Some with pre-existing conditions see hope in insurance changes

Liz Johnson says she and her partner owe a substantial amount from unpaid medical bills.
Liz Johnson says she and her partner owe a substantial amount from unpaid medical bills.

Liz Johnson and Robert Irby have diabetes and other medical conditions, so having insurance has been crucial to them.

The Nicholson couple, who are self-employed, had individual policies with high deductibles through Blue Cross and Blue Shield of Georgia.

Early this year, their monthly premiums jumped by about $100, reaching $628 for him and $677 for her.

The couple had automatic payment online through their bank. But they did not immediately adjust the amount paid to reflect the new premiums.

When they realized their mistake, they say, they sent in the extra money. But Blue Cross and Blue Shield of Georgia, their health insurer, sent the money back and canceled them.

The insurer, replying to a query about the situation from GHN, said in a statement that if a member’s premiums are paid through an online bill pay program via a bank, a member must alert the bank of any changes in amount.

Blue Cross does consider requests for reinstatement, but denied the couple’s request, Irby says.

Such individual health insurance policies have long been problematic for many people, especially those with health conditions.

Reason for cutoff disputed

A 2009 AJC investigation found that individual health policies drew a disproportionately high number of complaints to the Georgia insurance commissioner’s office. Not only are premiums for these policies high, and subject to big increases, the coverages can be relatively limited, the AJC found.

Johnson said she believes that the two were cut off because of their past health issues, a suggestion that Blue Cross and Blue Shield firmly denies. “We do not terminate policies based on claims history,’’ the company said in a statement.

The state’s insurance commissioner’s office says policy cancellations are not common complaints in Georgia now, and that only a handful were received from January 2011, when the current commissioner took office, through May of this year.

The problem of pre-existing conditions, though, has remained an enormous barrier for people getting affordable coverage. It has adversely affected millions of Americans, keeping them from changing jobs due to fear of losing insurance, and leading to insurers routinely rejecting applicants for individual coverage, or setting sky-high premiums.

Johnson’s and Irby’s cutoffs came in February, three months before the Supreme Court upheld the Affordable Care Act (ACA), the federal health law sometimes called Obamacare. Since the ruling late last month, Republicans have mounted a renewed effort to repeal the ACA through congressional action.

Georgia tea party activist Debbie Dooley, a staunch opponent of the two-year-old law, told the AJC recently that regarding “pre-existing conditions — we are deeply concerned about that — but Obamacare is not the solution to that because it will drive up insurance costs.”

Advocates of the ACA, however, note that it is designed to help people with certain health conditions, such as Johnson and Irby, in important ways.

Under the law, Johnson and Irby will be eligible for the state Pre-Existing Condition Insurance Plan, created for ‘’high risk’’ individuals like themselves. More than 1,000 Georgians with health conditions belong to this new health plan. The couple must be uninsured for six months before joining PCIP.

Johnson says she has looked into the PCIP and says, “It might be cheaper than what we had.’’

In addition, beginning in 2014, health plans will be barred from denying coverage to people with pre-existing conditions, and also won’t be able to charge them discriminatory premiums. And people with health problems and individual policies will be able to access private coverage through an insurance exchange, which should lower premiums for many consumers buying on their own.

Anxiety about being uninsured

In the meantime, though, Johnson and Irby are worried about the costs of their care.

Johnson, 56, a real estate paralegal, had a blood test done in February. Insurance has usually covered a good portion of her tests, she says, but this time “they covered nothing.’’ She was canceled briefly in 2010, also because of a payment problem, but was reinstated after three months.

This time, Irby, who tends to their small horse farm, called Blue Cross and asked to be reinstated, noting that they sent in the extra money, but he says the company told him no.

He takes Lantus, a form of insulin, twice a day, going through a $100 bottle each week. He also has high blood pressure and a serious leg problem. At 64, he’s a year away from qualifying for Medicare, the programs for seniors and the disabled.

Under the current insurance rules, the two are essentially uninsurable, except for the possibility of the Pre-Existing Condition Insurance Plan.

Johnson has been hoping that nothing goes wrong healthwise while they’re uninsured.

Like many Georgians, Johnson has serious reservations about the ACA. She cites, as one example,  how the complex legislation was passed in Congress.  “I think it went through too fast,’’ she says. But she’s willing to look again at the law and the coverage it offers to people like her.

“Money is tight,’’ she says, adding that she and Irby still owe medical bills.

“We owe everybody money,’’ she says.