Joining the 50 million

Our health insurance was canceled last month. We have joined the ranks of the uninsured. Collateral damage in health care reform and the race to parse the regulations, drive trucks of cash through the loopholes and squeeze every dollar out of every soul still breathing.

Payments were current. We had not made a claim that exceeded our deductible in a couple of years. Nothing had changed. And we weren’t even told until three weeks after it had happened. There’s no appeal. No reason required. No COBRA. It is just gone. And it was done on purpose.

Our business had used  Business Advantage, a PEO (Professional Employer Organization), to act as our “virtual employer” to provide Blue Cross group health care insurance. Technically, we worked for an LLC owned by Business Advantage for this purpose. According to Wayne Surman, National Sales Manager of Business Advantage*, “We decided to close that company because rates had gone up.” Business Advantage voluntarily shut down Near Northside, LLC because they didn’t think they were making enough money, which immediately canceled our policy and whomever else was in the plan. While failing to apologize for not telling us that we were going to be totally screwed, he did say we were welcome to “apply” for new coverage – coverage, subject to acceptance, with a new LLC and at new rates.

Responsible: Left to Right: Stanley R. Joseph, Wayne Surman and Jason C. Joseph of Business Advantage.

Were we just chumps? Hard to know so far. It seems pretty straight up for a business to fold a company and ruin the lives of anonymous customers when, in the owners’ judgment, it makes good business sense. The people behind Business Advantage, Stan and Jason Joseph, are well connected, and as far as I can tell, well thought of. Perhaps, they didn’t realize they were making a life and death decision in the lives of others? Perhaps, they needed the money more than we need health insurance? Perhaps, it had gotten to be too much trouble. All understandable these days. And it makes me hope there is a hell.

The CBO expects this to happen to 3 million others while waiting for health care reform to be fully implemented in 2014. Robert Woods Johnson research puts that number much higher. People who are employed. People who want coverage. People who won’t have it. People, like me.

While we will apply, no company is expected to take us on an individual policy because of preexisting conditions. Blue Cross has offered us a take or leave it conversion policy – take it and our rates will go up by $2,586.26 a month, plus, of course, a required payment for the month we had just lost and will never be able to use, a higher deductible and the expectation that rates will rise even higher.

A certificate of insurance was included with our cancellation notice. A certificate of insurance offers some federally required exceptions to preexisting condition exclusions if a policyholder is not without insurance for 62 days and is able to get back in an employee sponsored plan. It does not, however, give you squat protection for individual coverage. The 62-day clock on insurability had already ticked down to 42 days when we found out we needed it. We will apply, but acceptance and affordability is a serious concern. As is trust that it won’t happen again in a few months. Or next year. Or the year after.

By now, you must be asking yourself, “what about the health care reform bill, I remember reading on LikeTheDew.com that within 90-days of its passage, uninsured individuals who have a preexisting condition will have access to a state or federal high risk insurance pool?

There will be no Georgia pool. Georgia goobernatorial candidate and Insurance Commissioner John Oxendine has written US Health and Human Services Secretary Kathleen Sebellus saying of the fully funded federal program, “I cannot commit the state of Georgia to … a scheme which I believe the Supreme Court will hold to be unconstitutional, leads to the further expansion of the federal government, undermines the financial security of our nation, and potentially commits the state of Georgia to future financial obligations.” (Source: AJC) Georgia joined 17 other states refusing to participate (including almost all Southern states).

The federal high risk pool will be funded beginning July 1st. Details of the process and eligibility are still being developed, but the law requires that individuals be uninsured for six months – perhaps, this will save us next fall. The cost benefit is extraordinary: it is capped at $11,900 a year including all out of pocket costs. Easily $25,000 less than a private plan.

We could take the chance and bet we’d be healthy for six months to wait for the federal program, but what if we were wrong? Or, we could bet that we could pay the huge price increase even if we had nothing left to use it — which is what they want: pay as much as you can possibly afford and be too broke to ever use it.

