Sorry, Sir, Firefighting Is A Pre-Existing Condition
According to internal insurance industry documents recently released to the press, the reasons health insurers cite to deny insurance to private individuals is limited only by one's imagination: cops. firefighters, construction workers, and war correspondents are among the occupations that some insurance companies have considered deal breakers. Similarly, acne, allergies, ADD, and even bunions have caused companies to deny customers coverage.
The nonprofit group Consumer Watchdog released the documents, which date from 2003 to 2006. Known as underwriting guidelines, the materials were used by insurance sales personnel to find customers healthy and low-risk enough to cover. PacifiCare Underwriting Guidelines (2003), for example, instructed underwriters to deny coverage to athletes, loggers, police, firefighters, migrant workers, war coorespondents, and many other "ineligible occupations."
Health Net guidelines for 2006 say that people could be denied coverage or charged higher premiums if they were taking certain medications, including Zyrtec, an allergy remedy, and Lamisil, which is widely advertised as a treatment for toenail fungus.
Pregnancy and expectant fatherhood are common grounds for denial. Blue Shield of California's 2006 guide even goes a step farther and considers families with an adoption in process a "declinable condition."
The documents are several years old, however, and therein lies the defense. A spokesperson for PacifiCare, Cheryl J. Randolph, told the Washington Post that the underwriting guide in question "is completely outdated and predates the acquisition of PacifiCare by UnitedHealthcare." A spokesperson for Wellpoint refused to comment, citing the papers' age.
No doubt the other insurers would respond similarly... so here's a challenge for them all: why not release your current underwriting guidelines and show us how everything has completely changed in three years? Yes, I'm sure that despite the lack of any significant legislative or other policy reform, everything is totally, completely different and rosy now.
The funny thing is, the insurance lobby has actually shown support for outlawing the denial of health insurance for pre-existing conditions. If all insurers are forbade from cherry-picking customers, individual companies with more enlightened practices don't have to worry about competing against their more discriminating competitors. More people end up insured, and everyone wins.
Pre-Existing Health "Conditions" — Cops, Firefighters, Expectant Dads, and Those Suffering From Allergies, Acne and Toenail Fungus Are Uninsurable According To Internal Documents [Consumer Watchdog]
Acne, Pregnancy Among Disqualifying Conditions [Washingpost Post]
(Photo: Army.mil)
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Are there companies with more enlightened practices? At this point I'd go without "a choice in the free market" since I don't enjoy playing Russian Roulette with my one body.
IIRC from a recent episode of Top Gear, saying you are a reporter or television personality increases the amount you have to pay for insurance in the UK.
I was denied insurance a few months ago because I was pregnant. It actually said on the letter to some effect, "due to you being pregnant, you may not recieve blah blah".
They must have failed to notice that I am a man ("I look lika man!"), and that the insurance request was for me and me alone. My wife has her own insurance, and while my stomach may be getting into the double X territory, I had to convince them I was not pregnant.
I took Lamisil years ago for like 3 months, and when I applied for insurance, it was one of their major red flags that almost had me denied coverage. I am not sure why this is...supposedly the medication can be hard on your liver or something, but it is supposed to be safe...I feel like there is something someone wasn't telling me. "OMG...I had no idea you took that...sorry, no life insurance for you."
@ShruggingGalt: When I was a freelance animator I didn't have insurance. I'd bounce from job to job, work two months here,three months there. No stability. And because of that no insurance.
I got several quotes (I was 24 at the time, great health) and the cheapest insurance I could find was about $800/mo (more than my rent in Philly). The costs were prohibitive so I went without healthcare for about three years. I couldn't imagine what it'd be like for people with actual issues.
@Saboth:
Lamisil + booze = cirrhosis. If you answered "yes" to even occasional drinking, I expect they'd be worried.
I have a pre-existing heart condition and just switched companies...no problem. All I had to do is send the letter from my previous company that I had continuous coverage. I don't blame companies for not taking on new customers who weren't insured previously and now all of a sudden may come into high bills that they want someone else to pay. It's like closing the barn door after the horse ran out. Makes me wonder if many of those people would cancel their coverage after their proceedures were paid for. Seems like a good way to save a few thousand for a minimal monthly payment.
This is just scary, and angering. Seems they don't even have to have any reason to deny coverage.
"oh, you're breathing...sorry that's a preexisting condition." Big read stamp DENIED on the application.
Whatever our government comes up with for plans, they better stipulate that insurance companies have to cover people no matter what. They need to make sure all the loopholes are plugged, and also make it so that it is affordable.
@GitEmSteveDave_SomeAssemblyRequired: I saw that episode of Top Gear several years ago and they were talking about auto insurance.
