Pre-Existing Conditions
Advocates for health care reform typically emphasize either restraining cost or covering the uninsured. I understand the practical and moral facets of both arguments but believe advocates are dramatically underemphasizing the most potent issue: the tendency for insurance companies to deny coverage to people with pre-existing conditions.
The ranks of the uninsured include both people who want to have insurance but can't and those who don't want insurance -- in other words, both the needy and the comfortable.
By contrast, most everyone who had been turned town for coverage because of a pre-existing condition is suffering. And on a gut moral level, the idea of denying someone coverage because they had cancer last year ranks just as high in my book as the abstract argument that a just society should "cover everyone."
As one of the commenters on my blog wrote after describing her friends who can't get insurance because of pre-existing conditions, "we are all one job loss and major illness away from personal financial ruin."
Solving the pre-existing condition issue may require a broader coverage base but to me we have the cart before the horse both ethically and politically.
I heard Kathleen Sebelius on the Daily Show the other night and once again she was emphasizing the uninsured and "costs." I remain baffled as to why health care advocates don't stress the pre-existing condition issue.
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Let's get the issue straight. If an insurance company refuses to pay a legitimate claim, that is a crime, and it should be punished. However, if they refuse to sell you insurance, that is the company's right. As for pre-existing conditions, health issurance is INSURANCE against POSSIBLE future costs. If you have an increased chance of incurring costs (big costs), you're not a good risk. If pre-existing conditions cannot be considered, what's to stop someone from waiting until they are sick to seek coverage?
I was just canceled by Humana for a so called pre-existing condition. This plan, did not cover normal office visits or tests. It was a so called catastrophic plan, with a high deductible.
Six months after obtaining coverage. I went to my new doctor for an initial visit. Humana then sent me a letter stating that I did not have coverage for the prior twelve months prior to signing up with them, therefore my coverage was "under review" and no payments would be applied toward my deductible. This had all been revealed to them when I signed up. I told them this was why I was applying. Because I had not had coverage for over a year, after leaving work.
They found no problem in accepting my payments. However when it was time for them to credit me for my out of pocket expenses, they refused. I told them if I was receiving no coverage, I saw no reason to continue paying them. They sent me a reply simply stating that "due to your request, we have canceled your policy. However this will not affect our review of your case". They then finally sent me a letter stating that they would no longer be able to provide coverage for me in the future.
After a brief hospitilization for afib, I now join the long list of people without healthcare and huge medical bills!
My niece has a PRE APPROVED shoulder surgery. After all was said and done, she was denied payment on the claim. $60,000 out of pocket now she owes. Shes was off work for a couple months and no disability pay availble to her. Her and her hubby barely earn over minimum wage. They will either be forced into bankruptsy or be debted their entire lives. Why on earth did the insurance company pre approve this only to deny it after the fact. She never was treated prior for this issue but because she was on her job less than one year, the insurance labeled it pre existing. This has been submitted to the state Attorney Generals office in MN with the help of the hostpital and hopefully they will able to help her. The hospital is presntly taking $200,00 per month out of her wages and again they make just over min, wage, Its sensless!
I am sorry to hear this, but I also want it known that had the insurance company paid the claim, they certainly would not have paid $60,000. Yet the hospital is getting away with charging your neice the $60,000. If you have anything, and think you can just walk away from the bill, you are wrong. The hospital will go after you through collection agencies and the starting bill will be $60,000. So this idea that people with no coverage are a burden on people with coverage, are just plain wrong.
Couldn't agree more. I lost my job with the state last year so am now paying over $500 a month for COBRA because no one will insure me due to "pre-existing conditions" (I was born with "issues").
I will lose the COBRA coverage at the end of this year, so if I don't find a job that offers health insurance, I'll be uninsured, and uninsurable...again. When I was 29 I filed for bankruptcy because I had over $40K in medical bills. Since then, I'd been fortunate enough to have a job with the state with good insurance, and now I fear that I'll be in the same place again, only this time I've worked hard to buy a house and stand to possibly lose that as well as any savings.
I feel for anyone who is not working who has to pay for health insurance on an individual basis but so many people are confused by "pre-ex". if you have had continous coverage for 12 months you are not subject to pre-ex on a small group plan. Having a small group is as easy as setting up an LLC with a spouse and buying a group plan. if you work for a company that offers coverage, again no pre-ex if you have had continuous coverage. If you work for a large company many times pre-ex doesnt apply even if you did not have past coverage. When pre-ex does apply it is usually for a certain time period, and with universal health care the wait to see a doctor could be even more then the pre-ex waiting period. I cant go crash my car and THEN go by coverage for the damages, why should it be different with any other coverage. Medicare is FAILING and deeper in debt then we ever imagined. Do we really want a company (the goverment) that is failing with health care to take over our care? www.smallbizbens.com
So, if they can't cull you out by using a pre-existing condition, they'll do it by recission, alleging fraud for some ridiculous, unrelated excuse. UnitedHealth didn't get a 155% increase in profits last quarter by paying claims.