In complete candor, the medical history questions on the forms make me apoplectic – the fear of the costs rob my sleep –  the fear of an insurance need limited by a preexisting condition is cruel, but in America, hardly unusual.

________________

* Feel free to contact Wayne Surman, Business Advantage Program Employee Leasing, 11175 Cicero Drive, Suite 100, Alpharetta, GA 30022, Office: 678.242.5277,  Fax: 678.242.5241, Cell: 678.480.5200, email: [email protected] or [email protected] – Linkedin: http://www.linkedin.com/pub/wayne-surman/13/478/a14 or Stanley R. Joseph, President & CEO of Business Advantage, Inc. – Linkedin: http://www.linkedin.com/pub/stan-joseph/5/73b/954, Jason C. Joseph – Linkedin: http://www.linkedin.com/pub/jason-joseph/0/915/100, Co-Founder and Executive Vice President. The Josephs are also involved in  X1 Capital Partners, LLC, Hibernian Pacific Holdings, LLC and Fog City Blue Entertainment, LLC who do business at the same address as Business Advantage, Inc., but, of course, those businesses could close at any time without warning.

43 thoughts on “Joining the 50 million

  1. Jennie

    Stories like this are why I am structuring my financial life to buy into a European country’s health insurance plan before I reach US retirement age. I refuse to grow old in a system that has signaled in advance that it intends to beggar and abandon me.

    Reply
  2. Judy Huck Hinton

    This is awful. My sis has just been through a similar scenario, plus job loss, only her employer was a church! They don’t have to pay COBRA or unemployment compensation because of their exempt status. Where is the morality in this era?

    Reply
    1. Lee Leslie Post author

      I’m not qualified nor does our unlimited amount of space allow your question to be answered fully. However, I suspect there are some pretty complex levels of irony when questioning morality in capitalism and the state protection of church to protect the church’s right to act immorally. Thanks for reading. I wish your sis the best and hope she can find moral church or business that is hiring.

      Reply
  3. johnny

    Just wait, because now it gets even better:
    Since you’re uninsured, your normal providing doctor is not required to treat you. So if/when you get sick, you wait till it is at crisis point and the proceed to the local ER, who has no choice in treating you. How much more expensive this is than preventative medicine from your regular provider… and after it bankrupts you, our taxes have to pick up the (overpriced) difference. Go figure.

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  4. Bill Keller

    This needs a wider audience. You need to write an op-ed column for the AJC, and you also need to send a version of it to papers in Nashville, Columbia, Charlotte, Raleigh, and Birmingham. Sad.

    One of my cousins worked in Germany long enough to participate in that country’s public-private plan, and he still buys into it, even after living 20 or so years back here, first living in New Jersey, now in North Carolina. He’s in his 70s now and his wife has a chronic illness. The German insurance plan covers it.

    Perhaps if enough ardent states-righters here in the South fall victim to such, minds might change.

    Reply
    1. Lee Leslie Post author

      On the wider audience, please share it (button under the story for email and social sites). Danke! As for the silver lining for ardent states-righters, I don’t wish it on them, but it is pretty to think that a changing personal reality could change a mind.

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  5. Billy Howard

    This is the most depressing thing I’ve read since the oil spill. The lowest common denominator for these businesses is now death and we’re the pawns they use to make sure there’s enough money for dump truck size bonuses. Sarah Palin was right, there are death panels, but the panels are filled with insurance executives weighing their bottom lines against the health of their cash cow. Anyone who actually needs their product is forced out.

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  6. Alex Kearns

    Last night I was asked to write an article about a local woman who will die if she doesn’t receive a bone marrow transplant (her sister is a perfect match). She does not have the $250,000 required beyond what her insurer will pay to fund the operation and medical follow-up. I would suggest that she move to Canada but she may not survive the three month waiting period required by OHIP (Ontario Health Insurance Program) etc.

    And now I read this article.

