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My personal obamacare nightmare

+6
2seaoat
no stress
Yella
dumpcare
TEOTWAWKI
Hospital Bob
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Guest


Guest

http://en.wikipedia.org/wiki/Insurance_regulatory_law

Historically, the insurance industry has been regulated almost exclusively by the individual state governments. The first state commissioner of insurance was appointed in New Hampshire in 1851 and the state-based insurance regulatory system grew as quickly as the insurance industry itself. [4] Prior to this period, insurance was primarily regulated by corporate charter, state statutory law and de facto regulation by the courts in judicial decisions. [5][6]

As the various state governments each developed their own set of insurance regulations, insurance companies with multi-state business were hampered by the inconsistency of the dissimilar rules and requirements, as well as localism by the state regulators. These companies and their stakeholders joined a growing movement for federal insurance regulation – but, considering the lack of any significant federal regulatory framework, this movement may have been more about avoiding regulation rather than actually promoting federal superiority. [7]

In 1869, the United States Supreme Court cemented state-based insurance regulation as the law of the land when it ruled in Paul v. Virginia [8] that the issuance of a policy of insurance was not the transaction of commerce, and therefore beyond the scope of federal legislation. [9]

More than 70 years, later, however, the Supreme Court overturned that decision in United States v. South-Eastern Underwriters Association, holding that insurance was subject to certain federal legislation such as the federal antitrust statute. [10] Although the South-Eastern case focused primarily on the application of federal anti-trust legislation (the Sherman Act) to the insurance industry, some thought the decision opened the floodgates to widespread federal regulation of the insurance industry and signaled the demise of the state-based insurance regulatory system. [11]

The United State Congress responded almost immediately: in 1945, Congress passed the McCarran-Ferguson Act. The McCarran-Ferguson Act specifically provides that the regulation of the business of insurance by the state governments is in the public interest. Further, the Act states that no federal law should be construed to invalidate, impair or supersede any law enacted by any state government for the purpose of regulating the business of insurance, unless the federal law specifically relates to the business of insurance. [12]

After the McCarran-Ferguson Act, the business of insurance remained substantially regulated by state statutory and administrative laws through the years. Additionally, efforts such as the accreditation standards of the National Association of Insurance Commissioners, and other cooperative endeavors, have increased the uniformity of insurance regulation across the various states. [13]

Expanding Federal Regulatory Influence [edit] Despite the long history of state-based insurance regulation, federal regulatory influence has been expanding in the past several decades. In the mid 1970s, for example, the concept of an optional federal charter for insurance companies was raised in Congress. With a wave of solvency and capacity issues facing property and casualty insurers, the proposal was to establish an elective federal regulatory scheme that insurers could opt into from the traditional state system, somewhat analogous to the dual-charter regulation of banks. Although the optional federal chartering proposal was defeated in the 1970s, it became the precursor for a modern debate over optional federal chartering in the last decade. [14]

A wave of insurance company insolvencies in the 1980s sparked a renewed interest in federal insurance regulation, including new legislation for a dual state and federal system of insurance solvency regulation. In response, the National Association of Insurance Commissioners (“NAIC”) adopted several model reforms for state insurance regulation, including risk-based capital requirements, financial regulation accreditation standards and an initiative to codify accounting principles. As more and more states enacted versions of these model reforms into law, the pressure for federal reform of insurance regulation waned. [15]

In 1999, Congress passed the Gramm-Leach-Bliley Financial Modernization Act, which sets out certain minimum standards that state insurance laws and regulations were required to meet or else face preemption by federal law. [4]

Over the past decade, renewed calls for optional federal regulation of insurance companies have sounded, including the proposed National Insurance Act of 2006. [16]

The most recent challenges to the state insurance regulatory system are arguably the most significant, as well, showing further erosion of state primacy. Both the Patient Protection and Affordable Care Act (“PPACA”) and the Dodd-Frank Wall Street Reform and Consumer Protection Act (“Dodd-Frank”) are material forays of federal law into the insurance industry. [17]

