Is this common in US?

[Mish]

Say there is a fake person, sally, who is 32 years old. She has always been healthy so she's never felt the need to get insurance. One day she is diagnoses with something, and cannot afford to get treatment, so she applies for insurance. She has never paid into the pot for anyone else, so why should everyone pay into the pot for her.

That's not an example of an insurance company denying some one coverage due to an existing pre condition. An example of an insurance company denying coverage is this:

You are Sally and you have an existing health condition that you were born with and there's nothing you can do about it. You go to insurance company, they look at you and then tell you to go away.

Another example is you are Sally and you are a healthy person. You've been paying for health insurance all of your life, but one day you fell ill. You went to insurance company to get some money. They sent someone to examine you and that someone found a pimple on your body that you have had for a long time. Now that someone writes a report saying that you've had a pimple all your life, but you didn't declare it when you applied for the insurace therefore your insurance cover is void.

How do you justify this?

[sparkle_jello]

That's not an example of an insurance company denying some one coverage due to an existing pre condition. An example of an insurance company denying coverage is this:

You are Sally and you have an existing condition that you were born with and there's nothing you can do about it. You go to insurance company, they look at you and then tell you to go away.

Another example is you are Sally and you are a healthy person. You've been paying for health insurance all of your life, but one day you felt ill. You went to insurance company to get some money. They sent someone to examine you and that someone found a pimple on you that you have had for a long time. Now that someone writes a report saying that you've had a pimple all your life, but you didn't declare it therefore your insurance cover is void.

How do you justify this?

I have worked for a health insurance company for over two years, I can tell you the first and second examples are really not how it was ever done with my company. There are some good companies and some bad ones. I will give you some information about how we did it.

First, lets just say that the person has coverage, but there is a pre existing waiting period. This means that they will be covered for everything on their policy unless it is due to a pre existing condition and they did not have prior insurance. If they had prior insurance while they had the condition, the pre existing is waived and they will have coverage. Pre existing will also expire, so after say 12 months the pre existing clause is usually removed. Lets say they never had insurance before though. We would send a questionaire for the member to fill out, and we would ask for medical records from the doctor's office. I have reviewed and denied claims for insurance company for this reason, and this is what we looked for.... in the medical records we would specifically look at the diagnosis that the doctors are putting. We are looking for the specific diagnosis, and related diagnosis. If there is a skin care claim that I am checking for pre existing, when I look through the medical records I am not looking for blemish on skin, I am specifically looking for an actual diagnosis given.

That being said, we are also looking for the specific diagnosis in a time period. Usually, that time period is 6 months before they were covered with the insurance company. So basically, if a guy has skin cancer they will get denied if they were seen 6 months before they had medical coverage, and they did not have insurance with another company during that time.

You can get turned away if you were born with an illness and are not getting insurance through an employer, never had insurance before, etc... however, there are always ways to get insurance. Many people don't know this but if you start a business you are entitled to provide insurance for your employees. So if someone with a pre x cond really needs insurance what they can do is start a landscaping company, and only employ themselves. So basically they can cut the neighbors lawn and qualify for insurance it's just people don't realize this.

[Junket]

So basically they can cut the neighbors lawn and qualify for insurance it's just people don't realize this.

Wow, really??

So I just have to follow these steps and I'm entitled to insurance??

I never knew it was so easy.

