Going without

As of the year 2014 my family and I have been going without our high priced insurance coverage.

Until this year we have been paying several thousand dollars for an insurance plan that was suppose to cover all three of us for whatever medical treatment and coverage was needed. In order to pay for that, we would save all through the preceding year just to pay the premiums. However, when it came time to make a claim for my double Angioplasty last year, our claim was simply REJECTED.

I did not kick up a stink on the matter believing that civility and persistence would surely produce results and it did, not ideal but we got something and we promptly cancelled and cut off AETNA after 10 years of paying premiums. To me it was an insult to have to ask twice to be paid for a legitimate claim that we were entitled to, not to mention the fact that I “saved” them more money by going to a public hospital. Because it was a personal transaction I did not write about the details but this week I was reminded of that disappointment by an email from Mrs. Sophia Sims whose experience with her insurance company was equally disappointing. Below is her email:

Dear Mr. Beltran,

We are insured with Blue Cross Insurance. Our policy is Blue Royale A so our maximum coverage per aggregate year is US$500,000 and treatment anywhere in the world. My husband was diagnosed with cancer last December and underwent treatment in January of this year. Treatment was successful so he is cancer free now. Like any cancer, the possibility of recurrence is there. We claimed about P1,000,000 for the treatments done (radiotherapy and chemotherapy), which is 4.5% of our maximum coverage. For the renewal of his policy this November, his premium was increased by 420%. How does 4.5% justify a 420% increase? We think this kind of increase is unreasonable and unconscionable as it makes it too expensive for him to stay with Blue Cross but makes it impossible for him to transfer to another insurer as he already had cancer. Prior to claiming for his cancer treatment, we have never claimed for any medical expense and we have been insured for almost 10 years. This is our FIRST claim.

In the fine print of their brochure and contract, they specify that increase in premium is at their discretion. Still, this is simply too much. We also know that premium increases are not regulated by the government. I am writing to Insurance Commissioner Mr. Emmanuel Dooc regarding this. However, I do not think this is enough. Unless more attention is generated, the government will not do anything. I know there are more cases like us out there and if enough people complain, then there is more chance of the government putting in the necessary regulation on renewal premiums. At the very least, the government should require health insurance companies to give full disclosure in their brochures, website and contract on how renewal premiums are computed. In withholding this important information, health insurers are misleading the consumers. Without government regulation, the consumer is completely at the mercy of health insurance companies when they get really sick and have to renew their policy.  

We do not stand to gain from my pushing this issue. My husband’s policy is due for renewal by November 13. Since they increased the premium by 420% and given there is no regulation, we are opting to stop our health insurance. We feel more victimized than protected. I am pushing this because it is wrong.

I hope you can bring this to the attention of the public and the government.

Best,

Sophia Sim

The Sims and the Beltrans have some things in common; we believed in Health Insurance, we believed in two international brands, we paid through the nose for expensive medical insurance to have peace of mind, we did not make unreasonable claims (I had my double angioplasty at the Philippine Heart Center-a public/government hospital), Like Mr. Sim once you have had a procedure or disease you fall into the “Pre-existing category” meaning you are no longer eligible for coverage of the disease or they increase your insurance premium by “420%” to the point where the cost of insurance would actually pay for any claims made, or push you to get out of the program. 

In our case we were with AETNA and its predecessor for 10 years where the premiums increased annually or every two years. To cut the package cost we opted to have a plan where we would pay the first US$5,000 out of pocket for any medical bill. So in effect we were only insured for a major incident and not even the usual claims. In the ten years we had only two claims, the first was in the year 2000 when my wife had a natural delivery for our daughter, then in 2013 when I had my double angioplasty.

Imagine my shock and anger when our claim was rejected out right! We’re talking a few hundred thousand pesos not even half a million here, but the pencil pusher at AETNA somewhere said NO. Only after a couple of persistent emails did they grudgingly acknowledge our claim and sent payment without any sympathy note, wish you get well soon or thank you for being part of the AETNA family. I never knew how cold and indifferent a company email could be until that moment.

Like the Sims we have since left the program. Our current insurance is under the Philippine Star and the protection of GOD.  Reading Mrs. Sim’s letter brought it all back and I sincerely hope and pray that our friends in the Senate and Congress gets to read this column and makes a shout out to all the others who have become victims or “Biggest Losers” in what was supposed to be a relationship of trust. Unless government and Congress seriously investigate the matter, many older couples and families will be doing without.

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