Insurance denial can seem arbitrary

[question everything]

StarTribune.com
Insurance denial can seem arbitrary

By CHEN MAY YEE, Star Tribune

January 10, 2009

Three years ago, Ivy Emery left her job at Aveda Corp. to work as an independent hair stylist at an Uptown salon. No longer covered by Aveda's group health insurance, Emery applied for individual coverage for her husband and herself. Her husband, a self-employed construction worker and a smoker, was accepted. Emery, then 32, was rejected. The denial letter from Blue Cross and Blue Shield of Minnesota listed three reasons: She was using topical medication for acne, she had once sought emergency care for a migraine and she was on Paxil, a drug for anxiety and depression. "It was just insane," she said, her voice rising at the memory. "They wrote 'acne.'"

An outraged Emery found herself a member of a club nobody wants to join: the Uninsurables. It's a bigger club than you might think. Each year, one in six Minnesotan applicants for health insurance in the individual market is denied coverage because of a variety of pre-existing conditions. The market is small but growing fast.

(snip)

"Once you get individuals out there trying to shop for insurance, the will slice and dice those people, take the healthy people and charge them for whatever package," said Judy Waxman, a vice president at the National Women's Law Center in Washington. "This is why we want to get away from people being judged individually. It's not really insurance.".. In Minnesota, the most common reasons for denial are obesity, mental health conditions, hypertension, diabetes and cardiovascular disease. But there are less well-known reasons insurers consider on a case-by-case basis: chemical dependency, allergies that require costly injectable drugs, a previous C-section, previous use of infertility medicine or something as simple as being pregnant. Blue Cross and other insurers say they face a dilemma. If they took in too many sick people, they'd have to raise everyone's premiums.

(snip)

In states such as New York, where insurers are required to take all applicants, healthy people sometimes put off buying insurance until they get sick. The result: Premiums tend to be higher for everyone, according to a study commissioned by America's Health Insurance Plans. The association is urging the Obama administration to consider a system in which insurers must accept all applicants but all consumers must buy insurance.

(snip)

To further complicate matters, underwriting guidelines vary by insurer and can change from one year to the next... Some think women applicants have it harder than men. Last year, the National Women's Law Center published a report titled "Nowhere to Turn: How the Individual Health Insurance Market Fails Women," citing disqualifiers such as pregnancy and a previous C-section.

(snip)


http://www.startribune.com/business/37356659.html

[leftstreet]

1. 5 million new US jobs: Insurance Claims Denial Specialists n/t

[ayeshahaqqiqa]

2. We will call an insurance company and ask if

a patient's lab will be covered. The most common answer: We don't know. Do the lab, send us the results, and we'll consider it. Since many lab tests are in the hundreds of dollars, it can be a real gamble for a patient to rely upon their insurance company for payment. And generally they won't pay, even if a test comes back positive.

[Vinca]

3. They can't make a profit unless they deny care. nt

[question everything]

6. We should have never started with employer provided insurance

Perhaps, if each of us would have had to provide his or her own insurance for the past 50 years, or so, we would have long switched to universal health care.

[Lydia Leftcoast]

4. No, they wouldn't have to raise rates unless they were unwilling to cut

the lavish compensation packages of their executives and their bazillion lobbyists in Washington. Bloodsucking vultures.

[mrreowwr_kittty]

7. Having worked in the insurance industry in the past

I can tell you that if you saw the disgusting excesses that went on you would be sick to your stomach. I have attended conventions and seminars that were held at exclusive resorts. Where we were fed shrimp and pate' and taught how to sell bullshit policies and pumped full of pro-industry talking points. All I can say is, get this fucking parasitic industry OUT of health care!

[Lydia Leftcoast]

8. One of my most infuriating moments last year came when

the CEO of the insurance company where I have my nearly useless health policy wrote an op-ed in the local paper about how the health care "system" in the U.S. could be saved if everyone just got more and better preventive care.

You will not be surprised to learn that my high-deductible policy doesn't pay for preventive care. If we have to keep this lousy lack of a system, I would make one change: Ban deductibles and replace them with levels of copays. I could seriously afford to pay $100 for an office visit and $100 for each test, but $200 per office visit and up to $1100 per test out of pocket? No way!

[damntexdem]

5. Seeming arbitrariness can often BE true arbitrariness.

Can be, and often is.

[Kansas Wyatt]

9. Health Insurance equals....

Legalized fraud.

They do not give a shit about any policy holder's health care. They only give a shit about how much they can plunder out of the policy holder, while avoiding paying any health costs for the policy holder. That's why they never call it 'Health CARE Insurance.'

[question everything]

10. I know. When I hear talk about "universal health insurance"

I want to correct the phrase, to talk about health care. This is what it should be about. Health care, for everyone. Not any "insurance." And, yes, tax us to pay for it. Just as we are taxed to pay for roads and bridges and safe water why shouldn't be taxed for health care? At least we know we have it.