WHAT IS THE ROLE OF THE DEPARTMENT OF LICENSES & INSPECTIONS?
The Department of Licenses and Inspections (L & I) is the chief regulatory agency for the City of Philadelphia. One of its major responsibilities is to regulate business activity through the issuance of licenses and permits. The License Issuance Unit processes license requests and issues the documentation required to conduct a variety of activities.
HOW DO I KNOW IF I NEED A LICENSE FOR MY TYPE OF BUSINESS?
License Issuance will help you get information about the process as well as provide application packages upon request.
L & I PUBLICATIONS:
HOW TO START A BUSINESS IN THE CITY OF PHILADELPHIA
For information, call the License Issuance Hotline:
686-2490
LICENSE ISSUANCE
When you speak to a service representative, be prepared to provide:
�� The applicant name and address
�� The address of the business
�� A description of the business
The service representative will provide information on:
�� The type of license(s) the venture requires
�� The cost of each license
�� What, if any, other conditions you may have to fulfill to obtain the license(s)
(i.e., Zoning approval, Certificate of Occupancy, Health Department approval, etc.)
The representative will mail you an application package at your request. You may also obtain this material in person or by mailing your request to:
Department of Licenses and Inspections
1401 John F. Kennedy Boulevard
Public Services Concourse
Philadelphia, PA 19102
Note: If you are not calling during regular business hours, you will receive an answering service. Please leave a message and a representative will return your call or send you a package at your request.
Publication Number: 141-A Revision Date: 7/04
WHAT SHOULD THE APPLICATION PACKAGE INCLUDE?
The package you receive will include:
�� An application for a Philadelphia Business Tax Number (if necessary)
�� An application for each type of license you desire to obtain
�� Instructions about how to complete the forms
Note: Please read the instruction sheets carefully before proceeding
WHAT ARE THE STEPS TO COMPLETE THE APPLICATION PACKAGE?
When you receive the package and have read the instruction sheets, follow these steps:
Acquire all approvals that are conditions for receiving the desired license(s)
STEP ONE
There may be multiple approvals necessary to license your business. Some of these approvals are issued through L & I. Others must come from other City departments. Here is a list of departments along with common types of approvals:
1. L & I Approvals
This department regulates land use and construction. You may require these approvals:
�� Zoning Approval
No business can be licensed unless the location is properly zoned.
License Issuance will make you aware if you must apply to the Zoning Unit for approval. In most cases, if the kind of business you intend to operate is the same as the one which was previously operated at that address, additional zoning approval will not required. However, if you propose a different kind of business for that location, in most cases you will require this approval.
During the zoning review process, the “use registration” currently on file is compared with your proposed use. If the structure will be used differently from the previous owner’s use, you will require a Use Registration Permit. This permit is the City’s official record of the new use of your business site.
A zoning application can be requested by calling the Zoning Unit at 686-2435.
�� Construction Permits (Building / Plumbing / Electrical)
If your structure is new or an existing structure requires major renovations for the proposed business, the construction work must be approved by the appropriate permit units.
For information regarding…Building permits, call 686-2467
Plumbing permits, call 686-2578
Electrical permits, call 686-2513
�� Certificate of Occupancy
Some business licenses require that you have occupancy approval before you can receive a license. This usually occurs in instances when the building is new or where there is a change in use. A Certificate of Occupancy (C.O.) certifies that building requirements have been met.
The process of obtaining a C.O. begins in the Building Services section of L & I when you apply for a permit. The actual C. O. is finally issued from our district offices after the completed work has been inspected. When you apply for your business license, you may forward a copy of the C.O. to License Issuance, along with your license application. This will allow the unit to process the application more quickly. Please do not send the original document.
For information regarding a C.O., call Building Services at 686-2467.
�� Site Inspection – Business Compliance Unit
Certain licenses such as parking lots and garages, auto wrecking yards, and laundromats
require a site inspection as part of the license processing procedure. This inspection is prompted by the application itself and must be completed before a license will be issued. Your application will automatically be forwarded to the L & I Business Compliance Unit for the inspection.
�� Site Inspection – Commercial and Industrial Fire Inspection Unit
The Commercial and Industrial Fire Inspection Unit (C & I) conducts site inspections for safety factors in places of public assembly. If you operate a business such as a dance hall or dance studio, your license application will be forwarded to C & I for approval.
�� Fire Plans – Fire Plans Inspection Unit
Businesses that use hazardous materials such as compressed gas or acetylene need this approval. Plans (i.e., drawings) may be required.
For more information, call the Fire Unit at 686-2534
2. Health Department Approvals
Businesses that handle food, as well as other enterprises such as barber and beauty shops, require Health Department approval. The instruction sheet attached to your license application will inform you when this approval is required.
For more information, contact one of the following Health Centers:
District Address & Telephone Number
Center City and South Phila. (#1,2,& 6) 500 S. Broad St., Zip 19146 (685-6572)
West and Southwest Phila. (#3 & 4) 555 S. 43rd St., Zip 19104 (685-2285)
North and N.W. Phila. (#5,8,& 9) 131 E. Chelten Ave., Zip 19144 (685-2285)
Northeast Phila. (#7 & 10) 2230 Cottman Ave., Zip 19149 (685-0620)
Vendors 321 University Ave., Zip 19104 (685-7495)
3. Police Department Approvals
