Monday, May 19, 2008

A (Metaphorical) Trainwreck

This is a case of "TMI" (Too Much Information), and how it can actually hinder the decision-making process. Early last week, I got a call from "Suzie," whose COBRA plan will expire when this month does, and who has severa "issues:" she's overweight, diabetic and has sleep apnea. The nature and severity of her diabetes alone renders her "uninsurable." And then there's this: she's 63 years old, due to turn 64 this summer. At least two of the carriers she mentioned won't write anyone over age 63 and a half (don't ask; that's another post). Still, she continues to call agents trying to find her own Holy Grail.
I explained the problem(s) to her, and asked if she was aware of how HIPAA works in these cases.
[ed: briefly, HIPAA says that if one has elected COBRA and kept the plan in force the full 18 months, one is eligible for a mediocre, over-priced plan that can't exclude pre-existing conditions]
She indicated that she had, and named a figure which, while pretty hefty, was less than what I knew such a plan would be at her age. I patiently explained that the carriers she mentioned (as well as the rest of those in this market) would not take her. She insisted that at least one agent had told her "no problem." I know when I'm licked, so I suggested that she call that agent back and submit her application. She balked at this, saying that it "sounded too good to be true."
Progress at last!
I reiterated that her best bet would be the HIPAA plan, but that there was one other alternative: a guaranteed issue mini-med ("limited benefit") plan. The advantages of these plans, I explained, is that one needs only a pulse and a checkbook (not necessarily in that order) to qualify, and that they are much less expensive than the HIPAA plans. Still, I cautioned her, there were reasons for this: one, these plans typically exclude pre-existing conditions for the first 6 months (some for 12 months) and that, as their name implies, the benefits are extremely limited. But if one's budget dictated that it's a mini-med or nothing, it may be an appropriate choice.
I am always careful in these situations to stress that the mini-med is an alternative, not necessarily the best one.
She didn't like the 6 month wait on pre-ex, and I replied that that was fine with me. Then she asked a question about the prescription drug benefit. Since I didn't have the answer at hand, I offered to call her back, which I did the next day. She still felt uncomfortable with the mini-med, and I again assured her that this was no problem, I was sorry I couldn't help. She then asked how much time she had to make a decision, and I told her that, as long as she had the paperwork in by the 20th, the plan could be in force for June 1. We hung up, and I put my notes away.
Lo and behold, she called again last Friday. She had finally become convinced that she had to either go the HIPAA route or the mini-med way. I listened, and waited for her to tell me her decision. But she still couldn't choose. She had called still another agent, who essentially told her the same things I had (one would think this was a major clue, but apparently not). And again, she stressed how the 6 month wait for pre-ex was unsatisfactory. And again, I empathized with her (at this point, I was beginning to feel a bit like Bill Murray). I reminded her that she has until the 20th (tomorrow) to "pull the trigger" on the mini-med, and bade her a nice weekend.
I have no idea what route Suzie will take, and I empathize with her dilemna. Still, I think that, at some point, it should have become clear to her that her choices were limited. I don't mind spending the time "holding her hand," but I can certainly understand other agents' reluctance to spend so much time on such a case. Obviously, a second (perhaps even a third) opinion is appropriate for this kind of situation, but she's on her 6th or 7th, and hence in imminent danger of information overload.
Which really helps no one.
blog comments powered by Disqus