I thought I had written about this before, but I can't find it, so maybe we just talked about it over email.

We purchased health insurance through Highmark Blue Cross Blue Shield when I first started working for myself. It was the same plan as we had when workingfor Dynavox, though since there wasn't a co-pay any more, it was actual cheaper for regular visits, because some things are covered at 100% and some at 90%, and the 10% is cheaper than the $20 co-pay, which I hadn't realized would happen.

We purposely got a high deductible plan, at $3500 for each person with a maximum of $7000 for the whole family.  However, when Faith was born, we received a bill for $4500 or so, which seemed pretty strange.  We then found out that when they say there is a $3500 deductible on this family plan, they don't mean it, they mean there is a $7000 deductible per family and no deductible per individual.  The documentation is very confusing, and I ended up talking to the Pennsylvania Insurance Commission.  He originally thought I was being annoying, and after about an hour of talking, he finally realized what I was saying - he couldn't believe that we could have gotten a $4500 since we had a $3500 deductible.  Aha...  Now we're getting somewhere, or so I thought.  We just got the official word back from the Insurance Commission - they agree that the information is misleading, and are looking into changing it, but won't make Highmark stick by their agreements for all the people who are already signed up.

So, now we are looking into insurance plans.  Ick.  There are so many choices, and you never know what fine-print the seller is going to leave out, and so have to get a degree in insurance to figure out what they are actually selling.

It turns out that the problem was that when you add a Health Savings Account (HSA) that removes your individual deductible and apparently we are all just supposed to know that (though I find it humorous that the Insurance Commission wasn't even aware of that fact).  I am not sure why Highmark is allowed to lie to their customers and not face any consequences when they are discovered.

I am told my only recourse is to talk to my State Representative to complain about the Insurance Commissions findings.  I guess it is worth writing a letter, but hardly seems like anything will come of it.

As far as the future goes, I have been thinking that since we live in a state (and in a couple days, a country) that believes we should tax everyone to pay for the few, I might as well take advantage of the dollars that the system will give us.  The kids are probably eligible for free health care through the state programs.

Posted by Jon Daley on January 18, 2009, 9:35 am | Read 25256 times
Category Reviews: [first] [previous] [next] [newest]

I got dizzy with the deductibles of the health plan. But have Highmark done anything to resolve the problem? I mean, they should have explained everything from the beginning and the papers should have not lied.

Posted by blueshield on January 18, 2009, 8:40 pm

No, they have not done anything, and they insist that it is perfectly clear. They don't seem to understand the problem, where their application doesn't even have a $7000 deductible check box at all, and if it were there, I wouldn't have checked it. The online application at the main Blue Cross Blue Shield site shows very clearly a $3,500 deductible plan, and it isn't until you sign that document, and start using the plan when they tell you (in fine print in a 100 page manual) that the $3,500 deductible doesn't apply, though of course they don't really say it in plain terms like that.

As I said, the PA Insurance Commission agreed that their marketing, application and online documents are misleading consumers, and they are looking into forcing Highmark to change them, so in the future, they will be forced to tell the customers prior to applying what deductible they are signing up for.

The only bad thing is for all the customers who already signed up and were tricked into getting a deductible twice as high as the application said they would get.

Also, I think I might have forgotten to mention: when our health care provider looks up our plan on Highmark's website, it tells them we have a $3,500 deductible. Highmark's answer to that is that the vendors shouldn't trust the information Highmark has in the vendor website that Highmark created (I forget the name for it - an acronym of some sort). I think vendors would be quite surprised to hear Highmark say that the information is not reliable, since the vendors use that site to figure out if their patient is insured or not, and what their deductible, and 80/20, 90/10%, etc. plan is.

I think everyone except Highmark thinks this is a clear case of fraud. Maybe it'll end up being a class action lawsuit, and I'll get $0.20 of my money back or something.

Posted by jondaley on January 18, 2009, 10:19 pm

I did end up emailing Daryl Metcalf, our representative, and his office got back to me today, and asked some additional questions in order to research it further. Sounds pretty promising.

Posted by jondaley on January 20, 2009, 3:14 pm

Being a self employed graphic designer I know all too well what it's like to try and deal with an insurance company head on. I myself had issues with getting clear answers from agents and from companies doing the vague fine print shenanigans. Being in transition in life right now I'm back on the hunt again for insurance, but have been digging up great resources online for the self employed to help so that I don't get into the same situation that you're going through. Great post though, and I hope that your Representative is able to do something in the way of putting pressure on the commission and Highmark to be more honest with its customers.

Posted by C. Flores on January 28, 2009, 6:28 pm

Heather had gotten her new individual policy card a while ago, but they never sent a bill, so I was suspicious about whether it was actually going to work (seems like someone would figure out that their rates are completely strange, and would "fix" them before we got to sign up...)

But, I talked to someone today, and they always bill on the 10th of each month, so the bill should be coming any day now.

Can anyone explain the math?

Our old policy was a $7000 family deductible (deductible is the same whether the kids are on the policy or not - the kids added $100/month for premium), max out of pocket $10000 (including the deductible). The premium for that was $183/month.

The new policy has individual deductibles of $1200 and max of out pocket $2200 for each person and the combined premium is ~$200/month.

Perhaps doesn't sound too crazy until you consider the difference between individual deductibles and family deductibles, that the "normal" case where one person has a large bill in a year, and the other has basically none, would result in us paying a maximum of $10000 with the old plan, and a maximum of $2200 with the new plan.

Posted by jondaley on June 12, 2009, 4:27 pm

Some friends mentioned on facebook that they've been getting letters from their employers about their health care costs going up due to the provisions of the health care bill that recently went into affect (namely, dollar limits being removed for annual and lifetime benefits for prescriptions and "essential" benefits).

Since I haven't heard anything, I went to my insurance's website - they list the new provisions, but no mention of increased costs, though I would assume the prices have to rise to cover the additional costs.

But, I did note that they've finally changed the way the deductibles are listed, so now they are more clear about the higher family limit, though I guess it still isn't perfect, now that I re-read this post, and how I interpreted the deductibles originally, and not how I interpret now that I understand what they really mean.

Posted by Jon Daley on October 27, 2010, 10:39 am

I'm in the same boat in North Carolina, but still waiting for the NC DOI to make a determination.


Apparently Arizona has sided with the customer on the issue.

http://www.consumeraffairs.com/insurance/health_net.html (search for squeaky)

Posted by Dale on August 29, 2014, 7:08 pm
Add Comment
Add comment
E-mail me when comments occur on this article