Certain licensed activities are monitored by the Police Department. This includes the sale of firearms and ammunition or the operation of a pool room or dance hall. The instruction sheet attached to your license application will inform you when this approval is required.
L & I will forward your application to the Police for approval, if necessary.
For more information, call the Police Department at 686-3656.
4. Streets Department Approvals
Licenses for businesses that involve sidewalks and streets, such as newsstands or parking lots, require Streets Department approval. Scaled drawings may be required. Read your license application instruction sheet carefully. The telephone number pertaining to the appropriate unit will be listed there.
For more information, call the Streets Department at 686-5501.
5. Art Commission
Signs, awnings, canopies, or similar fixtures or structures that encroach the public sidewalk or are located in certain zoning control areas may require Art Commission approval. You may be required to submit working drawings of the actual design – drawn to scale – and other documentation.
The Art Commission is located on the 12th Floor of 1515 Arch Street. For more information, call 683-2095.
Complete the application for a Philadelphia Business Tax Account Number
(If you already have a Philadelphia Business Tax Number, skip this step)
STEP TWO
The application for this requirement will be included with your package. Remember to sign it once you have filled in the required information. When you are assigned a Business Tax Account Number, it can be used for all of your Philadelphia business ventures.
Note: In order to operate a business in the City of Philadelphia, you MUST obtain BOTH a Business Privilege License (BPL) and a Business Tax Number. Obtaining a Business Tax Number alone does NOT satisfy or supercede the requirement for BPL.
Complete the license application form(s)
STEP THREE
Carefully review the application(s) and provide the required information. Remember to sign it.
Attach a check or money order for the appropriate fee amount (if applicable)
STEP FOUR
License fees vary. The fee is listed on each license application form. The cost of a particular license can be found by calling the License Issuance hotline number. Please make checks payable to “City of Philadelphia”. Do not send cash. This form of payment can not be accepted.
Compile all the required items and return the package to the License Issuance unit
STEP FIVE
Your completed application package should include:
�� Completed license application(s) (with signature)
�� Completed Business Tax Account Number application (with signature)
�� All required approvals
�� Check or money order for required license fee(s)
Mail the package to the address listed on the license application or bring it to the License Issuance Customer Service counter at the Municipal Services Building – Concourse Level at
1401 JFK Boulevard.
WHAT DOES L & I DO WHEN MY APPLICATION PACKAGE IS RECEIVED?
When L & I receives your package, the following process takes place:
1. L & I forwards your Business Tax Account Number application to the Revenue Department so that it can assign you a number.
2. The Revenue Department will forward your tax number to L & I so that License Issuance can process your license application.
3. License Issuance will review your application for completeness, process it, forward it for approvals (if they had not already been received), issue your business license, and mail it to you (or present it to you over the counter, in person, in applicable situations).
4. If your application is incomplete, License Issuance will contact you by telephone at the number you provide on your application form or return the application to you by mail for completion.
HOW LONG DOES THIS PROCESS NORMALLY TAKE?
�� Processing time depends on the completeness of your application. If the application forms are completed fully and all other applicable conditions are met, issuance of your license may be processed in the same day. However, this time period may be extended when additional approvals are required.
�� If all required information is not available at the time of application, your application will not be accepted.
�� In certain cases, applicants will be required to show some form of identification, i.e., photograph ID, voter registration card, social security card, utility bill, etc.
Note: Regular business hours for the License Issuance Unit:
8:00 AM to 5:00PM,
Monday through Friday.
WHAT CAN I DO IF L & I DENIES MY APPLICATION?
If your license request has been denied or your existing license has been revoked, you can appeal the decision to the Board of Licenses and Inspections Review.
To file the appeal, call the Board at 686-2427.
HOW DO I RENEW A LICENSE?
�� Most licenses are renewable annually and the expiration dates vary. Usually, renewal notices are sent out automatically. You simply need to pay the fee indicated on the notice.
�� In some cases, your renewal notice will tell you to file a new application. Please consult your license application and the instruction sheet for information on the expiration date and renewal process for your particular license.
�� License renewals can be made in person or by mail. Please submit check or money order. License Issuance will not accept cash.
�� Failure to obtain a necessary renewal will make you subject to enforcement action on the part of the Department.
WHAT ELSE SHOULD I KNOW ABOUT LICENSE REQUIREMENTS?
There are some common requirements pertaining to licenses:
�� Business Privilege License
The Business Privilege License is L & I’s most-issued license. Every person who desires to engage in any business in the City of Philadelphia, whether or not that person maintains a place of business in the City, must possess one. This is a one-time license and can be used for all businesses operated within the City.
�� Multiple Licenses
Some business operators only need a Business Privilege License. However, other business operators need a combination of licenses in addition to the Business Privilege License.
For example, a street vendor selling fruit and vegetables may need four licenses:
Sidewalk Sales; Food Preparing and Serving; Scales; and Business Privilege. The type of license you need depends on the kind of business activity you will engage in.
By calling the License Issuance hotline number, a customer service representative will tell you which license or combination of licenses you need.

