By taking anti-AIDS medicine after a rape, Christina Turner discovered that she had made herself all but uninsurable.
Christina Turner feared that she might have been sexually assaulted after two men slipped her a knockout drug. She thought she was taking proper precautions when her doctor prescribed a month's worth of anti-AIDS medicine.
Only later did she learn that she had made herself all but uninsurable.
Peggy Robertson was denied insurance coverage because she had a c-section. She was later told that if she was sterilized, she would be able to gain coverage.
As Congress weighs legislation to provide universal health care in the U.S., correspondents from NOW on PBS, Tavis Smiley, Nightly Business Report, and SoCal connected provide analysis, discussion, and insight. Watch the video here.
Senator Rockefeller pointed out that there was a gigantic loophole in the Baucus bill that would leave half of Americans subject to potential discrimination by private insurers. Apparently due to existing federal law, large companies can call themselves "self-insurers" even though they provide coverage through a major insurance company. These sort of self-insurance plans are mostly exempt from state regulations and are allowed to deny coverage based on pre-existing conditions. Read it all at Campaign
Insurance company documents obtained and made public by Consumer Watchdog indicate how far some insurers will go to limit individual coverage to only the healthiest people (and those with the safest jobs). A hangnail? You'll get coverage. Toenail fungus? Perhaps not. You could be denied coverage if you:
- Work as a police officer, firefighter, stunt person, test pilot, logger, rodeo performer, or migrant, utility or circus worker (the big tent could come falling down, or maybe an elephant could get loose).
- Are pregnant, are an expectant father or are going to adopt.
- Take common prescription drugs like Allegra, Advair and Lamisil, the toenail fungus drug.
- Have chronic tonsillitis, varicose veins, acne (Accutane-free for less than six or 12 momths), hemorrhoids, bunions, asthma, arthritis, ADD or silicone breast implants.
- Have gotten therapy or counseling within the last six months, or "currently experiencing/experienced within the last 12 months symptoms for which a physician has not been consulted."
Read it all at MSN Money
Insurance companies have used the excuse of "pre-existing conditions" to deny coverage to countless Americans. From cancer patients to the elderly suffering from arthritis, these organizations have padded their profit margins by limiting coverage to patients deemed "high risk" because of their medical condition. But, in DC and nine other states, including Arkansas, Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming, insurance companies have gone too far, claiming that "domestic violence victim" is also a pre-existing condition. Words cannot describe the sheer inhumanity of this claim. It serves as yet further proof that our insurance system is broken, destroyed by the profit-mongering of the very companies who's sole purpose should be to provide Americans with access to care when they need it most. In 1994, an informal survey conducted by the Subcommittee on Crime and Criminal Justice of the United States Senate Judiciary Committee revealed that 8 of the 16 largest insurers in the country used domestic violence as a factor when decided whether to extend coverage and how much to charge if coverage was extended. It is clear that insurance companies refuse to police themselves. It's up to us to call on Congress to take action now to pass health care reform and end discrimination against patients with pre-existing conditions.
Source: SEIU - Service Employees International Union
Trying to buy health insurance on your own and have gallstones? You'll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take Metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.
This confidential information on some insurers' practices is available on the Web -- if you know where to look.
What's more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.
These issues are moving to the forefront as the Obama administration and Congress gear up for discussions about how to reform the healthcare system so that Americans won't be rejected for insurance.
It's especially timely because growing numbers are looking for individual health insurance after losing their jobs. On top of that, small businesses are frequently finding health policies too expensive and are dropping coverage, sending even more people shopping for insurance.
The problem is, material available on the Web shows that people who have specific illnesses or use certain drugs can't buy coverage.
"This is absolutely the standard way of doing business," said Santiago Leon, a health insurance broker in Miami. Being denied for preexisting conditions is well known, but when a person sees the usually confidential list of automatic denials for himself, "that's a eureka moment. That shows you how harsh the system is."
A 50-year-old Broward County, Fla., man, with two long-standing medical conditions, saw the harshness for himself when surfing the Web trying to learn why insurers kept denying him coverage. He was shocked to find several insurers' instructions to sales personnel, usually called the Guide to Medical Underwriting and often marked "confidential and proprietary."
"I think it's atrocious what's going on," he said. "Basically, they're taking only the healthy so they can get the fattest profits. If you really need insurance, then you can't get it."
The man, a self-employed consultant, didn't want his name or preexisting conditions identified for fear that the information might frighten away potential employers.
Insurers don't want to talk about the guides. Sunrise, Fla.--based Vista, which has its 35-page "confidential and proprietary" guide tucked away within its website, refused to make executives available for an interview and instead issued a brief statement:
"The medical underwriting guidelines used by VISTA are based on industry standards, comply with all regulations and are subject to review by the Florida Department of Insurance. VISTA's Guide to Medical Underwriting is an educational tool intended to assist agents and brokers who are selling VISTA individual plans. We do not comment on our specific underwriting processes and practices."
Sandra Foertsch, who sells individual policies, says the fundamental concern of insurers is clear: "They don't want to buy a claim," meaning that they would start to collect $500 monthly premiums from a person and quickly pay out more than that to doctors and other providers.
Foertsch said she was surprised that any of the guides could be found on the Web. "I'd guess someone made a mistake."
VISTA's Guide to Medical Underwriting is now on The Miami Herald Web site: http://media.miamiherald.com/smedia/2009/03/28/19/Vista_Producer_Guide.source.prod_affiliate.56.pdf
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What do they have on you?
