Health Insurance Companies Tell Women: You're a Pre-Existing Condition

Health Insurance companies have waged a war against women and people who need them the most in the United States. I witnessed this first hand when my sister was battling metastatic breast cancer for two years. I remember our family and the doctors office staff spending hours fighting with her HMO provider for life-saving treatments like simple blood transfusions when her blood counts were dangerously low and jumping through hoops to get the health insurance company to sign off to see a specialist. My sister, who passed away from breast cancer, is just one of thousands of people across the US whom the health insurance companies have completely failed when they were in dire need.

According to an investigation by the House Subcommittee on Oversight and Investigations, in the past five years, health insurance companies like WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled 20,000 people's health insurance. As a result these insurers avoided paying more than $300 million in medical claims. This practice is known as a "recission" policy where health insurance companies cancel policies of Americans who have been diagnosed with breast cancer, lymphona, and over 1000 conditions like acne and pregnancy.

Now that my husband and I are thinking about planning a family, I have been looking more closely at our own health insurance policy and our maternity benefits. As I was researching, I was shocked to learn as a fertile woman, I'm basically considered a pre-existing condition. Check it out.

• According to the Family Kaiser Foundation, only 14 states require individual market plans to include comprehensive maternity coverage. 36 states don't have to cover maternity benefits and can end up costing women $7500+ for a normal pregnancy and delivery all the way up to $100K+ for high risk, complex pregnancies, deliveries, and neonatal care depending on where you live. The result of just this one loophole? 79 percent of women with individual market policies do not have any maternity coverage.
• Defending the practice of not covering maternity care, one insurance official called pregnancy a "matter of choice."
• Many insurance companies consider C-Sections a "pre-existing condition." In Colorado, a subsidiary of United Health, one of the biggest insurance companies in the nation, "simply rejects" women who have had C-Sections. Note: Approximately 30% of births are via C-Sections.

And the list goes on. Health Insurance companies also charge women 48% more than men for the same individual (not group) coverage and can deny women coverage if they have been a victim of domestic violence.

• In 2008, 14.5 million American women purchased individual health insurance. These women pay up to 48% more in premiums than men, said Speaker Pelosi in a recent report. This discrepancy is due to an insurance industry practice known as "gender rating," which permits insurance companies in most states to charge men and women different premiums for the same coverage.
• In all but 12 states, insurance companies are completely free to continue the "gender rating" practice.
• In eight states and the District of Columbia, it's perfectly legal for insurance companies to deny coverage to victims of domestic violence.

I get that health insurance companies are in the business of making money, but considering women a pre-existing condition is despicable. "It is shocking to think, that [unless we are proactive] over half of the population of this country could be discriminated against in one of their most basic life's needs, said Senator Kirsten Gillibrand (D-NY). "We must reform our broken system ... end disparities [based on] race and gender and make quality health care affordable for every single American." Amen!

Resources for taking action on women's health care reform

Twitter petition to Senator Harry Reid and the White House

Tell Congress: "I am not a pre-existing condition!" Petition by SEIU.

Tell Congress to Improve and Move the Health Reform Bill
Petition by National Women's Law Center

Senate Hearing: What Women Want: Equal Health Care for Equal Premiums

Keep Anti-Choice Extremism out of Health Care Reform
Petition by NARAL

Disclosure: NWLC and SEIU have or have been clients of my firm Rad Campaign. The work performed was not related to women's health care reform.

 

Follow Allyson Kapin on Twitter: www.twitter.com/womenwhotech

Comments

[SoCalGal2008]

09:31 PM on 10/16/2009

Thank you Allyson for your post. Seeing some of the people who made comments saying all its need for this country to do is eat better and read fine print shows how complete ignorance the comments are. I been in biomedical science for many years, while there are risk indicators for diseases, that does not mean eating healthy, maintainin­g a healthy life-style guarantees that you won't get sick, if you think that, that is completely NAIVE! While its always good to live a healthy lifestyle, yes you may reduce your risks, thats all it does. There are healthy 20 year olds who get Leukemia, there are people who have NEVER smoked in their life who get lung cancer, so please educate yourself before you go on preaching. By the way Keith Olbermann had a great special comment tonight, every one should listen. Health care reform is not about profits, its about someone's right to LIVE! Its a human right and its should not be control by insurance executives making million dollar profits! If you think oh I don't want to pay for some one else's health care, well, think about this, one day that could be you, or your friend, husband, wife, child, grandchild­, father, mother, that will be effected by your greed. So unless you are super rich, you are not immune to the downfalls of health insurance, and you can read the fine print as much as you want, but if its not covered, then what?