    Never in my life have I thought of “health” and “money” in the same thought bubble. Even though I have insurance in this country, my deductible is high ($5,000) and thus far I am already in debt due to an episode of heat stroke and a dislocated finger (the 34 minutes in Emerg cost me $2,159.47). During my 47 years in Canada I received superb, timely and extensive health care (as do all citizens regardless of income, age or pre-exiting conditions) without ever counting the cost.

    The health insurance issue stands as the most confusing and appalling element of my new country. How any nation as “powerful” and “enlightened” as America could fail to address the health of its own citizens is beyond me for that is the foundation of the entire structure of society.

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  7. Richard Childers

    Lee,
    I have been through this with Humana Insurance. When I turned 65 they raised the monthly rate for my wife and me to $1,800 from $1,100 the year before. We were both healthy as horses with no serious problems, ever. We had only been with Humana for four or five years so there was no reason for them to treat us like valued customers. We were too old so they just kicked us to the curb. Now I am hearing about the $2,000 plus charges for a man and wife. That make $1,800 sound not so bad.

    I am sorry you are having to go through this. It is a hard lesson and there is still incredible ignorance in the general population about this issue. Unfortunately, the insurance companies still own Washington and I promise you they are not going to suffer from Universal Health Care.

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    1. Terri Evans

      George, we don’t want to make you sick so don’t be too empathetic! I’m hoping your insurance is good if it does make you sick. BTW, I agree with the “out loud” part. You can probably hear me howling from Atlanta.

      Reply
  8. Terri Evans

    Am I the only one who noticed the purposeful misspelling of “goobernatorial?” At least there’s something to laugh about in this piece.

    Reply
  9. Meg Livergood Gerrish

    How does one get one of these Tea Party-deals going, all this grass-roots gathering. In this case, I’d like for a day to be selected in which everyone cancels their insurance. Everyone. It’s the only thing I can think of that would really . . . shake and impress.

    Would it work?

    Reply
    1. Lee Leslie Post author

      Starting a tea party movement is a pretty straightforward formula:
      1. Name it for a symbolic but totally unrelated patriotic event that involved doing something that destroyed someone else’s property; make sure part of the name can be spelled for those who need help with spelling by using just one letter -- and that it includes a fun sounding word for those who really don’t give a shit (ie: party, dance, roast, camp-out, weekender, crusade, burning, hunt, etc.);
      2. Get some Wall Street traders and burned out politicians involved -- they know how to get corporate funding without naming names;
      3. Add a TV network partner that can handle the invitations, plan and cover the events with footage that makes it look as if you really have a crowd; get you face time each night and conduct polling to distort your popularity;
      4. Find a celebrity who naturally talks at the intelligence level of those you need to be your movement to travel around the country;
      5. Then, just suspend reason, add a pound or two of paranoia, mention Hitler and Communism in the same sentence with a straight face. Repeat. Repeat. Repeat. Repeat.

      So which single letter sounding word should you use: eye, bee, see, gee, jay, em, oh, pee, queue, are, you, ex, why, or zie?

      No, it wouldn’t work. While doing something obviously against their self-interest is a hallmark of the tea party, those with health insurance should do whatever it takes to keep it.
      Then there’s the problem of who could really do it. The rich could give up their coverage and still afford medical care -- so that would be only a gesture. The retired have medicare no matter what as do those below the poverty line. That only leaves the rest of us who are either too busy working, too busy looking for work or too infirmed to do much marching, sign carrying, spitting on politicians or insurance card burning.

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      1. Marie

        Welcome to the ranks of the uninsured. It sucks. I’ve been uninsured since about 1999, when I got divorced. That wasn’t so bad, as I knew that I could still qualify for Medicare, if I got really bad off, through the Social Security Title II disability program. I’ve been paying into that program for a lot of years. I suspect that you and yours are still covered under that program.

        But I am not any more. See, I retired. I got burned out. So my insured status under Social Security expired in September 2009. Now, I’m 60 years old, just about the time most people begin to have medical problems. So, I won’t be covered by Medicare for five more years. I can start drawing my Social Security in two years, but Medicare will have to wait till I’m 65.

