I want to move.  This would not happen if we had a single payer health plan.  It is immoral and unconscionable. When Congress was having their epic debate about health care reform, I wrote several times about the lack of attention to the problems faced by those on the individual market.  Despite all of my efforts, I am now mired in the impact of the neglect to address this issue.

I would appreciate any help you can give me in obtaining adequate, affordable insurance.

Sincerely,

Lucinda Marshall

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Former health care executive and Gov. Rick Scott (FL)

“The advocacy group Physicians for a National Health Program estimates that “private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”” http://www.stltoday.com/news/opinion/editorial/article_97afa329-42f8-5f12-adb0-97fa305c3e4b.html

(Former health care executive) “Gov. Rick Scott, a critic of the federal health care overhaul, is paying less than $400 a year for health insurance for himself and his wife.”
http://www.dailykos.com/story/2011/08/11/1005803/-Rick-Scott-Getting-Govt-Provided-Health-Insurance-For-Less-Than-$400-Per-Year

(Cross-posted from my personal blog, Reclaiming Medusa.)