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for PacifiCare, Cheryl J. Randolph, told the Washington Post that the underwriting guide in question "is completely outdated and predates the acquisition of PacifiCare by UnitedHealthcare."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)
]]>@microcars: Insurance protects you by (theoretically) making it financially easier for you to get preventive care, and either detect problems before you develop clinical symptoms or get things checked out early.
OTOH, college students aren't usually dissuaded by the cost of seeing the doctor - it's usually the schedule. They should address that if they want to keep people healthy. Have more evening hours at the clinic.
]]>@Skankingmike: At my school (large university) the student health insurance and staff/faculty were completely separate, so it's a lot less sinister. But I do think you're right in that it provides a larger base of students - so that they can get a better group policy. This assists students who aren't on their parents' health insurance, and, imo, students shouldn't be on their parents' insurance if they are taking charge of their medical well-being. But that's another rant...
Why students are required to be on health insurance I'm not 100% clear on; my best guess is so that they take advantage of preventive care. It also helps in instances of school-related injuries (like sports) to make sure everyone can get taken care of.
]]>Firefighters? Are you kidding? My father is a volunteer fireman, and has been for almost 50 years. Most of the firemen are volunteers in our area, and the thought of a health insurance company denying coverage because of that is dispicable. These are the guys who jump out of bed at 1 AM and race to your house in the middle of the winter to put out a flu fire so your house doesn't burn down, and then get up and go to work the next day.
How would the insurance company execs feel if the fire company said "sorry, can't come to your fire...you have a woodburner, e.g. a pre-existing condition"?
]]>My husband has an invoice from 1950-something, for surgery done to his father's back. 750.00.
Even with inflation, one can tell that things have gotten WAY out of hand.
I blame the insurance companies, but also the medical industry for their inflated costs and unreasonable mark-ups.
]]>hey my pre-existing condition/prescription is not on that list!
maybe this is my lucky day. (I doubt it..)
If they screw around with it too much, next the eczema will be a disqualifier. Which is ridiculous!!!
]]>sort of, it is a Community College, they have a small office that offers Testing, Exams,REFERRAL service and treatment of MINOR illness or injury. meh
The clinic does not satisfy the REQUIRED HEALTH INSURANCE policy.
as for Medicaid, I do not qualify. (I am not THAT old yet)
]]>I think we should all have "pre-existing condition" riots outside their corporate offices where we blockade their buildings and burn denial letter notices until they start paying for stuff.
]]>There is a kid that sits behind me in Chem that has been coughing since Day 1. I asked him if he had seen doctor lately, he replied "No, it's cool, it's just a cough..."
]]>Scary.
]]>As an insurance company, the surest way you can make a profit is to deny coverage to your paying customers or retroactively refuse to pay after scouring one's medical records.
If you are currently getting treatment for a disease (like diabetes, or cancer)... you have NO WAY of shopping for a new policy or switching carrriers because they are not compelled to take you.
Also, most insurance carriers don't give any savings to individual policies...only preference to large group policies. And those group policies are out of reach to self employed entrepreneurs like myself. It's time for a non-profit public option and real choice. That's something sorely lacking in this insurance market. Private companies doing the right thing? Give me a break.
]]>AHhhhh...but you say you don't want government regulation? Okay, back to the dealerships with you!
You see, when people are KILLED, this ceases to be a capitalism vs. socialism conversation.
It's not that those of us wanting the public option want health insurance companies to die, it's that they want US to die (literally) and we want them to stop killing people. Once the government steps in, if this bill gets passed the way it should, people will start getting covered and won't be KILLED any more.
Right now, it's about 100 murders per day.
]]>That's right, employees will quit, they won't be able to keep anybody, and CEO's will be correctly punished for killing other people.
]]>What's interesting is that until very recently (my paperwork from when our company last switched insurance companies at the start of 08) if you didn't have coverage before, insurers had no problem selling you insurance. They would just add a rider that excluded your pre-existing condition.
Now we're discussing regulation and all of a sudden, zits make you uninsurable. Funny, that.
]]>That's how it usually works in the US, believe it or not.
]]>We spend so much on defense because we LET them.
]]>As I said, that's one of the many reasons why insurance is a nonsensical way of funding healthcare.
]]>Because, outside of rape, getting pregnant requires an intentional act to be committed. It's like fire insurance covering your arson of your own house. Besides, if the pregnancy is unintentional there are a number of far less expensive ways of treating the condition other than paying to carry it to term.
]]>That's why I'm trying to abandon this sinking ship and more to Denmark. At least my high taxes will actually work for me instead of the defense department
]]>Wow, what a timely article. I am being laid off in 8 days so I started applying for health insurance this morning. The amount of questions they ask is staggering. I consider me and my family pretty healthy--no major problems. Usually all we use our insurance for is the occasional flu or twisted ankle. Filling out this form makes me feel like we are the sickest individuals on the planet though!