        I’m okay with that. We all die. I’m okay health wise, except for high blood pressure. Generic HBP meds are working, and they cost $4 per month. I did have to have a stern talk with my doctor about his prescription, which cost over $200 per month. But he worked with me and now I am on a generic drug that works just fine, and I can live with the $4 per month cost. My doctor also gives me a break on my office visit. They are cheaper by about $25 as he doesn’t have to file anything. He just needs to deposit my check. I think I am lucky with my treating physician, as I think he realizes that I will pay him and he doesn’t have to hassel with insurance companies on my account. So he gives me a “discount.”

        But YOUR post. Well, I think this is a post that should not be a comment.

        It should be a post/article all on it’s own accord.

        Take care.

        Reply
  10. Mandy Richburg Rivers

    but we like our inshause… ’bout as good as we like them french fried potaters and biscuits with mustard.

    Reply
  11. MKerley

    The news isn’t news, just the name of the messenger.

    In 1999, while insured by Humana at a cost of about $400/mo. through our family business, my wife was diagnosed with breast cancer. Fortunately, it was caught very early. She had out-patient surgery, a single course of radiation therapy, and was told to have two mammograms a year instead of one. As happy an outcome as could have been expected under the circumstances.

    Of course, I knew our rate would go up, and it did:

    2000: +/- $800/mo.

    2001: +/- $1,400/mo.

    2002: +/- $2,000/mo.

    We hung tough. How much worse could it get? Besides, with a pre-existing condition my wife would lack coverage for cancer if we dropped our insurance. So instead we paid premiums of $24,000 that year, despite having no medical expenses beyond the mammograms and a couple of prescription drugs. Our reward was:

    2003: $4,000/mo., a nice, round figure for change.

    That was financially impossible for us, so we dropped out (living in Georgia we knew we had no recourse to any kind of consumer protection).

    In 2007, my now former wife was finally able to buy health insurance again, after living stressfully without it for four years. As for me, I just dropped the entire issue, having vowed never to give a dime to a health insurance company again. Last year I became eligible for Medicare. I just hope those jack-booted government thugs keep their hands off the insurance that the Tea Partiers are now providing for me.

    Reply
    1. Lee Leslie Post author

      Wow. Hell of story. The most we ever paid was about the $2,000 a month, but with $10,000 deductibles for each family member (1999 -- 2004), co-pays and non-covered services, it ended up costing us a house and our idealism. Fortunately for us, the company left Georgia and cancelled our policy. When no firm would take us, we turned to John Oxendine to get into the Georgia high risk pool. He told me the legislature never funded it, but he’d make a couple of calls and get us covered -- he did, but the the rate was going to be north of $5,000 a month with exclusions for our pre-existing conditions. Forced us to be creative and find something else. That is how we ended up with Business Advantage.

      Reply
  12. Pride Evans

    It is criminal is what it is. In my profession I have often HAD to work with these pillars of our society (the 3 clowns you referred to). They all justify the same way, “If I don’t someone else will,” and guess what most of you blood sucking leaches all do it now. You are disgusting human beings and it drives me nuts that you cause me to think this way about another human. There is absolutely NO answer until these people come around. Is there hope, what will it take? You know who you are so “come on” do the right thing. Maybe you 3 clowns are reading this, but I doubt it – cowards like you will stop after the reality of the truth about yourself. If you do get this far I would like to say f--k you.
    Here’s to your health you assholes.
    Thanks for the vint!

    Reply
  13. Bob Tetley

    You better get insurance soon because ObamaCare requires it — under penalty of prison. He’ll hit you with a tax penalty then throw you in jail if you don’t pay. Glad the IRS is around to replace those evil insurers. Problem solved!

    Reply
    1. Lee Leslie Post author

      Hey Bob -- I WANT insurance. I’ve had it for 40 years and I need it. My problem is that I may not be able to get it until 2014 when reform finally comes into force. Also, technically, you are wrong. Under the new law, people who have insurance receive a tax credit -- an incentive for coverage. People who do not have insurance will not, and, in effect, pay a tax, that is in theory to pay for their indigent care. And what’s with this halliburton email address? You work for them or is it bogus?

