ON Health Care and the Nature of Reality

Subtitle – There is no such thing as a free lunch!

Subtitle – You asked for it, you got it brother!

Subtitle – Guess what, I got hosed, too!

I suppose I could have used hashtags, but the subtitles seem a bit more dramatic, don’t you think? Please be warned, this is a Rant. It can’t be all recipes and love all the time.

Well. I did it. I signed up for my Obamacare plan. I bellied up to the bar and paid my $375/month for a policy with a $3200 deductible and the promise that it will cover lots of preventative healthcare. I had to, you see, because I moved and I was no longer eligible for the California plan where I was paying $399/month for little to no actual coverage. I was pissed the first time I had to use it. Have you ever tried to decipher one of these ridiculous policies and understand what is covered and what isn’t? I mean, if some, unknowing, administrator writes on the form for your EOB (you all know what a fucking EOB is now, right? So special!) that you had a sniffle instead of “preventative” (or code goblledy-gook (10-289)), then you get to pay the whole bill. NO! Even though you are paying cash and won’t be stringing the doctor’s office out for 120-180 days for payment, no discount for you! That goes to the cronies at the insurance company. But, well, ok, I have it. It’s mine. It is the decision I made, right? I stood in line for my open enrollment, got my hand stamped and my number recorded, I’m good. Or am I? What? WTF?

“State places Oregon health insurer under supervision” (see below for more details)

I don’t have insurance. The bitchin deal that I decided to buy was from an IDIOTIC company who isn’t well-enough capitalized to actually service its clients? Wait, what? How can that be? Oh, right, Yeah…. Because


That whole reality thing is such a bitch, right?

So, what are my awesome and delectable choices now? Well, I can get in line to sign up for a policy which covers less and costs more. I can wait this out and see if, somehow, magically, MODA is going become more capitalized and stable by doing the same thing they have been doing. OR, I can decide that I’m not standing for it. I think I may just choose the latter. I think if I don’t pay my premium, they have to continue to cover me for a while, and, that seems like my best option. BTW, I read today that the IRS cannot put any lien on wages or otherwise if you refuse to pay the “penalty fee” for not having health insurance. I’m going to look into this a bit.  I have had it with all of these jerks. “I’m MAD AS HELL, and I’m not going to take it anymore!”

State places Oregon health insurer under supervision

(Salem) – The Oregon Department of Consumer and Business Services, Division of Financial Regulation announced today that it has issued an order of supervision to Moda Health Plan, Inc., because of concerns over its financial condition. At the same time, the department will begin working with Moda to transfer its individual market plans to another carrier.

An order of supervision allows the department to have a representative on site and in control of all financial decisions to ensure that consumers are protected. The order prohibits Moda from issuing new policies or renewing current policies in the individual market, and from adding new groups. The order also requires the company to obtain sufficient capital and present a business plan to DCBS that clearly demonstrates that it can operate in sound financial condition going forward. The supervision order is available at http://www.cbs.state.or.us/external/ins/admin_actions/actions_2016/insurer_2016/financial_2016/other_2016/16-13-001.pdf.

The department took this action because of Moda’s excessive operating losses and inadequate capital and surplus. Capital and surplus is the amount a company’s assets exceed its liabilities. The required minimum increases as the company assumes more insurance risk.

“Our primary goal is to ensure consumers are protected,” said Patrick Allen, director of the Department of Consumer and Business Services. “We will continue to work closely with the company to find a sustainable path going forward while minimizing risk to consumers.”

The order became effective late yesterday; however, Moda’s insurance policies may still appear on HealthCare.gov through the end of open enrollment, Sunday, Jan. 31. DCBS advises consumers still shopping for plans to choose a carrier other than Moda. In the event that Oregonians already enrolled with Moda need to switch plans, there will be a special enrollment period. In the meantime, Moda policyholders can continue to access medical services and get their claims paid.

DCBS, which also runs the Oregon Health Insurance Marketplace, will keep Moda customers apprised of new developments and actions they may need to take.

As of Sept. 30, 2015, Moda enrolled a total of about 244,000 Oregonians in the commercial market, including 95,000 in the individual market, 16,000 in the small group market, and 129,000 in the large group market. Moda also has members in the associations and trusts market.

Eastern Oregon CCO, which serves Oregon Medicaid members and is owned by Moda, serves 48,000 Medicaid members. No one on Medicaid is losing coverage.

The Oregon Health Authority is also working with the Public Employees’ Benefit Board and Oregon Educators Benefit Board partners to minimize any potential impacts to their members. There are 1,100 PEBB members and 42,000 OEBB members enrolled in Moda health plans.

Consumers with questions should call the DCBS Division of Financial Regulation’s consumer advocates at 1-888-877-4894 (toll-free). Staff will be available to answer calls until 8 p.m. More information can be found on the division’s website at http://www.oregon.gov/DCBS/Insurance/insurers/regulation/Pages/moda-faqs.aspx.

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