вторник, 18 сентября 2012 г.

New Mexico Alliance Offers One Health-Care Haven for Uninsured. - Knight Ridder/Tribune Business News

By Winthrop Quigley, Albuquerque Journal, N.M. Knight Ridder/Tribune Business News

Nov. 24--ALBUQUERQUE, N.M.--Otis D. Brown had a bum knee, so bum in fact that it was replaced last year.

The surgery was successful. However, his pocketbook nearly hemorrhaged following post-operative insurance complications.

Health insurers found Brown's new knee an unacceptable risk, which drove the cost of his coverage into the stratosphere. Along with 4,500 other New Mexicans, Brown found an affordable option, through the state-managed Health Insurance Alliance.

The cost of Brown's surgery itself -- about $20,000 -- was no problem. Brown's wife, Eleanor, had Cigna coverage for the couple through her employer, Kmart Corp. Insurance cost them about $170 a month while she worked. When she retired in 2001, she elected to continue the insurance for another 18 months, an option allowed by a federal law known as COBRA.

Because the Browns picked up Kmart's share of the cost, the insurance cost $787 a month, a big jump but affordable.

Otis Brown, a radiology technician by training, has been self-employed since 1986. He runs his company, Snappy Duplicating Service, from a small darkroom in the family home. Snappy Duplicating copies about 10,000 X-ray films a year. Most of Brown's customers are attorneys involved in medical malpractice cases. With the 18 months of COBRA-mandated coverage reaching expiration, the Browns began shopping for health insurance. Sticker shock doesn't describe what they found. Brown uses the word 'traumatic.'

Should Brown's new knee become infected, still a possibility after one year, it would have to be removed, the infection treated and a new knee installed after six months. Cigna told the Browns they could continue their coverage for $1,200 a month for six months. After that it would cost $1,600 a month.

'There was no way we could afford insurance,' Brown said.

They shopped around and decided on another company that would charge $580 a month. Once the coverage began, however, the Browns noticed their policy excluded Otis's knee. The agent hadn't told them about the exclusion.

'I want my whole body covered,' Brown said. Another company offered to insure Brown's knee for $700 a month more, bringing the monthly insurance bill back up to an unaffordable $1,280.

Then an insurance agent told the Browns about the New Mexico Health Insurance Alliance. It was created by the State Legislature in 1994 to allow individuals and small companies to obtain health insurance when standard commercial policies are unavailable or unaffordable.

'Yes, the rates may be higher because there is no medical screening,' said alliance executive director Joan Rutherford. 'But the rates are required by law to reflect the average rates in the commercial markets.'

A man in his middle 40s living in Albuquerque might pay from $165 to $330 a month, depending on the plan he chooses, but he can't be refused for medical reasons, Rutherford said.

Alliance coverage includes prescription drug benefits, hospitalization, physician services, outpatient care, maternity care, mental health care, substance abuse treatment, preventive care and emergency benefits. HMO and indemnity plans are offered. Deductibles can range from $500 to $10,000.

'The alliance currently covers 4,500 lives throughout New Mexico,' Rutherford said. 'Close to 1,500 of these lives are individuals who have involuntarily lost their employer health coverage.'

The law requires any insurance company that covers public employees or retirees in New Mexico to participate in the alliance. Today, alliance participants are Allianz, Blue Cross and Blue Shield of New Mexico, Cigna, Cimarron Health Plan, HMO New Mexico, Guardian, Lovelace Health Plan, Presbyterian Health Plan, Principal, United of Omaha and United Wisconsin Life (AMS).

Not everyone qualifies for alliance coverage. Individual participants can't have any other health insurance coverage, must have exhausted COBRA coverage and can't be eligible for coverage under a group health plan, Medicare or Medicaid. Small businesses must have at least two and no more than 50 employees and offer no other group health insurance plan.

The Browns now pay $767 a month for alliance coverage, replacement knee and all.

Details about Health Insurance Alliance products and requirements can be found at www.nmhia.com.

To see more of the Albuquerque Journal, or to subscribe to the newspaper, go to http://www.abqjournal.com

(c) 2003, Albuquerque Journal. Distributed by Knight Ridder/Tribune Business News.

CI, KMRT, AZ,