      Reply
  14. Andy Meyer

    So appalling. So horrifying. So disgusting. But sadly, not shocking. Our country has become a nation of “I got mine, screw you” mentalities. Where in the world do we go from here?

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  15. Bob Tetley

    Obama and the Democrat leaders denigrated and demogauged the insurance business in order pass their atrocious bill that will accomplish nothing. Why does it surprise you that owners of such businesses would choose to exit the industry? If leaders of the federal government want you to fail, wouldn’t you chalk that up to a significant business risk — maybe too great to remain in business?

    Remember, healthcare is expensive for the basic economic fundementals of the business. While there is a fair share of fat-catism, costs increase for entirely secular business reasons. I don’t know the answer but of course I know handing over the system to the government will only result in failure.

    Of course you want insurance. Your insurer’s business calculation mostly like was based entirely on the increasingly hostile attitude from “leaders” like Obama.

    Reply
    1. Lee Leslie Post author

      What a cynical argument -- canceling policies and/or raising insurance prices entirely based on their hostile attitude toward our elected leaders. It is un-American, undemocratic and sociopathic. It is, however, a compelling argument against corporate power and enforcing anti-trust laws.
      My provider didn’t exit the industry. The closed a subsidiary to negate their contracts in order to force acceptance of higher prices. They didn’t do it because of the new health care law, they did it out of pure predatory greed with the confidence they could get away with it.

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  16. Kate McNally

    Oh, Lee, this just pisses me off. I think it’s shameful that the US has so many people uninsured. And so many who can’t afford it--and at those prices, let’s face it, who can? Personally I think that it’s obscene to make a profit on healthcare. It’s life and death, not dollars and cents.

    I wish you could move to Belgium. People here don’t believe me when I try to describe the health care situation in the US.

    I’m so sorry.

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  17. Jim Fitzgerald

    Isn’t it interesting how the “socialist” countries are able to provide health care to every citizen at an affordable rate and we continue to place our health in the hands of for-profit companies. I’m so sorry to hear about your problem Lee.

    Like many of the stories here, I was forced into higher and higher premiums and deductibles by BCBS as I approached my 60’s. At the end, I was paying $500 a month for a $10,000 deductible. I’m afraid I did not have any chickens to barter in return for doctor services and, in any case, my doctor would not have known what to do with a chicken.

    And thanks for the laugh over how to form a movement. God that was good.

    Reply
  18. Cliff Green

    I swore off answering nameless, faceless cowards like Bob Tetley, but he just threw up a softball when he typed, “I don’t know the answer….” Truer words were never written.

    Reply
  19. Jimmy

    Yes, y’all have the answers. Let the government pay for everything. That’s really working well — here and in Europe. GOOD LUCK!

    Reply
    1. Meg Gerrish

      “Let the government pay for everything…” Since it’s money the government collected from us, then, yes, let’s spend spend spend on helping to keep the citizenry healthy — sort of a Good For All policy as opposed to a Who Can We Invade Today policy.

      Personally, I like the idea of Our Money being used to support health care instead of (there is a list a mile long that could be inserted here, help yourself). It must not have escaped your attention that all those whacky-headed developed nations like Canada and Denmark and Costa Rica, et al, don’t pay so much attention to reforming other governments or building war machines, but instead focus on the issues within their own borders. Not that they aren’t out there lending a hand when necessary, they just somehow manage to be stable, happy and dignified all at once. In your few words you let on to thinking somehow that’s a bad thing.

      I think we can find a way to continue being The Boss Of Everyone (since that’s gosh-darned important) and have our fellow citizens, family, friends and neighbors be allowed to keep the homes and businesses they’ve worked to own and not go bankrupt because of the whimsy of genes and fate.

      Thanks, Jimmy, for sharing your thoughtful insights. And GOOD LUCK to you, too. May your cells never grow too fast, may your bones stay strong and healthy, may calamity never find you and may every decision you make be precisely and exactly the right one throughout your forever.

