For the past three years, ever since they took the first elephant-sized hit on their premium, Ceci Ellis and her husband have been slogging though the health care jungles, swinging a figurative machete at the various vines health insurers have strewn across their path.
It hasn’t been easy, and they have not reached a clearing yet. They have had to chop away at exorbitant cost increases; disqualification for "pre-existing conditions" that are arbitrary, occasionally ludicrous and, in some cases, don’t even exist; inaccurate medical records; and age discrimination.
All of these are unconscionable, and beg for the state to regulate them, Ceci says. It is long past time, she says, for the state to take charge of both policy and practice, and change the way health care is delivered in California.
Ceci, 51, is a Realtor in Redwood City, where she has lived since 1982. Brad, 59, is self-employed. For many years they were insured through her employer. When she hung out her own real estate shingle, she maintained coverage through the California Association of Realtors.
Three years ago the premiums started to increase, by hundreds of dollars a month. Then, in 2002, Ceci made the mistake of turning 50: Blue Shield wanted another $200 monthly. "I started to think that I really wanted to get serious about finding (affordable) health insurance," she says.
She shopped around. In 2003, she switched from her group HMO to the group’s PPO that cost them $541 a month but had a high deductible – $2,500 for each of them. She continued to look for a better deal.
Blue Shield was widely advertising a plan for $250 apiece, pitching it as a health care bonanza for the discriminating shopper. They went for it. She was accepted, at $123. But as to Brad, "they flat out rejected him," she says, "for what amounts to ridiculous and, in a couple of cases, incorrect information from his medical records."
Ceci says Brad was rejected for two medications he hasn’t taken in over a year; anxiety disorder, which is a mistake on his records; a back surgery done more than 30 years ago; and an over-the-counter vitamin supplement he takes for osteoarthritis.
So that left them with the group plan, which is now $709 a month and retains the high deductibles. She could take the $123 plan, but that would leave her husband uninsured, since he can’t be on the group plan unless she is.
Meanwhile, Ceci continues to look. She applied to Megalife, which rejected Brad because, the insurer said, he has kidney cysts and polyps on his gall bladder. This was news to Ceci and Brad, and alarmed them. They believe there is something wrong in the medical records and are trying to straighten that out.
They also say the supposed anxiety disorder and depression used to disqualify Brad are a mistake. But, Ceci says, what if it weren’t? Should anxiety be a reason to refuse health coverage? "That doesn’t make sense," she says. "In today’s world if you don’t have some kind of anxiety, you’re the one who is nuts."
Ceci has since gone to other insurers who have confided to her that insurers have seemingly endless reasons to reject you for coverage, including diabetes.
Insurers are abusing the concept of pre-existing conditions in order to drive people off health care, she believes. She is not alone in that belief.
"There should be some kind of standard for approval and disapproval, so you know where you stand," Ceci says. "It’s arbitrary." So is the age-related increase. One person who turns 50 or 60 could be in excellent condition while another is not. Why should a person who takes good care of himself have to pay higher premiums because someone else doesn’t watch his health, she asks.
Ceci also is fuming about the supposedly low-cost health care plans Blue Shield touts that turn out to be more expensive or to have hidden qualifiers. She considers them tantamount to false advertising and bait and switch. "Blue Shield‘s initials are aptly BS," she says. "In their website they say, "Oh we’re for you, when they have no intention of honoring those (advertised) rates."
"Any advertised rates need to be available to the average person in the applicable age bracket – not the to Bionic man."
As frustrating as it is for her and Brad, Ceci says "this isn’t just about me and my husband. There are seven million Californians who don’t have health insurance. It’s the people who need it who are taking it in the neck."
Ceci, like a growing number of Californians, wants the government to step in and regulate costs, and provide uniform standards.
There needs to be some sort of balance, she says. "Maybe the insurance companies need to make a little less."