Tuesday, November 27, 2007

Buckle Up.

Have I bitched to y'all yet about group health insurance?...

Though my job is primarily finance-related, human resources and employee benefits fall under my responsibility as well. Our core full time staff number around 30, and are spread between three locations (Pennsylvania, Florida and Texas). Until a few years ago, Aetna provided decent HMO/PPO coverage in all three locations under one plan, and life was hunky-dory.

Then, about three years ago, Aetna decided that they were no longer going to provide no-deductible coverage in Florida. But at renewal time, did they write me a letter that said "Hey, dude, here are your new rates and we're no longer going to provide no-deductible coverage in Florida! Instead, we're going to substitute a horrible, minimal-coverage, high-deductible plan and charge you three times what you're paying now for it! Have a nice day!"?

No, that would be too simple, wouldn't it?

Instead, they took our renewal (at a 20% rate increase, I might add), and when one of our Florida employees tried to use the insurance for an MRI a few weeks later, they pointed at her and laughed until their bellies ached and then charged her $3,000 for the exam, which would have been covered in full just a few weeks earlier.

Who do you think got to calm that employee down, investigate what happened, try and fail to straighten out the mess, bang her head against her desk, write a $3,000 company check to the hospital for the employee's MRI, and quickly try to find a carrier that would cover all three geographies that we do business in very very very quickly so as to forestall any further such outrages?

When the dust cleared, I had found a new carrier who would provide decent coverage to all three areas -- United HealthCare -- and I quickly converted all of the employees over at a very reasonable rate. The network was a little flimsy and their enrollment department was seriously understaffed, but after about 8 short months we finally had all of the enrollment bugs worked out.

I kid. It took about 10 months.

But the coverage was good and their provider network was growing by leaps and bounds, and I breathed a sigh of relief and wiped the blood off my desk and got back to my real job.

Then renewal time came, and the renewal rates were 50% higher than the initial rates.


I started searching for new carriers that would cover all three of our corporate branches. Aetna was still snubbing Florida and the Blues wanted even more money than United HealthCare. I was almost resigned to eating the increase when my boss happened to read an article in some weekly business magazine about the fastest growing insurance companies, one of which was headquartered in western Pennsylvania. A little leg work, and we've got Health Assurance ready and willing to provide decent coverage at a reasonable rate to -- wait for it -- our PENNSYLVANIA EMPLOYEES ONLY. They do not have networks in Florida or Texas, but were more than happy to cover the 18 or so people with Pennsylvania addresses.

So we did it. We bifurcated the company down geographical lines, and with guilt in my heart, I made sure that the plan we selected with Health Assurance mirrored the United HealthCare coverage as closely as humanly possible. Enrollment with Health Assurance went more smoothly than it had any right to, and I breathed another sigh of relief and went back to my real job for another 10-11 months.

Now, you don't have to hit me over the head more than four or five times before I realize that this is an issue that is not going to go away. So this year, I got a little smart. I called our broker a good two months before renewal and and started hounding him to get our renewal rates early early early so that we'd have time to react and find new options if we needed to.

The hounding was only marginally productive, but I had the renewal rates about 45 days before the effective dates, which was better than last year. Health Assurance -- looooooooove. Less than a 10% increase. Got to love them. But! Still no networks in Florida or Texas. Oh well, can't win 'em all -- let's see what United HealthCare has to say.

Would you believe a 50%+ increase? Oh yes. Because god forbid an insurance company should ACTUALLY PROVIDE INSURANCE rather than make a disgusting amount of profit from the premiums!

After I finished with the smelling salts I called the broker and said "Find me a different solution." Yada yada -- the Blues are still even more expensive, yada yada -- what about Aetna? They have a new program in Texas; looks pretty good. Let's ask about Florida. Yeah, I know, we got burned in Florida before, but let's ask. Holy hell -- they say if the primary group location is in Texas, they will cover the employees in Florida! Fantastic! The rates are exceedingly reasonable, sign us up, get me the applications, all systems go. We were now down to about 2-3 weeks before Renewal Date and scrambling to get everything in quickly so that I could get a group number for my peeps to start using the coverage on November 1.

