Breaking the Wall

I have Blue Cross Blue Shield of Utah and they are pretty fair. Sasha I am in the industry and there is not an insurer out there that will not go by the age:( And it truly is unfair for those of us who strive to be in good shape and actually take care of ourselves... That is the reason I don't sell it anymore, its just to volatile!!!

They should look at the individual and access a premium based on the physical attributes of that person, but they won't!!

I agree they are to darn lazy!

And I could go on and on, it drives me crazy!!!!!

I guess telling you that I work for SelectHealth would be a bad idea (I even work in the department that sets the rates). Rates are based on averages and it would be be next to impossible to assess the risk and set rates for each individual. It would be nice to have incentives for living a healthy lifestyle but how could you prove that?

Let me know if you find one.

You could do an optional fitness test. If somebody feels he belongs to a younger age group, have him prove it by running a 5 K on a certified course, for example. Or performing in some other athletic event at a level characteristic of a younger age group.

That still will not prove that you won't get cancer, that your wife won't have a baby, that your kids won't be sick, etc. Athletic people can also cost a lot because of the injuries associated with participating in athletic events. It is frustrating to put so much money into something that you never use but it is worth the security of having it in case you need it.

Pretty much all of the insurance claims I file are running-related. I would be healthier if I wasn't a competitive runner.

I agree with Andy & Paul there are draw backs and issues assiated with every individual and it is nice to have that added security... But there are some companies that will pay 100% for some procedures if they help with prevention such as, Mammograms and the like... So that is a positive:)

I still won't sell it though, its to hard to keep the client happy because of the frequent rate hikes, and taking away of coverages...

Alot of people complain about having and paying for insurence whether its health, auto, home, commerical or farm, until they have a loss and then there dang glad they have it. Its alot better to have the insurance company use their check book as apposed to using your own:)

From an agents point of view anyway:)

No, but how is being chronologically 25 any better than being chronologically 35 for those things? Merely being 25 still does not prove you will not have cancer. Running a 5 K under 20:00 minutes goes a lot further to prove that I will not have cancer or heart disease in the near future than just plain being 25.

My insurance rate went up $69/month solely for the reason of me moving into a higher age group. And this is for a catastrophic insurance, which does not pay for maternity, and has a $5000 per person deductible.

Do not know of anybody has done any research on this, but I would be very surprised if age was a better predictor, or even got anywhere close, of the need for medical treatment above $5000/year than your recent 5 K time.

Are the insurance rates going through the roof because America is now becoming more athletic, and the cost of treating athletic injuries is increasing, or is it more because Americans are becoming obese, and we are starting to pay the cost of treating the consequences? If it is the former, I do not mind paying for the risk of being fit. If it is the latter, I do not want to have to pay for other people's choices to get fat and lazy.

My rates just increased 43% and neither me or my wife hit a new age group this year. I totally agree that age alone makes no sense. Highly fit people must have a statistically lower probability of major medical problems. I am still seeing red over the increase.

Without a doubt, rates are going up because we are generally less healthy because of our lifestyles. Aside from putting every person through a thorough physical and genetic testing, is there really a good way to assess risk? On average, 35 year olds are more expensive than 25 year olds. While this is not true for you or probably anybody else on the blog, it is true for the population as a whole.

Paul - it is because you are too healthy to file other claims, and that health comes from consistent exercise and the life style that it forces you to live. If you did not run, you would be filing other claims after a while, which would be more expensive.

Clay - I do not mind paying for insurance. I understand how insurance works. It is all about risk management. You work with statistics, and try to identify the levels of risk for each group. What I mind is paying for the failure of others to manage their own risks, and the failure of the insurance company to recognize that I belong to a different group.

Andy - how do you know it is not true for me or anybody else on the blog?

Suppose your boss told you that you could insure a group of 1000 35 year old men that have run a 5 K under 20 minutes every year for the last 5 years at the rate of the 25 age group, and then whatever difference was left over from what you had to pay in expenses for that group was the profit you could take home, but otherwise you had to pay for the loss out of your pocket, would you do it?

I really really don't think that any insurance company is going to start taking 5K times as a qualification for premiums. So few people out there run competitively! Do you realize how mad it would make most of their customer base if they started evaluating people that way? I know that you really feel everyone in the world should run (I think I even remember seeing a comment that people should be chained to cars and dragged ten miles if they cannot run it (chuckle/wince)). But the reality is that insurance companies work with averages, and the average person does not run competitively, unfortunately.

