Pat & Dave Parker — Orange County, California

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When Pat Parker sorted through the mail she threw the envelope from Blue Cross on the pile with the other bills to be paid, without opening it right away. That’s what she always did: After all, the amount never varied, and Pat had an efficient system for making sure she and her husband Dave paid what they owed.

What Pat didn’t realize when this particular bill plopped into her mailbox in early April was that it had raised her health care premium by 38 percent – from $673 to $941. The increase was due to take place May 1.

Pat was soon to find out that there is very little she can do about it: the health insurance industry can raise premiums at any time for any reason, with no accountability. The only restriction put on them: They must give 30 days notice.

There is never a good time to get hit with a piece of bad financial news, but this blow came at a particularly bad time for Pat. She and her husband, who have lived in Orange for 27 years, are semi-retired. Dave was let go from his job at a small electronics sales firm in October 2001. They have been on COBRA since then. Dave had open-heart surgery in November 2002, the first time either of them had incurred major medical expenses.

As with so many people who are nearing or have arrived at unexpected retirement, the Parkers struggle to get by month to month. Every nickel matters.

When she realized Blue Cross was jacking up the premium, "it made me angry," says Pat. "I was under the impression that we had a year’s contract" on COBRA, in the Parkers’ case from October to October.

Pat tried to get to the bottom of the matter. She thought Blue Cross had made a mistake, or the rise was tied to her husband’s open-heart surgery. Neither proved to be the case.

A Blue Cross employee told her there is no year-to-year contract and that rates can and do go up arbitrarily. Pat asked to speak to a supervisor and, after a long delay, was told that the supervisor was too busy to speak with her. Blue Cross then sent her on the all-too-familiar bureaucratic shuffle, bouncing her from agency to agency.

Although the bottom line was the same – she is stuck with the increase – she did learn one new piece of information: health care premium increases do not need to be based on the insurer’s actual costs. In fact, when she went on line to look up Wellpoint’s (Blue Cross‘ parent company) report to its stockholders, she discovered that in the most recent reporting period revenues had gone up 39 percent while medical costs had risen by only mid- to high single digits, hospital costs by the mid-teens and drug costs rose in the low double digits.

Why the huge premium increase, then? Pat does not know. Blue Cross never has explained it, nor does it feel any need to do so. The inference is inescapable: this is pure profiteering.

That was not the only maneuver Blue Cross tried on the Parkers. They also told Pat that Dave’s COBRA expired in May. Pat checked into it, however and found that because Dave was over 60 when he was laid off, and had been with the company longer than five years, he could stay on COBRA until he turns 65, in December of 2004.

Pat did get some satisfaction from Blue Cross, because it failed to meet the 30-day notice requirement when it sent the rate increase: The envelope was postmarked April 3 for a May 1 increase. Blue Cross gave her a $138 rebate.

But that is not nearly enough. Pat figures if Blue Cross missed the 30-day requirement with her, it may have done the same with others, and she is looking into a class action lawsuit.

Beyond that, she wants the state to regulate this industry. "They’re sticking it to everybody," Pat says, but prey especially on the weak – people under COBRA, retirees, older people. "They are out of work and already struggling to maintain their medical insurance on limited incomes, trying not to go into retirement accounts or Social Security."

Blue Cross and its industry peers are "entitled to make a profit," Pat says, but not in a way that discards the people they are supposed to help.

"The whole system is completely out of control. I just don’t understand it."

Consumer Watchdog
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