Thomas Richardson – San Diego, CA

Published on

(Updated January 2013)

We’ve just been notified that the Blue Shield policy covering me and my wife is rising 11% from $1090.00 a month to $1219.00 a month as of March 1, 2013, with $5500 deductibles and 30% copays for both my wife and me.

In September I get to apply for Medicare, three months prior to my turning 65 years of age. Most likely, prior to that, I will drop off our unaffordable coverage, leaving my wife insured with Blue Shield and myself uninsured, with fingers crossed.

Blue Shield of California recently canceled my policy for “underpayment” after its own computer rebated an $89 “bonus” granted by Blue Shield. Then it randomly took $527 out of my checking account, which is taking weeks to get back. I’ve spent hours on the phone with them. Can’t anyone hold these incompetents to account?

Here is the whole story:

Since Blue Shield of California is a "not for profit," they kick back to policyholders anything above 2% profit after "administrative costs".  So in December 2012 rather than taking $1090.00 out of my checking account through my 15th of the month auto-pay, they took $991.90, saving me $89.10. 

The first week of January 2013, I got a letter saying our insurance had been terminated for non-payment of premium!  It took me about four hours over two afternoons to get it straightened out. They reinstated coverage and said they would resume the auto-pay. 

Shortly after that, my wife answered the phone and the Blue Shield employee told her we needed to pay them $1179.10 right away to get current (the $1090.00 plus $89.10). 

I spent a couple more hours on the phone explaining that the auto-pay was back on and that no way were they getting the $89.10 back.

On the 9th of January they took out $1090.00 from our account (which normally would have come out on the 15th to cover till the next 15th). Then on the 14th they took out another $527.42.  After more phone time, no one could explain why my small-business checking account was raided for $527.42. 

I asked them to put it back in my account before it might cause me to be overdrawn or face monthly charges for not keeping a high enough balance. I was told they would have to mail me a check and that it would take five to seven business days. I called again on the 21st and I was told it was going out that day. My wife got a call on the 25th saying I should get the check within seven more business days.

On Jan. 30, still without the check, I called again, and asked once more what happened. This time I was told it was an erroneous decision to recoup a “shortage” from my January 2012 payment, which also been reduced for the 2% refund policy.  Apparently a computer glitch caused the "over 2%" refunds to appear as insufficient premium payments, not just from December's premium, but January's as well. 

I don’t know if this is happening to thousands of policyholders or just me. Either way, it’s infuriating that no one can hold Blue Shield accountable for lost time, frustration, overdrawn accounts or bank fees.

If I did to my pool maintenance customers what Blue Shield did to me, I’d be out of business. But to Blue Shield, I’m just a gnat to swat.


Tom Richardson’s March 2012 story:

I'm 63 and my wife is 60. I’m self-employed, with a business of swimming pool  maintenance and equipment repair and installation.  Business is  fairly steady considering the economy, but our health insurance premiums are through the roof. Blue Shield recently sent me a notice that the premium on our policy would go up to $2,410 per month on April 1, 2012!

That's more than 100% above the $1,181 we paid as of September 2010, only 18 months ago. We were already strugglng to pay a January increase to $1,905 a month.

We made a tough decision when we got the January notice increase to switch from our $2,000 deductible to a $5500 per person deductible–$11,000 for the two of us–to reduce the premium. We'll now pay $1090 a month (until it increases again). It's almost as much as we paid for the better policy in 2010. The copay is still 30%, so it's a pretty bare-bones policy. But getting the notice of increase to $2,410 a month on our old plan made it clear we had no choice. At least for a little while we won't have to worry about whether to pay the health insurance premium or the mortgage and property taxes, which come to $1,758 combined. 

Now we can worry about paying the $5500 deductible if either one of us gets sick. The deductible makes it kind of hard to decide to see the doctor for anything but an emergency. And at the rate our premiums are going up, I wonder if we can both stay insured long enough to get Medicare when we turn 65. It's an odd world when we have to wish we were older.

I also wish we had a single payer system that would cover everyone and take the profit motive out of health insurance. But lacking that, we at least need better control over these premiums. I can’t believe insurance company costs are going up at such a high rate when the rest of the economy has almost no inflation.

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