      Reply
      1. Billy Howard

        My presumption is that “Jimmy” (not his real name, I am sure) and all his ilk would gladly go into bankruptcy and lose their homes, investments and security in order to pay their healthcare bills and insure that they don’t take advantage of the poor insurance companies and pharmaceutical giants who are ever so put-upon by all these pesky sick people.

        Reply
    2. Kate McNally

      It DOES work well in Europe. It’s not that complicated, it’s not that expensive. It’s just that nobody’s making fortunes off someone else’s illness.

      Reply
  20. Jimmy

    Where is this mythical government that will make no mistake, solve your health troubles while balancing its finances? Belgium, Costa Rica, Canada? Where? If it’s so darned great in all these places, why aren’t you all fleeing to them? And why do so many people continue to flee here if the United States is the horrible place you suggest?

    Reply
    1. Billy Howard

      I hadn’t noticed that Canadians, Belgians, or for that matter, Costa Ricans, were fleeing to the United States. Stay healthy and keep your health benefits Jimmy or you may have to experience what tens of millions of Americans already know about how the country feels about us: get sick, get lost, die.

      Reply
      1. Meg Gerrish

        Bravo, you, Billy. My immediate reaction leaned towards something mean-spirited, but mother always said, “If you can’t say anything nice…” Your considered response was both dignified and very much to the point. — Thanks

        To Jimmy, it was Denmark posited in my previous posting, not Belgium. Denmark. And I never suggested that the US is horrible.

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  21. clifton

    Lee, There are many ethical PEOs. Unfortunately, you were not enrolled in one of them. Here’s how a few operate. They set up an LLC, enroll a bunch of companies with young, healthy employees and get quoted great health insurance rates. Then, they go out and solicit additional business — which they get because their insurance rates are so low — but lots of these employees are older and not so healty. As a result, there comes a time when the carrier says “Whoa! we can’t insure your employees any longer,” and the LLC folds. A PEO is a great solution for small to medium size businesses, but you need to do your homework to see how long they’ve been around and what kind of reputation they have. I know whereof I speak, because until I retired my business used a PEO, and I have a relative who works for one. Good luck!

    Reply
    1. Lee Leslie Post author

      Thanks, that is good advice. I don’t know if Business Advantage’s shutting this down was ethics or just greed (and no longer fully understand how ethics and greed seem to coexist in our system). One of the many betrayals for me in this, was in the month Business Advantage was shutting it down -- I had contacted Business Advantage wishing to thank them for what they had done for us. I pitched a story about them to Maria Saporta. I friended them on Linkedin and offered to help them get their web site back up (for free) and help them wish social marketing. They didn’t say a word to warn me.

      We are trying to qualify as a small group and are hopeful. One of the many tricks in this process has to do with the so-called 62-day window of insurability. Cancellations occur on the last day of the month. New plans all start on the first day of the month. The 2 months, ends up being 1 months, plus 1 day.

      Reply
  22. Lee Leslie Post author

    Some closure:
    BlueCross (Wellpoint) has accepted us as a small group and last Thursday at midnight, we joined the insured class again. The cost has gone up a little over $1,800 per month and the fear of sustainability has us feeling as if we are riding in Cinderella’s coach and not know how close it is to midnight.

    For those of you in a similar situation, here’s a link to the new New Pre-Existing Condition Insurance Plan (PCIP -- aka: Federal High Risk Health Insurance Pool) which came into law in the health reform bill, went in to effect July 1st and the details have just been announced: http://www.healthcare.gov/law/about/provisions/pcip/index.html

    It will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs; all covered benefits are available to you, even to treat a pre-existing condition. Won’t charge you a higher premium just because of your medical condition; doesn’t base eligibility on income.
    It requires that you be a citizen or national of the United States or lawfully present in the United States; have been uninsured for at least the last six months; and have had a problem getting insurance due to a pre-existing condition.

    Reply

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