Troubleshooter: Health premiums

April 5, 2010 3:12:16 PM PDT
Cathy Jones is self-employed and works two jobs to stay ahead. She told ABC11 she's been insured with Blue Cross and Blue Shield of North Carolina for at least seven years.

She's managed to stay healthy, which she thought that would mean affordable healthcare. Instead, she said her premiums have become more like a mortgage payment for her.

"I'm having to work more hours to pay for health care and I have less time to take advantage of it," she said.

In 2008, her rate with Blue Cross was $493 a month. In 2009, it was $548, an 11 percent increase.

"I called and they said, well that's just everyone in your group. It's the high cost of health care," Jones explained.

Then in 2010, Jones' premiums jumped to $722 a month.

She went online to get answers, but received no response from Blue Cross.

"I'm not doing anything for it to increase," said Jones. "Choosing not to smoke, choosing not to drink, choosing not to engage in risky activities that would adversely affect my health, I've made all the right choices, but I was penalized."

ABC11 Eyewitness News I-Team Troubleshooter Diane Wilson contacted Blue Cross to try and get Jones some answers.

"It's not based on a member individual's claims experience. It's based on the claims experience of everyone covered by the same plan that you're on," explained Michelle Douglas with Blue Cross and Blue Shield of North Carolina.

So, choosing a healthy lifestyle doesn't matter. Douglas explained Jones was on the richest benefit package with only a $250 deductible. That package gave every member in that plan a 20 percent increase this year based on the claims from every member in that group. Plus, Jones had another disadvantage.

"In this case, this member had a birthday that put her in a different age bracket and in this case that put her in additional 11percent increase on top of base," said Douglas.

That totaled a 31 percent increase in one year. Douglas explained if Jones was willing to take on more risk, she could lower her premiums.

"She could have gone to a $2,500 deductible and her rate would have decreased 12 percent," said Douglas.

As for why Jones didn't get a response from Blue Cross for help?

"In this case, she sent to a technical box, which is for people having technical issues with the website. At least with Blue Cross, you can't change your coverage by sending an e-mail. We require people to call in or send a letter by registered mail," said Douglas.

Jones did that and canceled her policy.

"I told them I couldn't afford 722 dollars. That's like a mortgage payment or rent payment for a family," said Jones. "Right now, I'm looking for options because I don't want to be one of those uninsured people who has to live in fear that something is going to happen that you can't take care of."

Blue Cross also said they would be happy to work with Jones to find a more affordable policy. So far she is still considering her options.

Experts say the best advice, is to do your research and get all the information you can when shopping for health insurance. Most people think, like Jones, that the price tag for health insurance is based on usage. This case is a great example of how you're not paying for what you used, you're paying for what everyone in your group is using.

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