But I do agree that it would be nice if there were extra bonuses for people who make healthy choices, and penalties for people who, say, ride death-mobiles, I mean motorcycles. (I just made someone mad, I can feel it.)

Sasha, you can be the most physically fit person in the world but you are still at risk for cancer, or whatever!!! A Friend of mine took care of himself and exercised daily, ate right and developed colon cancer and died with in a year of getting diagnosed, and he was 44.

He would probably agree with your argument and like it or not regardless of how well you take care of yourself as you get older your body starts to deteriorate and I can attest to this being 45 years old! There are things that I could do at 35 that I can't do as well at 45 and when I'm 55 I'm sure it will be the same and I consider myself to be in good shape:)

Just food for thought:)

Not to change the subject drastically, but did you know that you can significantly reduce your risks of developing cancer of any kind by fasting regularly? My brother is learning about this in medical school. He said that when your body goes without food, after a while it starts to break down its own cells for energy. I know that doesn't sound very good, but it is, because the body chooses to cannabalize the older, more damaged cells first, which are the ones more prone to turn cancerous. I'd bet Sasha's risks of developing cancer are significantly lower than that of the average population.

Why because he would rather starve than eat the average persons diet? I do agree with you Lybi about the 5k comment and the last one. Insurance coverage is what it is and the insurance plus medical world can and will make money off of us because we need them. Ya this makes me mad just as much as the next person. But what are you going to do?

I think Sasha is just trying to get something going here to beat you Lybi in most comment on his bolg.

Interesting discussion. I agree that it is frustrating when premiums go up with age, but that is inevitable. I know my dad's went up $600/month when he turned 50. $600!!! It is true that medical expenses get higher on average as you age, though- higher chance of cancer, heart attack, more medicine, etc.

I like the idea of having fitness bonuses, though. My company is charging employees higher premiums if anyone in their family smokes. I hear they are considering BMI premiums, too, for obese people. And they discount fitness centers and give small rewards for some health improvements.

Clay - your friend is an exception. Insurance is not about what might possibly happen. It is about how many times it will happen if the group is large enough, and how to define the group to reduce the probability of it happening. We know that being sedentary and eating junk will make costly things happen more often. We also know how to distinguish with a high degree of certainty between those who are sedentary and those who are not.

Lybi - why would it make anybody mad if the insurance company provided discounted rates to those who met a certain set of fitness standards? Not a lot of people run competitively, but most people who do what they are supposed to and deserve a cut in insurance rates can either run a 5 K under a certain time, or bike 10 miles under a certain time, or swim 400 yards under a certain time. You do not have to be a competitive athlete to meet a certain appropriately determined standard. Anything wrong with having a choice? I can tell the company to use my age to calculate my rates, or my 5 K run time, or my 10 mile bike time, or my 400 yard swim time. As opposed to using something I absolutely can do nothing about - my chronological age. Overtime this would encourage more people to exercise consistently. Going from a 30:00 5 K to 25:00 5 K would mean more than just bragging rights.

And we would also have more data on the correlation between exercise performance and health, as the insurance companies would be tracking it. Which could lead to some important scientific discoveries in the future.

I think the root of the problem is that 95% of the employees of the insurance companies do not regularly exercise themselves. Therefore, they come up with policies that represent only their sedentary perspective. In a democratic society that consists of 19 wolves and 1 sheep, what would be the popular answer to the question: "What's for dinner?"

Sasha, come to the UK. For all its problems, NHS (National Health Service) is absolutely free for everyone. I was skeptical at first, thinking it is too "socialist". After my recent ordeal, I am very impressed with doctors' expertise as well as their attitude. They do not overprescribe medications and they do not order million of unnecessary and expensive tests. They also listen to their patients. I do have private insurance as well, paid completely by my employer (no contributions from me), and I even managed to get money FROM my insurance - simply because I stayed in NHS hospital rather than a private one. I was shocked.

But to your point, I understand your frustration. But I do not know any US insurance company that would not increase rates based on age. The best I've seen were incentives for exercising, like covering the cost of gym membership.

Sasha, I think you reached the root cause when you said that 95% of people don't exercise. I'm sure it is not worth the time/money to come up with exceptions like this from the insurance company's perspective. Besides, if you allow exercise exceptions, then someone else will want exceptions because their family has a history of living to 100 years with no heart problems and no cancer. I'm sure there are lots of people that could seek exceptions, but it would be too difficult to figure out what was legit. Hence, the simple, age-based cost.