Practice [edit]

The practice of insurance regulatory law requires knowledge and understanding of administrative law, general business and corporate law, contract law, trends and jurisprudence in insurance litigation, legislative developments and a variety of other topics and areas of law. An insurance regulatory attorney provides legal services and practical business solutions on a wide variety of administrative, corporate, insurance, transactional and regulatory issues. The practice of insurance regulatory law involves providing legal services and counseling on a wide variety of administrative, corporate, insurance, transactional and regulatory issues such as the following: The formation, acquisition, sale, merger, restructuring, reorganization and dissolution of insurance companies, their affiliates and other businesses in the insurance industry; Negotiating, structuring and executing associated transactions, such as the purchase or sale of blocks of insurance business, or providing compliance services relative to public and private financing; Drafting and submitting National Association of Insurance Commissioners (NAIC) Uniform Certificate of Authority Applications (UCAA) and related documentation with respect to insurance company formation, admission, licensing, expansion, re-domestication and other transactions; Drafting and submitting other required applications and related documentation with respect to the formation, admission, licensing, expansion, redomestication and other transactions of insurance affiliates, holding companies and other businesses in the insurance industry; Representing insurance industry clients before state insurance regulatory and other government agencies with respect to compliance issues, complaint resolution, administrative hearings and other administrative processes; Creating, drafting, developing, submitting for regulatory approval, negotiating, revising, supplementing and withdrawing various types of insurance products, policies, contracts, forms, rates, fees, schedules and other regulatory filings, including compliance programs required under state and federal law; and Providing general advice and counsel to the officers, directors and management of companies in the insurance industry with respect to issues from day-to-day insurance operations up to board and shareholder/member level matters.

Hospital Bob

Hospital Bob

What happened to me is ALL the fault of healthcare.gov employees and not anybody at Blue Cross.
First the ignorant bitch who couldn't tell the difference between Feb 1st and Jan 23rd, even though I must have said Feb 1st to her a dozen times.
Secondly, the supervisors who couldn't deal with a dispute as cut and dried as this one is.
Thirdly, whoever hires and supervises these people.
In other words, the effing government.

I said I would go after Blue Cross only because it's another deep pocket. And the first thing I picked up from watching Lawline ten years, is you always try join as a co-defendent every deep pocket associated with the case.

Hospital Bob

Hospital Bob

I put this story into a few paragraphs and just emailed it (one email address at a time) to all 50 email addresses you see when you scroll down this page...

http://www.foxnews.com/story/2010/10/14/contact-us/

Let's find out how sincere these clowns are.  Do they want to talk about real shit happening to real people?  Or do they just want to spew out the crap they make up?

Maybe they can also explain why obamacare cancelled all those legit policies,  but approved the continuance of a Mega Health and Life policy which I would say (and ppaca will confirm this) is the Yogu of health insurance except that would be an insult to Yugo.  That policy did not meet any of the obamacare minimum standards but the same employees who can't even comprehend dates on a calendar said it was A-OK.

Guest


Guest

I think you would have a case if anything were to happen before 2/1 or if they refused to pay for your services.

You fulfilled your part of the deal... and likely paid more in premium than the services you received. Take a deep breath.

Guest


Guest

It's all Obama's fault,Bob. I think you should testify before senate hearings to have him impeached.

Hospital Bob

Hospital Bob

Dreamsglore wrote:It's all Obama's fault,Bob. I think you should testify before senate hearings to have him impeached.

All impeachment ever does is cost the taxpayers millions and millions of dollars to execute.  It accomplishes nothing else.  Because there are no longer any competent leaders to take obama's place or any other president's place.
All there is now is a Washington full of self-serving incompetent career politicians.   Our government from top to bottom is a nightmare of dysfunction.
We can keep being in denial of that or we can accept the reality.  And get used to it because there is nothing any of us can about it.  It's all now so big and out of control that it's like a Godzilla on acid.  It just walks all over us and we don't have no Jap army to bring it down.

dumpcare



My personal obamacare nightmare What a Face Shocked Evil or Very Mad bounce affraid confused 

God I'm glad I wrote very few on the exchange. Some other agents have gone bald pulling their hair out. lol! lol! lol! 