The Greater Philadelphia Chamber of Commerce is dedicated to supporting and encouraging the continued growth of each of its nearly 6,000 member companies, and the business community at large. Its main objectives are to influence business-friendly legislation in government, participate in initiatives to improve education and the community, present professional enrichment programs, and to provide its members with cost-efficient ways to run their businesses.
__________________________________________________ _______________________
On behalf of the Department of Licenses and Inspections,
thank you for choosing to conduct business in the
City of Philadelphia.
We are happy to serve you.

[sparkle_jello]

Of course there are steps you have to follow, but it is a way that you can go about getting insurance. I know this because I've worked with health insurance for over two years. There could be other laws in different states, but this was a way that I know of people getting insurance. I've seen it.

[Junket]

Of course there are steps you have to follow, but it is a way that you can go about getting insurance. I know this because I've worked with health insurance for over two years. There could be other laws in different states, but this was a way that I know of people getting insurance. I've seen it.

Hate to break it to ya, but your industry is fubar.

[sparkle_jello]

Hate to break it to ya, but your industry is fubar.

It's no longer my industry, I'm attempting to obtain a career in law enforcement. There are some broken parts to it, but at least I can say I understand a lot of the workings that go on with it. Many people have these opinions with nothing to back them up.

[Junket]

It's no longer my industry, I'm attempting to obtain a career in law enforcement. There are some broken parts to it, but at least I can say I understand a lot of the workings that go on with it. Many people have these opinions with nothing to back them up.

What more does 99% of the population need to know besides, "Wow, my rate is really high for the services I'm actually able to obtain." or, "They're denying me coverage because of X."

Do you really care how your light switch works, so long as it works?

Most still wouldn't care once it stopped working, but I'm sure they'd still want it fixed.

[sparkle_jello]

What more does 99% of the population need to know besides, "Wow, my rate is really high for the services I'm actually able to obtain." or, "They're denying me coverage because of X."

Do you really care how your light switch works, so long as it works?

Most still wouldn't care once it stopped working, but I'm sure they'd still want it fixed.

Well, the truth is there is no perfect system. Before the recession most American's were happy with their coverage, it's the economy that is causing much of this struggle and only time can heal that. We have insurance for people with economic hardships, medicaid, medicare, and state programs are designed for people who qualify for their need.

[Mish]

You can get turned away if you were born with an illness and are not getting insurance through an employer, never had insurance before, etc... however, there are always ways to get insurance. Many people don't know this but if you start a business you are entitled to provide insurance for your employees. So if someone with a pre x cond really needs insurance what they can do is start a landscaping company, and only employ themselves. So basically they can cut the neighbors lawn and qualify for insurance it's just people don't realize this.

So as Fras pointed out, that's not actually the case^

So, if you have a condition you were born with and you get turned away that's pretty much it for you?

[sparkle_jello]

So as Fras pointed out, that's not actually the case^

So, if you have a condition you were born with and you get turned away that's pretty much it for you?

No, it is not. There are many people with pre existing conditions that get health care.

[Mish]

No, it is not. There are many people with pre existing conditions that get health care.

And the ones who can't?

[sparkle_jello]

And the ones who can't?

There will always be a few people who can't be helped for whatever reason, but this goes for more than just health care. If you look at the big picture though, many countries in Europe wont treat someone the same if they are very old. I don't know much about european hc, but I know there was a woman who found out she had lung cancer, they would make her 'comfortable' but wouldn't pursue expensive treatment because of her age... this wouldn't happen in the US.

[Junket]

There will always be a few people who can't be helped for whatever reason, but this goes for more than just health care. If you look at the big picture though, many countries in Europe wont treat someone the same if they are very old. I don't know much about european hc, but I know there was a woman who found out she had lung cancer, they would make her 'comfortable' but wouldn't pursue expensive treatment because of her age... this wouldn't happen in the US.

I don't necessarily see that as a bad thing, but that's getting off topic.

[sparkle_jello]

I don't necessarily see that as a bad thing, but that's getting off topic.

I was merely stating that people slip thru the cracks in every system. If a good person that has been a productive member of society goes ill, I would have a hard time denying him treatment. I don't think getting health care should be for the elite, but I don't think you should be able to get it if you are not a productive member of society.

[Mish]

I was merely stating that people slip thru the cracks in every system.

What's the comparison in numbers though? There are 40 million uninsured in US, that's 1 for every 5 people. I don't think there are as many people slipping through the cracks in Europe.