This is the body of a letter I wrote to my local State Representative.
(I commented out Towns and names to protect the innocent)

Today my son's provider asked for our $250 deductible up-front. He didn't
have it and didn't see that doctor today. What is happening with our
healthcare system? Our policy is from my employer, XXXX IXXXXXXXl, who
has a policy from XXXXX XXXXh CXXX. In that police we have a $20 co-pay
for office visits, a $250 deductible per person with a max. of any two
person's in the family paying before we don't have to pay it for in network
providers. Nowhere in our policy does it state we have to pay this provider
up-front. This is a local provider in XXXX XXXX, just a few miles away
from our home. If this is the saturation, we might be forced to find him a
doctor that doesn't ask for that up-front. Sure it might be the logical
consequence of such a policy, however it doesn't settle the problem. Are
providers having cash flow problems to the point where they ask patients to
pay for this up front? Is this a tread?

Problem is we don't always have $250.00 to go towards that at the time. That
means many people will be thinking twice about going to the doctor. Again
the system is rationing healthcare in other ways. Is this the intended
impact? What are the solutions to this new crisis? Sure this Doctor might
work it out with us, but already we owe thousands that was not paid by an
insurance company on a policy from another employer with high premiums and
low Max per year ($2500). Since 2001, I have lost jobs due to business
turndowns, had COBRA policies that jumped from $750/month to over
$1130/month. Finally, changed jobs to an employer with much better insurance
and now the providers are in a cash crunch and ask for deducible up-front.
What is next?

The dr can only collect the copay

CALL YOUR STATE ATTORNEY GENERAL ASAP

We just switched to Blue/Cross Blue Shield and we have a $250 deductible per person. None of our Drs. have asked for it upfront. We will get billed, then pay. Maybe it depends upon what kind of policy you have- I know BC/BS has different policies.

We have talked with several folk in the State office that deals with this type issue. They are sending forms to be filled out and this may take sometime, meanwhile we are looking for another doctor for my son.

My son told me of a man before him who had $10 in his pocket and because his plan raised the co-pay to $20, turned him down along with the asking for the deducable up front. This was being done by that group of doctors office manager.

This is forcing lower or fixed income patients from seeking healthcare from private doctors or into the hands of clinics with long lines. This is a backdoor rationing of healthcare.

Its a competator of Blue Cross/Blue Shield with the same deductables and so on. My company switched from a more expensive BC/BS policy. They were asking everybody in the office that day for the deductables up-front. They were turning back people needing to see those doctors one after the other.

I've contacted my company about that issue and it floored the HR person, she was just horrified. She called the Ins. Company and they told her that was against their agreement with providers. Look like another one bites the dust on their Network Provider list!

I hate to say this but our healthcare in this country is only going to get worse. With the HUGE PR campaign designed to PUSH all of us into HSA's (health savings accounts) we will not even recognize our healthcare system. In order to be eligible for a low premium HSA you have to buy a high deductible policy (at least a $1,000 deductible). To some of us, having to pay $1,000 might just as well be $100,000. Those that live paycheck to paycheck can not afford these high deductible plans when we need to use them. Once all of us are in these HSA's they will then start to raise the premiums and lower the benefits. Before long we will be paying the same premiums that we pay now for good policies. And, if that is not bad enough, just wait -- there are even scarier things being planned.

I read an article yesterday (see next post for full article) that said that some employers are now refusing to hire people that smoke. These employers are even planning on giving random drug tests for nicotine to ferret out those closet smokers. Those that test positive or refuse the test will be fired.

What is the rationale for these draconian violations of individual rights? The employers say that smokers cost them too much money in healthcare dollars. Because only 23% of adults smoke the smokers are in a minority. The employers and the insurance companies know that most of the non-smokers will not stand up for the smokers rights. They have witnessed over the years how non-smokers react when proposals are made to increase the tax on cigarettes, sometimes 30, 40 & 50%. No objections. They have watched how non-smokers have embraced the idea that smokers do not deserve any rights (stick them outside in sub zero temperatures --they deserve it). Almost anything negative proposed against smokers these days has the full support of most of the non-smokers. Let's face it, smokers have become a dispised minority in this country by a large portion of the majority.

The odds are that if you are reading this you are probably a non-smoker -- so if you are a non-smoker why should you care about this issue? I'll tell you why. You are kidding yourselves if you think that the employers and insurance companies are going to stop with just smokers. Smokers are just the first group they are targeting because it has become acceptable to discriminate against them. Once they have achieved the precedent of doing this to smokers it will be much easier for them to move against other groups. You will begin to see higher rates charged to obese citizens -- again using the rationale that they"cost too much" in healthcare spending. You may see people that drink being singled out for higher premiums. As they successfully discriminate against each successive group for their "behavior" they will go after others. Maybe you ride motorcyles and your employer thinks that it is too risky. You may just find yourself being soaked for higher healthcare premiums or being fired unless you give up riding motorcyles. Don't laugh, people have actually already been fired for having "risky" hobbies. The show 60 minutes aired a program years ago talking about this very thing.