So when I looked into starting my own business and investigated getting health insurance, the agents I talked to were wrong when they told me I could never get a policy? I have a medical condition (I refuse to call it "pre-existing.") which is not a problem for me now, but has the potential to cost big bucks if it flares up in the future, which it may never do. I was honest about my medical history with the insurance companies and was told that I would not be issued a policy - at any price - not for me and not for any employees. How does my experience jibe with what you've described?
My condition exists and it's not going away. Who would ever insure me if I leave my corporate job with their group policy?
This comment illustrates a large hole in the health bill. The reason insurance works is because people that are not sick pay it. What kind of incentive does this give healthy individuals to purchase insurance? I can't believe people are not talking about this. It boils down to two problems.
1. By allowing unhealthy individuals to purchase insurance with prexisting conditions the price for healthy individuals will increase as well. After a matter of time healthy individuals will drop the coverage increasing rates further.
2. If people can get health insurance regardless of their preexisting conditions the incentive to carry coverage when one is not ill goes down. I mean, if a healthy person goes without insurance due to the expense and contracts cancer, under this plan he can go get the insurance without any penalties for a preexisting condition. This would raise the insurance premiums for everyone and further discourage healthy people from purchasing coverage.
If any type of legislation were to be made to solve the problem the only practical solution would be to force all people to purchase insurance like people are forced to purchase auto insurance. Otherwise people have no incentive to do so. If A bill like this passes, believe me, I won't pay for insurance until I need it and it can be written off as an expense to a poorly planned piece of legislation.
I have a brother with type 1 diabetes who had to have the inevitable kidney transplant (had it since he was three). He does have insurance through the American Dental Association because he's a member but it's wicked expensive, over 2 grand a month.
Because of his transplant and the very expensive anti-rejection drugs he's rapidly approaching his lifetime limit of 2 million. He's only 44 years old, has a wife and 7 year old son. He has to be on those drugs for the rest of his life and will need another transplant probably in about 5 years or he'll die. There's no way, if the system is not changed, any company will cover him for that.
The pre-existing condition denial practice by insurance companies is a major factor in medical bankruptcy and people being uninsured. Not to mention unnecessary deaths.
There is no such thing as a human being without a pre-existing condition.....that would take genetic perfection and staying locked in a padded room your whole life, never coming in contact with anyone or the outside world at all. It should be illegal to deny care due to 'pre-existing conditions and illegal to gouge them with exhorbitant fees. I wish Congress and Obama would address this issue a lot more often and more strongly than they are.
I think the problem is in the wording. Health Care and health insurance are two different things. Countries that have Universal health care give different service than countries (are we the only one?) that only provide health insurance. I don't want health insurance I want health care. With good health care you don't need health insurance.
Because this has never been a key issue for Sebillious. HHS was a payback for early support in the primaries. I think she is hoping for a bill that sounds OK so they can have the Health Care Reform checked of the list of promises. She is not a visionary.
Everyone talks about the insurance companies, but the fact is that other corporations control us and hold people hostage with employer-sponsored plans. The cost of health insurance is astounding, but they'd rather pay it than demand change because that's what really matters to them. It's the best justification for "Medicare for everybody" and it's also the reason that the congress is not going to end employer-sponsored plans. America, Inc does not want that.
Another issue is the "optional" treatments that insurance won't cover that are "required" for your insurance-approved provider to do any actual work.
I had dental insurance for 6 years (before I got laid off) and watched my teeth rot away the whole time.
The assembly-line dental place I "selected" out of my 2-3 options refused to do any work on my teeth unless I coughed up $600 for the "optional" deep-cleaning, the dentist said it was so they knew "what color" to make my caps/fillings. My teeth were falling apart and he kept repeating "you'll look like a movie star, you'll have Tom Cruise teeth", etc.
I didn't care about the cosmetic stuff, I really just wanted to chew my food and not be in pain. I'm sure my "insurance-approved" dentist got a bonus for "cutting costs", I'm just upset that when the ploy to get a few extra dollars out of me didn't work (because I didn't have the money upfront) he wasn't interested in giving any actual treatment for what I was supposed to be insured for.
Years later when I got laid off (for the last time) and with several teeth less I got some independent contract work and paid for a private dentist myself, it was much less than I was quoted WITH insurance AND the dentist was actually willing to perform the work without trying to screw me out of a few extra bucks.
Do you buy car insurance AFTER an accident and expect the insurance to fix your car? No
Do you buy fire insurance after your house burns down and expect it to be rebuilt for the price of your premium? I don't think so.
Do you buy flood insurance when your house is under water and expect it to be rebuilt? No
Pre-existing conditions are the same.
You're comparing cars and houses to PEOPLE and think that they should be equated somehow? You've got to be kidding, right?
I'm comparing preparing for future problems. That is equated.
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Piffle. You can't treat humans as inanimate objects. Oh, well, maybe YOU can -- work for the insurance industry, do you? Nebber mind.
I do not work for the insurance industry. I plan for the future.
Someone decides to take the risk of not having health insurance. Then they get AIDS and require $600,000 of treatment. Do you really expect any company would sell a policy for $200 a month knowing they have to pay $600,000? If that happens then nobody would buy insurance until they needed major medical treatment. The person taking the risk is the one who should have to live with their choice.