This is why I never take any medication and never go to the doctor because I know if anything ever shows up I will end up being denied coverage. Right now I keep a minimum of coverage just so they can't say I came down with something during the period of non-coverage. I'm essentially paying $200 a month for nothing.
Watch out!
If you've ever breathed Oxygen and discarded carbon dioxide, it might be considered a declinable condition!
Obviously this is that communist Obama's fault.
@GitEmSteveDave_HasANewNameToday: But insurance is a very different matter there because of the NHS.
@Underscore_Lysdexia: I always knew my addiction to aerobic respiration was going to come back to bite me in the ass.
@madog: Important: my wife was pregnant. So while it was stupid, it was just poorly worded because it didn't take much to convince them otherwise.
@GitEmSteveDave_HasANewNameToday: That was from Series 07 Episode 04, aired 4 Dec. 2005, the episode where they all buy mid-engined Italian supercars for under £10,000.
They were talking about how much they would have to pay for car insurance. Jeremy Clarkson said he lives out in the countryside and was a Doctor, while James May was truthful, saying he's a television personality living in a not-so-great part of London.
If I remember correctly, there is no health insurance in the UK. They have national healthcare.
@madog: I'm calling Ms. Swan, I've got you now.
How fun was it to call them and tell them you're the pregnant person they wouldn't cover?
@Sunshine1970: The flip side to covering people "no matter what" is that people will often wait until they're pregnant or have cancer and then walk into an insurance agent's office and say they want a policy. The problem's called adverse selection, which means that people who are poor risk are more likely to seek out coverage. The only fair counterpart to mandatory approval is to require everyone to carry coverage.
The more I hear about your healthcare system, the more it makes me happy to be Canadian. I don't know how anyone could possibly think that universal healthcare is a bad idea. It boggles the mind. Police, Fire, roads, defense, governance . .all paid for by everyone, yet healthcare isn't? What is wrong with you guys?
Public Option.
'nuff said.
@madog: Maybe they realize pregnant women are moody, and are afraid of the injuries she may cause you...
Last week the What's Your Problem column (by Jon Yates) in the Chicago Tribune ran several anecdotes focusing on the failure of healthcare coverage. Interesting and appalling reading.
"...the underwriting guide in question "is completely outdated and predates the acquisition of PacifiCare by UnitedHealthcare."
Yeah, because that acquisition made things SO much better. My co-pays for office visits and prescriptions have only doubled in the last two months. And premiums have gone up by a third. *hedsmax*
I have not had health insurance for...well lets just say a long time after being insured and letting it lapse and then having Blue Cross deny me coverage (over 20 years ago!) So far I have been lucky and the few times I have been in the hospital I have paid for the procedures myself. (was still cheaper overall than if I had been paying premiums)
I am going back to school and have found that "having health insurance" is a PREREQUISITE to taking classes in my major!
I do not work for a company with a health plan so I have to get one on my own and I have been denied in the past because of... a pre-existing condition. One that involves me taking 1mg of a pill every day so I can sleep fine. That's it.
But I can't get Health Insurance because of this.
(well I CAN, but I cannot afford the premium of over $1000 a month)
I also found that most every college REQUIRES students to have health insurance and appear to have some sort of agreement in place with Health Insurance companies so that you are AUTOMATICALLY signed up for their Health Insurance Plan UNLESS you can prove to them that you already have Health Insurance (through work, spouse, parents etc...).
So when I heard about this and saw the prices, I thought "hey, this sounds great, I can get student coverage!"
Unfortunately the cutoff point for the "student" plan is 30 years of age.
I am older than 30 so I am SOL.
I have tried to ask WHY students are REQUIRED to have Health Insurance to take classes and just get BS replies like "Well, we want to make sure that our students are able to continue their education despite having a health problem".
Really?
So if I have an accident or get cancer I will somehow magically be able to keep taking classes? Really?
If I manage to get a policy that has a $100,000 deductible, does that mean I "have Health Insurance"? Does it?
So lets say I am taking classes and then I end up in the Hospital for a week for something but my deductible is $100,000 (that I have to pay) how does this affect my classes any differently than if I did NOT have ANY Health Insurance?
I mean if I DON'T have Insurance I would just go to the ER and still get the same damn bill that I would have to pay off. I don't see any difference.
I have found some private Health Insurance policies that appear to cover me ONLY while I am taking classes (?) and the cost of the policy is basically equivalent to my tuition costs, except I don't really get anything in return. (super high deductibles)
check out the typical preexisting conditions quiz you typically have to go through just to get a coverage in America.
sure, the insurance companies support a mandate that everyone carry insurance. then they can compete on the basis of who can turn down the most claims from their (over)paying customers.
health insurance does not equal health care.