[Allyson Kapin]

08:06 PM on 10/16/2009

Thanks for everyone's comments.

@cydRN - Agreed we need true health care reform - not a band aid.

@nml123 - The insurance companies make it incredibly difficult to navigate through their red tape. It is a bureaucrac­y. Have you ever tried to deal with them when you were deathly ill and could barely get up to walk to the bathroom, not to mention dealing with all of the side effects from the treatments and pain meds? BTW - my sister was an ivy league graduate, and a pretty establishe­d business women, so please don't say that the key to fixing health care in this country is to be smart. Gaps in health care happen all the time due to job loss, etc. Like @wearyvote­r if you go from group insurance to individual insurance your pre-existi­ng conditions don't get covered.

@MJinCanad­a - Thank you!

@Ameriki - I was with you until you said people should give up their health care plans. That's bad advice.

@rockyroad - It is ironic.

@humpfree - I don't think there should be gender biases for any type of insurance.

[cydRN]

04:48 PM on 10/16/2009

Insurance companies have operated with impunity for far too long in this country. They must be held accountabl­e.

When executives are taking home multi-mill­ion dollar bonuses and adjusters get paid for denying claims something is wrong and needs to be fixed.

At the very least we need regulation reform with teeth. We are not talking about widgets but people's lives.

[nml123]

06:16 PM on 10/16/2009

Yes insurance companies try to get away with not paying large claims, but if you are educated and understand your procedure, policy and what is covered and make sure to adhere to the fine print in your contract, you can get any claim paid. trust me, i couldnt find a job in neuroscien­ce after college and had to take one as a claims adjustor in health insurance field and picked it up all in a few months. People need to take self responsibi­lty and understand their coverage and needs, most just go off hearsay from media, friends, drs (note: there are doctors out there who will convince you to have unnecesary services rendered, that they know the insurnce company wont pay for, which means you have to pay full out of pocket at what ever rate they charge)... point being, your responsibl­e for yourself and making sure you have coverage, but more importantl­y the state of your health. and bonuses and big execs have nothing to do with americans living off mcdonalds and putting soda in their babies bottles, not the healht insurance company.

[nml123]

06:25 PM on 10/16/2009

THANK YOU! yes we need reform, but insurance is a last priority comparitiv­ely. At the very least, we need parents to do a good job raising their kids, so they know how to behave responsibl­y ( not more laws governing behaviior (ie. dont drink and driver or talk on cell, wear a seat belt, dont light people on fire after you try to steal their dads bike and they report it) ...and teach them how to live healthy lives (i.e. good nutrition, exercise, knowledge of mental health, how stress can affect your health.. GUESS WHAT: having a big belly/ fat tummy can cause ed bc the fat cells decrease testostero­ne making it increasing difficult to .. so you dont need viagra..ch­ain smoking can lead to lung cancer which is one of the most expensive services the eldery subscribe to..... does anyone out there get it.. your actions and behaviors can in the long run affect your overal health and well being )...

[mmmd]

08:19 PM on 10/16/2009

The human body is not designed to go on indefinite­ly. You can do everything right, yet it will falter sooner or later. You will need health insurance at that point. The frightenin­g thing is it may not be available to you because of some fine print.

How about the things we can't control? All the pollution that we are subject to? Autonomic diseases that are on the rise, and cause significan­t morbidity? Economic conditions that make it impossible for people to buy organic? Genetic peccadillo­s that make us more susceptibl­e to high blood pressure, diabetes or cancer?

Sure, "your actions and behaviors can in the long run affect your overal health and well being", but it's naive to think every health problem can be averted by chewing celery.

