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If you’re insurable you’re in for a rude awakening in 2014

I just have to comment on “Arizona: Know your health insurance options and rights” by Diane E Brown (Arizona Capitol Times, Dec. 13, 2013).

“As the clock strikes midnight, many Arizonans will be able to celebrate having health insurance for the first time,” which is a good thing because those who are medically uninsurable will be able to get health insurance.

In view of the fact that, as an independent agent, I am already aware of the available premiums, depending on your income and whether you are eligible for a subsidy, the rates in 2014 will be up to 100 percent more than what they are now.

But, if you were never able to obtain health insurance this could be affordable. But, affordability is a relative term.

Then, I found it interesting that under “Options” there was no mention of contacting an insurance agent or broker “option.” I find it odd that when someone wants auto or homeowners insurance they call an agent. When someone has an auto or homeowner claim the first person they call is their agent. But when it comes to health insurance, Ms. Brown would prefer you to go on the Internet or call an 800 number. That’s personal!

And then there was “what are my rights.” It’s not true that, “You can receive emergency care when and where you need it without huge out-of-network costs,” as the majority of plans in 2014 actually state that the emergency room in-network benefit can be 20 percent to 30 percent coinsurance after your deductible has been met. Currently, the majority of health plans have an out-of-pocket cap of $200-$300 for an emergency room visit.

The statement “In addition, you cannot be dropped when an unexpected condition or accident makes your care expensive” has never been true. The only two reasons that you can have your policy canceled: You stop paying your premiums or you lied on your application. In 2014, you still will be canceled if you don’t pay your premiums.

It is also true that “you have the right to free preventive care” unless the health care provider finds something wrong with you. Then it becomes a diagnostic procedure and becomes part of your office co-pay or deductible.

And, statistically, regular preventive care does not “keep you healthy” and does nothing to keep “your health care costs down.”

In terms of choosing your primary care doctor, pediatrician or OB/GYN, many will not have to worry about a referral as the doctor networks are, in some cases,

40 percent to 50 percent smaller than they are now. In fact, I would recommend that everyone who is considering a new policy in 2014 call their primary care doctor to find out if they are part of the network for the plan they are considering.

“You also have the right to an appeal if coverage for needed care is denied by your insurer” has always been in place. This is nothing new and has been an integral part of the insurance industry.

Individuals and businesses are already feeling the impact(s) of the so-called Affordable Care Act. If you’re medically uninsurable it’s a good thing, but if you’re insurable you’re in for a rude awakening.

Henry GrosJean lives in Glendale

3 comments

  1. Talk about cost of healthcare. I recently visited the Banner Estrella Emergency Room for severe back pain. I was there four hours, received anti-biotics for an infection and shocked when I received the bill for $11K, to be billed to my insurance carrier. I think that I was seriously overcharged and should have known what the charges were going to be upfront. My insurance carrier covered it, but hospitals are overcharging patients for simple procedures. The pain was relieved, but $11,000 is too much. We should move towards transparency of charges from doctors, hospitals, medical specialists, imaging, labs etc. We can as consumers determine whether we wish to do business with the hospital, doctor, etc. or not. Medical costs should be transparent in the marketplace and let the consumers decide.

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