Hospital Bob

Hospital Bob

ppaca,

I just woke up in the middle of the night to get a drink of water.
And it hit me.

What I was told by the Blue Cross rep on the phone doesn't make one iota of common sense.
I was told that it's not Blue Cross I need to call to cancel the policy,  that I needed to call the government to cancel.
That's the part that makes absolutely no sense.  
It's Blue Cross who sold me the policy,  not the government.
It's Blue Cross I pay the monthly premium to,  not the government.
And most of all,  the statements I receive in the mail to pay the next months premiums are sent to me by Blue Cross,  not the government.

So why in the hell would I call the government to cancel the policy?  They're not the ones billing me to keep the policy in effect,  so why in fuck would they need to know about a cancellation?
It would be the fucking insurance company who needs to be notified of cancellation,  not the government.

All the government does is provide a subsidy.  Why in hell would anyone need to cancel a subsidy.  It's the insurance policy that needs to be cancelled,  not the subsidy.

So the more I think about this,  it's Blue Cross who screwed me up.  When I called them they should have acknowledged the cancellation and that should have been that.  Instead they had me on the phone from one department to the other for almost an hour and then they tell me I need to call the government.  That is assinine.  And any fair and honest small claims judge would see it that way too.

Guest


Guest

Bob wrote:ppaca,

I just woke up in the middle of the night to get a drink of water.
And it hit me.

What I was told by the Blue Cross rep on the phone doesn't make one iota of common sense.
I was told that it's not Blue Cross I need to call to cancel the policy,  that I needed to call the government to cancel.
That's the part that makes absolutely no sense.  
It's Blue Cross who sold me the policy,  not the government.
It's Blue Cross I pay the monthly premium to,  not the government.
And most of all,  the statements I receive in the mail to pay the next months premiums are sent to me by Blue Cross,  not the government.

So why in the hell would I call the government to cancel the policy?  They're not the ones billing me to keep the policy in effect,  so why in fuck would they need to know about a cancellation?
It would be the fucking insurance company who needs to be notified of cancellation,  not the government.

All the government does is provide a subsidy.  Why in hell would anyone need to cancel a subsidy.  It's the insurance policy that needs to be cancelled,  not the subsidy.

So the more I think about this,  it's Blue Cross who screwed me up.  When I called them they should have acknowledged the cancellation and that should have been that.  Instead they had me on the phone from one department to the other for almost an hour and then they tell me I need to call the government.  That is assinine.  And any fair and honest small claims judge would see it that way too.

Bing! Bing! Bing!

Markle

Markle

Bob wrote:
ppaca wrote:
Bob wrote:ppaca,

Look at those attachments in the email where it says "enlarged prostate".
Why would that even be on an EOB page?  That's bizarre to me.

Wait I think I have it:  By any chance when you went to do bloodwork did you ask for an extra chair for your little friend to sit in? I have to ask once in a while for a place for mr P to sit.

Ok, I saw that, it looks like the doctor put that on the order. Did he check it? They probably did a PSA.

I can't open the details because only you can do that.


I'm gonna email you my login name and password so you can see the whole thing.

Yes,  the doctor did the digital rectal exam.  But he never said a word about an enlarged prostate to me.
I guess that's just how they do the best health care system in the world.  lol

Just because a prostate is enlarged does not mean it isn't normal. At your age, if it was NOT enlarged it would be abnormal and they also check the surface to see if it is smooth and without lumps.

Hospital Bob

Hospital Bob

Markle wrote:

Just because a prostate is enlarged does not mean it isn't normal.  At your age, if it was NOT enlarged it would be abnormal and they also check the surface to see if it is smooth and without lumps.

I've since talked to a half dozen people about this, markle, including two who are prostate cancer patients. And every one of them told me what you just did.
So I now know not to worry about it before I see the result of the PSA test.