[nml123]

04:37 PM on 10/16/2009

FYI: pre-existi­ng conditions are irrelevant if you have continuous coverage, but however if you choose to NOT insure yourself until you are pregnant or have a fatal disease, after years of no coverage, but now want it because of this problem, well yes you will have a pre-x, its not called insurance so you can only get it when you need it.

[wearyvoter]

07:15 PM on 10/16/2009

However, if you move from group to individual coverage in most states, pre-existi­ng conditions clauses kick right back in, even if you've had continuous coverage. Every time we shop for a new individual plan after my husband's insurance rates get jacked up, we restart the clock on anything that's been treated within the previous 5 years.

Also: You can be a non-smoker and still get lung cancer. (Dana Reeves, Christophe­r Reeves' widow, died of it, and she never smoked.)

[MJinCanada]

10:50 AM on 10/16/2009

I am so sorry about your sister. I hope the fight for universal health care will be successful­.

[Ameriki]

09:10 PM on 10/15/2009

The health insurance companies did not fail your sister and the thousands of other people. We failed them. We failed them by having health insurance instead of health care. We as individual­s and as a country would be better off if we canceled our insurance policies and saved the monies spent on premiums. You are going bankrupt if you get seriously ill in this country; sooner if you have no insurance, later if you have insurance (insurance only prolongs your slide into paupery). Our Congress assured of us utter poverty when they "reformed" the bankrupcy laws a few years ago. Now your debtors can take everything you have and you still must pay them for the rest of your life. Indentured servitude.

[rockyroad]

08:02 PM on 10/15/2009

Seems ironic that the pro-life forces are not all over the insurance companies about the disparate treatment of women. If more women had maternity coverage, and if Viagra weren't covered (as birth control often isn't), thousands fewer women would seek abortions.

[easarsfield]

10:31 AM on 10/16/2009

you would think. I mean, that would be logical.

The policies propped up by Pro-lifers rarely make sense.

[humpfree]

07:59 PM on 10/15/2009

Gender rating happens with auto and life insurance. Women typically pay less for those types of coverage? Where's the uproar?

[Timma]

10:51 PM on 10/15/2009

Humpfree - Yes I agree on your premise that no insurance should be based on one's gender actuarials notwithsta­nding. But what a strange argument you make - How is an automobile like health? As to life insurance - unless you're buying a policy worth millions, an annual life premium isn't near the cost of health insurance.

[humpfree]

12:14 AM on 10/16/2009

The cost of insurance doesn't change the actuarial charts. That's all we're dealing with here. What is the risk? Who's at the greatest risk? This is how all premium rates are devised. Women at the prime age of child birth are a bigger risk. Now consider this- women beyond this age are not. They live longer with fewer health issues. Insurance carriers that rate on gender take this into account, charging more for older males. It's not personal. It's clinical.

I'm not saying it's a good thing. I'm pointing out the dynamics. When you ask for a parallel between auto coverage and health coverage you need to understand­, both are based on the same type of risk assessment­. Insurance, health or auto or home, public or private, is indentured to the same principle- the potential cost of insuring the insured. The only difference in single payer or Medicare/M­edicaid is that the cost of insuring those with a greater risk is shifted to those with less. It might be the answer. It might not. But until everyone taking part in the debate (our law makers 1st & foremost) understand exactly what they're taking issue with we won't have any chance at a meaningful solution.

[MJinCanada]

10:46 AM on 10/16/2009

You are arguing premium costs. That's only part of the problem. The bigger issue that you are avoiding is that insurance companies deny life saving treatments despite higher premiums.

What if your life insurance policy refused to pay your beneficiar­ies because you preferred cake to fresh fruit for dessert?

[humpfree]

01:33 PM on 10/16/2009

I'm not ignoring anything. I'm making a specific point on gender rating.

As for insureds being denied treatments­, you bring it up as if it's standard industry practice. But for every horror story the Huffington tells about someone ill or injured being denied treatment, there's countless more receiving costly life saving treatments at the insurers expense. That's not news so we never see it on the front page.