One thing you can be sure of, though. Regardless of your premiums increasing, your out-of-pocket costs should be lower because you are fit. So in some ways, you are saving money versus unhealthy people.

Jon - it should be. Because we are talking about rewarding a behavior that moves an individual into a lower risk group. Rewarding somebody with good genes does nothing to change the behavior.

There are two types of companies - the ones that are there just to make a profit, and the ones that are there to make a profit while making a difference. An insurance company that cares to make a differences will not be satisfied with accepting the current patterns of behavior and merely profiting from them. It would try to contribute to improving those patterns. And it would reward any exceptional pattern of behavior that is proven to reduce health risks if there existed a logistical feasibility. They would also seeks ways to reward those patterns for the cases when it was not logistically possible at the time.

WE need more Sasha's running these types of business's! I agree 100% with what you are saying and get frustrated every month when my auto draw takes out my health ins. premium!

At one point health ins. companies were considering lowering premiums to companies that had a Welness program, I am out of the cooperate world now so I don't know if that is happening??

Wife says everybody wants grandma to live sicker and longer and they all want Cadillac treatments at Hyundai prices.

She would know,believe me being in health care management.

I can see it now, everyone lining up for the annual 5k fintess dicount program, winner gets free insurance for a month. No I do think it is a good idea but, I don't think it should go off time just completion of something that shows you are active. Like a 5 or 10k or a mini tri or something of that sort. The fact is that these are money driven businesses and they don't want to give healthy people discounts.

I know from my own experiences this past year, I haven't had a physical in 3 years, yet when I went to get one, despite my insurance saying they cover 1 physical / year, I was informed I owed 165 bucks. Why you might ask? Because they don't cover "preventative" medicine. Go figure that even with super high premiums, they'll only cover it if you're actually in grave danger. FYI I have Blue Cross Blue Shield. Currently looking for a different one. I think there was a commercial about one that gives discounts if you have an active lifestyle.

Wow, quite the discussion. Being in the healthcare business, there is not a real solution to the problem. I will say, however, that IHC has a big strong hold on the Utah market. Other carriers offer private policies. A lot of it depends on what facilities and physicians you want access to. I have DMBA, they offer incentives for healty living in the form of CASH! I also have a policy from Colonial life which pays extra (cash to me) for healthy choices, annual exams and screening.

I completely recommend that before signing up for any policy that all coverages are understood completely. My biggest frustration with patients is their lack of understanding what they pay for with insurance.

I agree with Steve Ashbakers wife!!

But bottom line - Would anyone risk going without insurance?

pres Hinckley was asked once if he runs. He said something like "no, but all of my friends that did are dead". there is a lot more to health and longevity than just excercise.

Well said Ryan!

So the solution to long life is to not run and to be the prophet! Hmm... not too many could sign up for that one. :)

Or to drink a beer and smoke once in a while. Check this guy out:

http://news.bbc.co.uk/1/hi/england/london/7275861.stm

he could very well say that his younger friends who never smoked or drank are dead too.

I have mentioned this before and it is actually a thread on the message board. There are alternative methods for health insurance in the form of HSA's. You would carry the high deductible insurance (which I agree is over priced due to many reasons), but from then on YOU manage your own health costs from a tax free account. The account grows when you don't use it (there is your incentive to not see the doctor unnecessarily). If people were actually responsible for paying more than $20 co-pay health care cost would decline for everyone.

That being said, I agree that people should have good health due to exercize incentives. How they do it can be argued forever, but there should be some. However, that COSTS money to the company in the short term so they dont do it. They always choose the easier/cheaper routes.

The bigger problem is all the genetic disorders or cancer or high risk pregnancies that people have (I am speaking from experience here). Do you punish the people that have them? Since they raise the average cost for everyone, should they be charged more? THAT is the whole point of insurance. It is easy for people to say, "Insurance costs too much" but they are probably not the people who were not the recipients of aid. Do the people who have cancer or a genetic disorder complain that they paid $450 a month for thousands of dollars in aid? Could they also run a 5K in 20 mins or less, many could. Would it change much of their actual costs if the ones that couldn't actually could? No I do not disagree that many americans are over-weight and could benefit from exercize, but that is not my point.

Fix the Hospital/Doctor overpricing issues and the insurance will go down. That is the main problem. Having everyone run a physical fitness test would help, but stopping the doctor from charging $100 for a 5 min poke and prod would help more.