(I'm leaving out the part where we did something a little tricky so that Aetna would cover our Florida and Texas employees but not mind NOT covering the Pennsylvania employees. Shhh! If you really want to know, email me.)

(I'm also leaving out the part where we decided to pay the HUGE November premiums to United HealthCare when I realized that there was no earthly way I was going to have an Aetna group number for my peeps in any kind of reasonable timeframe.)

(I'm also leaving out the part where, around a week ago, we learned that the coverage to the Florida employees was NOT IN FACT THE SAME as the coverage for the Texas employees. The only coverage Aetna could provide the Florida employees was -- wait for it -- a PPO with a DEDUCTIBLE! Not a huge honkin' deductible, but a deductible nonetheless. After yelling and screaming at the broker for not catching this earlier, I luckily thought to ask whether the PREMIUMS were going to be the same for Florida and for Texas. Oops! Nope! Silly girl! The Florida premium was going to be MUCH MUCH more than the Texas premium -- in fact, it was going to be juuuuuuust about the same at the renewal premium quoted by United HealthCare! Lollipops for everyone!)

We scrambled and frantically filled out paperwork and submitted everything to the broker (who submitted it to Aetna) around mid-November. The story should end right here with sweetness and light and rainbows and fuzzy puppies and new insurance cards for everyone. Hooray!

Who thinks that that's how the story actually does end?...

Sorry, that was a nasty trick question BECAUSE THE STORY HASN'T ACTUALLY ENDED YET. Guess what happened yesterday. Go on, guess!

Those of you who guessed that Aetna called the broker and told him that the reasonable rate that was quoted for Texas was NOT ACTUALLY the rate they were going to offer after all are RIGHT and get a gold star. If you guessed that Aetna told the broker that, after reviewing the applications, they would be in fact charging us 50% more than they initially quoted, you get a BIG FAT SHINY GOLD STAR and a shot of tequila.

You get no gold stars or tequila if you guess that I used very loud, unladylike language on the phone with the broker yesterday morning, for that is about the only development that was perfectly reasonable and foreseeable in this whole sorry mess.

Yes, I should fire the broker, who has not been watching my back the way he should. Yes, Aetna pulled a (legal, unfortunately) bait and switch and I do not want to send them a goddamned penny of our hard-earned money. Yes, I should start all over, after I finish weeping and rending my tunic.

But I'm really and truly out of options, I have less than a week before December 1, and I have employees who need medications and doctor visits and x-rays and lab work.

If you need me, I'll be over in the corner banging my head against the bricks. Send chocolate, and next November, for the love of all that's holy and for the sake of what remains of my sanity, vote and vote wisely.


Jozet at Halushki said...

I hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate, hate,hate,hate, hate, hate, hate, hate,hate, hate, hate, hate, hate health insurance companies.

I have to buy my own coverage ad the rates go up every 6 months. When I was pregnant, I had just lost my group coverage, and no private insurer would cover me because pregnancy is a pre-existing condition in PA that private insurance does not have to cover.

Do you want to know how much COBRA cost?

Yeah, that much. Then double it.

Really...boil them all in their own pudding says I.

we_be_toys said...

Girl, what a nightmare! I know what you mean about coverage and how it skyrockets every year. And we're lucky - we have our coverage through a pharmeceutical company - they seem to have better coverage and rates than most companies (probably because they're buddies with the insurance companies), and even in the sweet spot, where we are, we're seeing the rates and deductibles going up this year...again.

Gahhhh! Now I want to beat my head!

Sending you warm thoughts of Scharffenberger Semisweet - grated into hot milk, melted over raspberries, or just eaten as is.

Anonymous said...

Our HR group starts negotiating with the Insurance companies in August to negotiate the new rates. Every year, the rates go up as do the deductibles. We seem to get a new dental provider every year.

I'm not sure that any of the candidates out there can solve this. Edwards is the only one that actually seems to have a vaible plan, but I don't think he has a chance at winning. :-(


zmulls said...


I'm with you on Edwards. I don't believe anything about the pre-Iowa polls, frankly.

There's going to be a lot of foofawraw in the next two months before Iowa and NH. Interesting that people keep "winning" and "losing" and not one person has actually voted yet.

He's still got a shot, and yes, he's the best one to start sorting out this mess.....