They gave me an initial quote of $200 per month for a high deductible plan that covers office visits and has catastrophic coverage...we will see how much that premium amount changes once I enter in all of our info though.
My son, my husband and I all have seasonal allergies...we take a generic for Claritin over the counter. My son has exercised-induced asthma--he has an inhaler but he's had the same one for over 2 years, so that shows you how often he uses it. And I have tendonitis in my right foot. Based on the above article, I am now afraid they will deny us coverage.
]]>@shepd:
Absolutely correct. Lamisil by itself puts a lot of stress on the liver (several reports of cirrhosis and chemical hepatitis). When alcohol (in any quantity) is added, the risk really skyrockets.
People taking lamisil should not drink AT ALL. Unfortunately the frequently-run TV ads don't make this point strongly enough with a generic "don't drink while taking lamisil" warning (generic enough to be ignored by a cynical public desensitized by all of the other similarly-generic warnings and nannying encountered in daily life).
The freewheeling prescription drug marketing REALLY needs to be reigned-in.
]]>I would say that a bigger problem is that the insurance paradigm is a fundamentally flawed method of funding health care. From an actuarial standpoint, pre-existing conditions should be denied coverage because the premium they'd need to charge would be equal to the expected out-of-pocket costs. Additionally, health insurers are frequently required to cover things that make little sense from an insurance standpoint, like pregnancy and maternity care (hint: insurance traditionally doesn't cover intentional acts). The purpose of insurance isn't to cover expected costs (except to the extent necessary to mitigate potential future costs, which is why doctor check-ups are covered), it's to hedge unexpected risks. What we need isn't health insurance reform, what we need is health care reform.
]]>Most people could get coverage for very little money, but the coverage wouldn't really help in all but the most mundane of medical needs. Either the deductible would be significantly high or the copays would or there would be many things that wouldn't be covered.
That's why there's such a stress on quality as well as affordability.
Of course the real question shouldn't be how we can get everyone health insurance, but rather health care.
]]>@VikingP77: Oh SORRY thisistobehelpful...that was aimed at Daveinva!
]]>Apparently, the moment I mentioned I wanted prescriptions covered it jacked up the rates dramatically. Or maybe it was the fact the quote was for "Philadelphia". I lived in North East Philly, too. That's the happy-go-lucky suburbs. Nothing bad happens there.
]]>@thisistobehelpful: You must be joking right? Do you see how these big companies operate? What we need isn't more health insurance companies. We have plenty and it hasn't worked for squat!
]]>I don't believe for a second that costs will go down for those of us with pre-existing conditions if the whole nation is frogmarched into buying private insurance. Not as long as the insurance industry is profit-driven. After all, the only people able to get independent coverage now are those free of pre-existing conditions like pregnancy, allergies, toe fungus, and firefighting, right? So where are all the high-risk consumers that are supposedly driving costs up (besides those of us the insurance companies were required to take under group plans)?
I fail to see what's so terrifying about a nationwide public option (I mean, I see why it's terrifying to the insurance companies, but not the public):
_embedded#t=159We can all get affordable, high-quality coverage? Or keep our shitty high-cost coverage? And it's not tax-funded? Heaven forfend!
]]>2. Have you tried signing up for Medicaid? (better than nothing...)
3. The whole "over 30" thing is biting a lot of college students in the butt (yours truly included), and not just because of health insurance.
4. Just how much of a kickback is your school getting from their "mandatory coverage" insurance provider?
Oops... Your school would never be that slimy and underhanded, would they?
]]>Proof of immunization makes sense because children have weaker immune systems and we've basically wiped out a lot of really deadly childhood diseases in this country (despite the efforts of Jenny McCarthy). The thing is, you're going to get what you're going to get. If it's something highly communicable like the flu, you can't get over it until you get over it once you have it. Having insurance doesn't change the fact it has to run it's course and the vaccinations don't cost much but they aren't given in case of infection.
]]>@Mr_Human:
Obviously republicans do not know.
@montusama: Totally in agreement!!!!!!!
]]>"Life may be hazardous to your health..."
]]>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.
]]>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.
]]>@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.
]]>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: 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.
]]>In my opinion, it should be the ONLY option.
]]>Wait? What's that? I *can't* shop around for better insurance?
Oh, right.
INCREASE competition-- don't eliminate it.
]]>@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.
]]>health insurance does not equal health care.
]]>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)
]]>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*
]]>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.
]]>'nuff said.
]]>@AllanG54: Those darn babies with their ear infections!
]]>@BobSalawalatski: There is private health insurance in the UK as well.
]]>@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?
]]>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: 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.
]]>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.
]]>"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.
]]>Lamisil + booze = cirrhosis. If you answered "yes" to even occasional drinking, I expect they'd be worried.
]]>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.
]]>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.
]]>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?
]]>