What do you want next? To let terminal cancer patients take out $1,000,000 insurance policies? How about letting families buy life insurance for someone who died?
No, they are not same. Imagine having insurance, getting cancer, losing your job, being dropped by your insurance company and then being unable to obtain new insurance due to your preexisting condition.
If you lose your job you can get COBRA to bridge you until you get a new job. If you have a pre-existing condition the new insurance has to cover you if the COBRA is in place.
When you make the choice to live without insurance don't ask me to pay for your bad judgement.
The problem is our history of employer based coverage. You and your employer pay for insurance, but it is not portable if you lose your job. If you don't find another job immediately, you have to buy private insurance and the list of conditions that make a person uninsurable is very long. Acne is one.
It's completely different. I've had health insurance for the last 30+ years. But if I were to get skin cancer, I could be denied coverage because I had a bad sunburn in my teens. That's the lengths the insurance companies go to to deny coverage for "pre-existing conditions".
I am one of those with a "pre-existing" condition who is routinely told that I'm "uninsurable". My "pre-existing" comdition is a result of medical malpractice, for which I did not litigate (despite the fact that I am a tort attorney). It is hard on a list of "damages" in court to detail how it feels when you are told repeatedly that you are "uninsurable". I have two advanced degrees and own my business, but I am "uninsurable." The first time that I heard it, I cried and believe me, litigators don't cry. It's hard for me to think that my 5 year old may be without a mother someday because i can't afford to go to the doctor as often as I'd like because I have to pay for everything out of pocket, so I'm not getting the wellness exams and other things that I need. If my daughter becomes a ward of the state because I die of an illness, it's a cost. If my community loses the free legal clinics and pro bono service that I provide, it's a cost. If the money that my albeit small, business generates in the overall economy is lost, it's a cost. I'm simply expendable because I'm "uninsurable." When the politicians talk about costs, they should keep all these costs in mind.
President Obama: it's not only about those without coverage!
If you don't address the current insurance companies's right to deny coverage based on ANY B.S "pre-existing conditions" THEY define, why would I support your plan?
It's also about those denied coverage due to "pre-existing conditions"! Get our support and you will win!!
I am one of the thousands denied coverage after losing a job - IN SPITE OF the fact my physician says I'm very healthy/low risk.
Appeal to me and to the millions who will be denied coverage like me if they lose their jobs! They will have coverage - but only hugely expensive/poor coverage insurance!
I am not uninsured, but I DID have to buy high cost "high risk group" insurance that is more than double the price of my desired BCBS policy, for FAR LESS COVERAGE.
This in spite of my excellent blood pressure, a very healthy BMI and very good cholesterol (I'm a distance runner and healthy eater).
A routine colonoscopy at 50 showed a very healthy colon with no follow-up needed for 10 years, BUT it did reveal one tiny benign polyp - which BCBS used as grounds to deny coverage.
Golden Rule (United Healthcare) high-risk catastrophic coverage is my only option. Annual premiums jump 20% annually (I don't even make claims!) and I have no alternatives unless Obama provides one.
Anyone notice the health insurance company CEOs pull down obscene 8-figure annual salaries from this fixed system?
Thanks for the heads up, commonsense. I just had an identical colonoscopy result (and mirror your good health). In fact, my doc said 1 in 4 have this condition. It occurred to me that I should google around to see if the polyp history would haunt me later. It sounds like it will - heck it already did - my employer HSA plan pays for a clear colon screening, but the minute they find anything, I'm on the hook for whole screening cost. How nice.
So much for preventative healthcare incentives promoted by insurers...my procedure lowered my future risk, which benefits my insurer, but they skate away from any payment for it. It's cheaper for me to skip the screening, get colon cancer in five years, and have coverage. Obama! Be brave and do this thing!
This is so relevant to my brother's life today it isn't even funny. I posted this on the Bachmann story. I spent last night in the emergency room with my Type 1 Diabetic uninsured brother. He is working at a new job and has been out of work for awhile. His new insurance does not kick in until next month and he has been without for about 1 year. He can't find affordable healthcare. He wasn't making $100,000 a year at his old job. He is not poor but he is definitely not rich. He was admitted into the ICU last night and will be there indefinitely. He has basically been financially ruined in a matter of hours.
Great post!
Earlier this week I posted on my FB account the following:
"There is no morally defensible argument against single payer health care."
Pre-existing conditions are just one piece of the health care mess. Solve that problem and you still have hundreds of others to solve.
The special intersts love to get people off on tangents like malpractice lawsuits and pre-existing conditions. The problems are cost and access, neither of which have been dealt with.
For people with pre-existing conditions, it is pretty critical. It totally exempts you from our current healthcare system.
Many of the right wingers want you to believe that if you disallow all pre-existing conditions, then you've solved all of the problems in our health care. So if you disallow pre-existing conditions but the insurance company charges you $25,000 a year for coverage, have you solved anything?
Every proposal that has been offered short of single payer is to put band-aids on a failed system.
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