@shannanigans slash pterodactyl: they need to be regulated. This industry is ripe for abuse because the market for healthcare is so inelastic.
@Fuzz: Never fails. Every single time, some blowhard from Canada tells us how it is. Thanks, we know.
@microcars: Partially it's to protect you, the student. Mostly, it's to protect the university and other students from being sick through your negligance. I was required to have insurance while I was in college, as well.
i was denied insurance because i bumped my funny bone and the doctor speculated on my chart that my pain might be due to a subluxing ulnar nerve, a genetic condition. no diagnostic tests to prove such a thing, just a hunch. good times.
Maybe we all could just shop around for better insurance, and pick the best plan that covers us.
Wait? What's that? I *can't* shop around for better insurance?
Oh, right.
INCREASE competition-- don't eliminate it.
@Daveinva: Because remember-- Americans can be trusted to buy our own car insurance, home insurance, renters insurance, life insurance, pet insurance, asteroid strike insurance. . . but we can't be trusted to buy own health insurance.
@Alys Brangwin can't stop the beat: There is most definitely private health insurance in the UK. Every citizen automatically pays into and has NHS, ie, bankruptcy protection.
@Preyfar: Did you have pre-exsiting conditions? At 23, I was able to buy my own insurance for $115 a month. I got a letter the month before I canceled (I had a job with insurance by then ) saying that it would go down to $98 a month at the beginning of the next year. I know their are regional difference in cost, but $700 difference between Raleigh NC and Philly seems unreasonable.
@Saboth: It occurred to me that the Lamisil denials may only be because the drug is (or was at that time) under patent, so very expensive. My Zyrtec was about $100/month, if I recall correctly, before it went generic and subsequently over the counter a couple of years ago.
@AllanG54: Not every person who is denied coverage was not covered at one point. I actually got denied after being covered for 18 years under my parents. It just depends on your pre-existing condition and how much they think they will have to pay for it. The more expensive it may get, the less likely it will be that you will get coverage. You got lucky so good deal there but don't assume that people who CAN NOT (not will not) get any kind of coverage are dead beats.
@pecan 3.14159265: lets be honest about it, it's how schools get great benefits for it's staff and having a larger base of coverage to keep their premiums down.
I had coverage and didn't show it in time and thus they signed me up automatically. I had to "prove" I had coverage so they could remove it.
But I wonder how many students who go to school don't care if they're signed up (because the fee is so small) thus making their would be small coverage policy into a larger one.
Nothing is ever done out of the kindness of somebodies heart.
@AllanG54: Except for a lot of people that have gaps in coverage have it because they can't afford it not because they were uninsurable due to health problems. Private remiums are pretty prohibitive for even young healthy people. This is my last week of work since my company's going out of business and so I'm losing healthcare. I'm going to TRY and get onto the state's plan but if I don't I can't afford COBRA so I'll be going uninsured. It's not all due to bad health.
@ShruggingGalt: The problem is that fewer employers are providing health insurance for various reasons, and its too expensive for most people to buy a policy on their own. As long as the price of individual policies are high and employers are required to provide a policy for all employees (regardless of status), then young people will refrain from buying their own policies.
So if having insurance is to be mandated, then the price has to be reasonable, or subsidized.
@chrylis: Roger that on the mandatory approval/mandatory coverage.
Car insurance is largely the same thing, with Your Good Government(TM) mandating coverage for the same reason, to prevent honest responsible drivers from having to pick up the slack for dishonest unresponsible drivers.
OTOH, I can buy car insurance from a number of local, state and national insurers, each of whom can tailor a policy that matches my state's requirements. Getting the individual state health insurance mandates (only one guy I know of who needs pregnancy coverage so far) out of the way will help, too.
@microcars: If I had to guess, I'd say it's for the same reason they require proof of imunizations. Someone with health care is more likely to go see the doctor when they get swine flue (or whatever) than to just tough through it and go to class, causing a school wide epidemic. Doesn't make it justified, but I can understand the fear of an epidemic in an area with so many stupid kids so close together
current college students: don't get pissed about me calling you stupid. You may have a 4.0GPA, but I promise you do all kind of things that you will look back on and be like what was I thinking.
Carrie good catch on their reversal - the insurance companies have publicly stated they won't oppose a removal of preexisting condition clauses so long as everyone is mandated to buy insurance.
So long as the young healthy people don't buy insurance, "costs" will never go down. It's like trying to buy hurricane insurance in places where hurricanes hit. Do you think it's going to be cheap?