With corporate friendly Bush in the Whitehouse there is no telling what other rights will be in jeopardy. Here is another example: In those states where there are no laws protecting smokers from discrimination (most of the states) they will not have any recourse. In those states that offer protection, good luck going to court to have those laws enforced. The Bush Adminstration and their corporate friends are also trying their best to make sure that any damages against corporations won in court are limited. If you want to try for a class action you can forget that idea too unless you want to go to Federal Court.

The bottom line is that these are very scary times and as citizens we must carefully review any new idea or policy that corporate America promotes. They may say that it is good for us, but look a little deeper and you may discover that it is not good for us at all. We must also remember that, in addition to being wrong, when we allow discrimination to occur against others it always has a way of coming back on us.

http://www.baltimoresun.com/news/health/ba...ealth-headlines

Citing health care costs, employers impose smoking bans
Opponents say rules applied outside workplace violate individual rights

By Daniel Costello
Los Angeles Times

January 30, 2005

Employers have recently tried every carrot they can think of - including cash incentives and iPods - to convince employees to quit smoking. Now they are trying the stick.

Pointing to rising health costs, and the oversized proportion of insurance claims attributed to smokers, employers around the United States are refusing to hire applicants who smoke and, sometimes, firing employees who refuse to quit.

"Employers are realizing the majority of health costs are spent on a small minority of workers," says Bill Whitmer, chief executive of the Health Enhancement Research Organization, an employer and healthcare coalition in Birmingham, Ala.

Federal and state laws bar employers from not hiring or firing workers based on their race, religion or gender. Some states have enacted laws offering similar protections for smokers. But experts say workers in nearly half the states have few legal options if employers decide to prohibit them from smoking outside the workplace.

Employees in many states "work at the discretion of their employers and can be terminated for almost any reason as long as it's not illegal," says Stephen Sugarman, a law professor at the University of California, Berkeley.

In fall, Union Pacific Corp., an Omaha, Neb.-based transportation company, stopped hiring smokers in seven states. Company officials said the move was made to help quell employee health costs, which have jumped more than 10 percent each of the past three years.

Weyco Inc., an employee benefits company with 200 employees in Okemos, Mich., began random drug tests for nicotine on Jan. 1, saying it would fire workers who failed the test or refused to quit smoking.

Four Weyco employees resigned rather than take the test, said the company's president, Howard Weyers.

The Riverside County, Calif., Sheriff's Department plans soon to require applicants for deputy sheriff positions to sign a no-smoking agreement.

In most cases, employers are asking workers to report their smoking habits voluntarily or adding disclaimers such as "nonsmokers only" to job postings. Others are requiring workers to take breathalyzer tests that can catch traces of carbon monoxide in their lungs or submit to urine tests to detect nicotine.

A sheriff's office in Florida is asking job applicants who have a recent history of smoking to pass a polygraph test proving they no longer smoke outside of work.

Employees, workers' rights groups and some unions are decrying the smoking bans as an invasion of individual rights. "What you do in your own home after work or on the weekend is none of your bosses' business," says Lewis Maltby, president of the National Workrights Institute in Princeton, N.J., a spinoff of the American Civil Liberties Union. "The last time I checked, tobacco is a legal product."

Maltby says his organization is trying to persuade some states to pass broader worker-protection laws.

Critics of the smoking bans say it's not clear that smokers are more costly than other workers, such as people who are obese. While some studies have shown that smokers have higher absentee and lower productivity rates than non-smokers, economists who study the issue say the research is limited. It's possible, they say, that smokers don't drastically increase health costs with chronic and expensive conditions such as emphysema, heart disease and cancer until they're much older, when they're often employed elsewhere or retired.

"It sounds right for employers to say 'if we get rid of them, we'll save money.' But no one has the concrete data to prove that right now," says Tom Morrison, senior vice president of Segal Co., an employee benefits consulting firm in New York.

Although smoking rates continue to fall across the United States - an estimated 23 percent of adults smoke today, down from 37 percent in 1970 - employers say they need to find new ways to reign in health costs. According to the Kaiser Family Foundation, a health policy group based in Menlo Park, Calif., health insurance premiums rose 11.2 percent last year, the fourth consecutive year of double-digit growth.

Some companies have begun charging smokers higher health insurance premiums and forcing others into employee wellness programs filled with a bounty of smoking-cessation plans. Last month, Alabama announced plans to raise insurance rates on public employees who smoke, and it is considering doing the same with obese workers. And, of course, many private and government employers have banned smoking within the workplace for years.

In December, a national study by the Society for Human Resource Management found that nearly a third of U.S. employers polled had smoking-cessation programs; 5 percent prefer not to hire smokers and 1 percent refuse to hire smokers.

Weyers, of Weyco, says he instituted his new employee smoking policy after realizing that "if I don't do something to change employees' demand for healthcare, I'll never do anything about costs." Weyers estimates he now spends $750,000 a year on employee health premiums, and he worries he can't absorb many more cost increases. Weyers says that while some employees complained about the smoking ban - and several left - most employees have slowly come to accept the new policy. The company estimates that about 10 percent of its workforce smoked and calculates 28 employees and their spouses have quit since the new initiative was announced a year ago.

The Los Angeles Times is a Tribune Publishing newspaper.



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