By law, data-mining companies are required to tell you what they're telling health insurers about you. To ask for your file, contact:
Ingenix MedPoint Compliance
Write: 2525 Lake Park Blvd., West Valley City, UT 84120
E-mail: MedpointCompliance@ingenix.com
Milliman Intelliscript
Call: 877-211-4816
E-mail: IntelliScriptSupport@milliman.com
Medical Information Bureau
Call: 866-692-6901
NOTE: Milliman and Medical Information Bureau say they will have files on you only if you have applied for individual insurance.
by Dave Lindorff
As the country contemplates a major reform and restructuring of the way we run our national health care system (if it can even be called that), it needs to be pointed out that the mammoth health insurance industry is nothing but a parasite on that system.
Health insurance companies add zero value to the delivery of health care. Indeed, they are a significant cost factor that sucks up, according to some estimates such as one by the organization Physicians for a National Health Program, as much as 31 percent of every dollar spent on medical services (a percentage that has been rising steadily year after year).
Insurance companies are damaging in more ways than simply cost, though.
They also actively interfere in the delivery of quality medical care, as anyone who has had to battle with some "nurse" on the phone at an insurance company to get required pre-authorization for needed procedure can attest. Just recently, the editor of a local weekly alternative paper in Philadelphia, Brian Hinkey, the victim of a near fatal hit-and-run accident last year who spent several days in a coma, and has been working hard to regain the use of all his limbs and faculties, reported in an opinion piece in the Philadelphia Inquirer on how his insurer after a few successful weeks of in-hospital rehab, denied him coverage for six critical weeks for out-patient rehab services, though every specialist on head injuries knows that early, consistent therapy is crucial to recovery of lost brain function.
This kind of human abuse is standard operating procedure for companies whose bottom lines are fattened the more services they can deny to insured clients. My own father, once doomed by a metastasized cancer following prostate surgery, was saved by a procedure offered by a physician in Atlanta that his Blue Cross plan in Connecticut refused to pay for. He had to finance the expensive treatment himself.
Now these medical system parasites are suddenly running scared, because it is clear that if everyone in America is to be guaranteed health insurance coverage--a promised goal of the new administration of President Barack Obama, and, according to polls, the desire of a large majority of the American people--they are going to stand exposed as a costly impediment to achieving that goal.
Insurance companies have managed to stay profitable and at least somewhat affordable to the private employers and workers who, together, have to pay for them, by denying care not just to policy holders, who are denied certain tests and treatments but especially to those who have known ailments, who are simply denied coverage altogether.
For decades, people with "pre-existing conditions" have been either barred from coverage, or have had to sign waivers that excluded them from getting coverage for treatment of those pre-existing conditions. In the worst case, which is all too common, people have ended up dying because they couldn't get treatment for common and easily treated ailments like high blood pressure or diabetes.
Now we hear that two big insurance trade groups, the Blue Cross and Blue Shield Association and America's Health Insurance Plans, have offered to "phase out the practice of varying premiums based on health status in the individual market" in the event that all Americans are required to obtain health insurance.
Well sure they're doing that. If they didn't, the government would force them to! The insurance industry, in saying that it would not price sick people out of coverage in a nationally-mandated health insurance scheme, is merely recognizing the political firestorm that would arise if it were not to do that, and were to force the sick and inform onto some government insurance plan, subsidized by taxpayers, while they just cherry-picked the healthy population, as they've been doing now for decades.
The whole point is that if everyone is included in the insurance pool, instead of only the healthy population, then the overall cost of being chronically or critically ill to the individual is spread over the whole of society. Premiums get adjusted accordingly.
Medicare is the model. Here we already have a government plan that covers every single elderly and disabled person.
If we were to simply extend Medicare to cover everyone in America, we would essentially have the Canadian model of health care (which, it should be pointed out, costs half what we pay in America for health care when private insurance and government programs are added together). As with current Medicare, the government would pay for treatment, with private doctors and hospitals providing the care, and with the government negotiating the permissible charges. That, in a nutshell, is what "single-payer" means--the government is the single payer for all health care. It doesn't mean, as the right-wing critics claim in their scaremongering propaganda, that people would be forced to use certain doctors and certain hospitals. Far from it. That's what private HMOs do.
Medicare is efficient (only 3.6% of Medicare's budget goes to administrative costs, compared to 31% for health care delivered through private insurance plans), its clients like it, and doctors and hospitals accept it.
We should not be tricked by this seeming sudden appearance of decency on the part of these corporate parasites. There is simply no valid reason for preserving the private insurance industry's role in any health care reform plan that is aimed at giving everyone access to health care in America. The Obama administration needs to jettison its "free market" fetish when it comes to health care. The financing of health care for all Americans can all be handled much better by the government. Medicare has proven this. Other countries--Britain, Australia, France, Canada, Taiwan and most other modern nations have proven this.
Leave the insurance industry to handle our car insurance and our life insurance. It has no more place in the delivery of health care than do tapeworms in the digestive process of our bowels. Source - The Smirking Chimp
"Most Americans today get health coverage through group plans offered by employers. When workers receive insurance through their jobs, an insurer cannot exclude them from coverage, or charge more, because of a preexisting condition.
But for increasing numbers of Americans who are losing their jobs and their group coverage - or who never had it to begin with - a primary option is to buy insurance as an individual or family on the open market.
In 44 states, including Pennsylvania, insurers are allowed to deny coverage - or charge more - to individuals and families because of preexisting conditions, according to the Kaiser Family Foundation.
Without insurance, these sick Americans too often go without needed care, or go into debt paying out of pocket. A report by the Institute of Medicine confirmed this week that the uninsured get sicker and die sooner.
The exclusion 'is in some ways the ugliest corner of our current system,' said Len Nichols, director of the Health Policy Program at the New America Foundation."
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