Before this year I was healthy all my life so I'm new to learning about most all kinds of health problems.
But thanks much for helping to confirm what others have now told me. And now I realize that my doctor didn't need to make any mention of it to me until he sees the lab report and that tells him something different.

Hospital Bob

Hospital Bob

Dreamsglore wrote:

Bing! Bing! Bing!

Not totally bing bing bing,  dreamsglore.

Yes,  Blue Cross should have acknowledged the cancellation and that should have been the end of it.

But there is also absolutely no excuse for what those government idiots did either when they cancelled the subsidy on January 22 when I had repeatedly and emphatically told them the cancellation needed to become effective on the last day of the month.   And when I asked for help to rectify it that stupid incompetent bitch hung up on me.  

The whole thing is a monumental clusterfuck that I now have to deal with.
The total incompetence of both the insurance company and the government fucked me over on this and if they come after me for those bills I'm not going to roll over for it.  I'm going to make a goddamn lot of noise about it to anyone who will listen to me including a judge.

Hospital Bob

Hospital Bob

The latest episode of this tragicomedy.

The "advance resolution center" of the ACA/healthcare.gov/the Marketplace (or whatever it's being called)  just called me.
The lady was on the phone for 28 minutes and this time I recorded the conversation.
This one was smarter than any of the others I talked to before.  She took all of the information and was very sympathetic.  
But even she could not give the final resolution.  She "advanced" my case
to an even higher authority who she said would call me sometime between today and Wednesday.  lol
But she seemed confident that I will win the dispute.

p.s.  she wanted to know what the weather was like in Florida (revealed to me she was in Kansas).  Said her son (or some relative not sure) was getting a doctorate at the University of Florida but that he had come home without finishing and didn't know if he was going back.  And she apologized for the other woman hanging up on me.
When I asked her "doesn't it make sense to you that it's the insurance company who should be informed of a cancellation and not the government?",  she wholeheartedly agreed with me.  She also said she came to this outfit from Medicare where everything "runs so much more smoothly" and she anticipates this outfit getting the bugs worked out with time too.
So there you have it.



Last edited by Bob on 1/24/2014, 12:53 pm; edited 1 time in total

Guest


Guest

It's illegal to record calls w/o permission in Fl.

Hospital Bob

Hospital Bob

Dreamsglore wrote:It's illegal to record calls w/o permission in Fl.

That's funny.  Because I was on the phone when the call came in and they left me a voice mail with a number to call back.  And when I called that number and it answered,  a message immediately told me "this call is being recorded for blah blah blah".  At no point did anyone ask for my permission to do that.  They just did it.
And since I started MY recording before I placed the call,  I have THAT on my recording too so they can't deny it.  
I think if anybody is going to try to arrest me for recording without permission then I'm gonna have to see to it that they get arrested too.  lol

I'm gonna take milk duds into the movie theater again,  I'm gonna go right now and rip all the tags off my mattresses,  and I'm damn sure gonna record every call from this moment on when I'm talking to Uncle Sammy.
And if anybody don't like that they can come arrest me for it right now.

Guest


Guest

Bob wrote:
Dreamsglore wrote:It's illegal to record calls w/o permission in Fl.

That's funny.  Because I was on the phone when the call came in and they left me a voice mail with a number to call back.  And when I called that number and it answered,  a message immediately told me "this call is being recorded for blah blah blah".  At no point did anyone ask for my permission to do that.  They just did it.
And since I started MY recording before I placed the call,  I have THAT on my recording too so they can't deny it.  
I think if anybody is going to try to arrest me for recording without permission then I'm gonna have to see to it that they get arrested too.  lol

I'm gonna take milk duds into the movie theater again,  I'm gonna go right now and rip all the tags off my mattresses,  and I'm damn sure gonna record every call from this moment on when I'm talking to Uncle Sammy.
And if anybody don't like that they can come arrest me for it right now.

I think they just have to notify you but you're not going to get arrested unless you use it against them.LOL!

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