Guest opinion: What makes $2,040 a month affordable insurance? |

Guest opinion: What makes $2,040 a month affordable insurance?

Lynn Kirchner

I read Vince Plymell’s guest opinion in the Post Independent on Dec. 8 and thought at first it was written tongue in cheek. Then I realized he believed what he wrote and was serious. Really?!

Anthem Blue Cross sent our renewal notice back in November cheerfully telling us our coverage went to $2,040/month.

How can you even say $2,040 per month is affordable? Affordable to whom? This is not some luxury coverage, it is basic, huge co-pays with a $12,000 deductible. That monthly premium is more than most mortgage payments; add in the deductible and it’s well over $3,000 per month. So prior to having anything major covered, we are out of pocket a minimum of $36,000.

When I spoke with Anthem Blue Cross about this, I was told the Insurance Commission approves their rate hikes.

(Editor’s note: Plymell is communications director for the Colorado Division of Insurance.)

How can the Insurance Commission even begin to consider it OK to approve such overpriced premiums?

How can you justify these as affordable? I will ask again, affordable to whom?

That price, $2,040 per month for a healthy married couple (not taking any medications, doesn’t need a doctor’s care, does preventative care, lives a healthy lifestyle, no smoking, no drugs, exercises regularly and tests out 20 years younger than actual age on health exams) is the lowest premium we could even consider through Anthem Blue Cross in our area.

However, if we used our old address in Denver the fee was below $1,000/month. How can you justify the difference in fee schedules because we live in rural Colorado and in one of the aforementioned counties? The insurance companies blame it on the fee structures of our service providers. Why aren’t the regulatory agencies cracking down on service providers in our area for price gouging instead of approving outrageous insurance premiums?

How people in the Department of Regulatory Agencies sleep at night is beyond comprehension knowing they authorized and have allowed these insurance companies to increase their premiums to such levels most average working people cannot afford them. Then, to add insult to injury, there is a penalty to pay if you don’t have health insurance.

When will the Department of Regulatory Agencies start looking at how service providers set their fees? For example, a simple MRI costs on average $350-$500 in Denver. In our area, the hospitals charge well over $2,000 and up to $3,500 if you have insurance. If you pay cash, you can get it done for $750-$1,000 at a clinic outside the hospital.

How is that legal? A service provider can charge more to people with insurance because insurance will pay their fee? Why isn’t the procedure one value at one price regardless of whether or not insurance is involved? Those of us with insurance coverage are being gouged in paying more for the procedure, then again for our insurance premium.

I recently received notice from Anthem Blue Cross that three procedure/services I received from various providers back in 2010 should have been covered by insurance. When I had the procedure/services and was told insurance would not pay for them, I was billed and paid for them out of pocket immediately upon being billed.

Instead of reimbursing me, Anthem sent the payment to the service providers, with interest (because the providers have that in a contract with the insurance companies) and I had to request the service providers reimburse me, since now they were overpaid. The service providers, who had been paid in full and were never out any money at any time for the procedure/services, kept the interest.

I was out of pocket several thousand dollars for the past six years. This is money I should not have had to pay the providers because of a mistake on the part of the insurance company and yet I was not compensated for their mistake at all. I didn’t get any interest on the money owed to me. That is just wrong.

So when you tell people not to panic about their insurance, please understand there are people who have been priced out of insurance coverage and it’s the Colorado Division of Insurance and Department of Regulatory Agencies’ fault.

Our health-care system is very, very sick and the doctor is not in. That is something to cause growing concern.

Lynn Kirchner is a Carbondale Realtor.

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