Damn that benign testicular cyst
My application was held for "further processing" and a few
days later, I got a rejection note. The insurance company said my
benign cyst presented "uncertain medical underwriting risks."
I asked if they needed my doctor to explain what "benign" meant, but
was told it wouldn't matter. Health insurance companies in California,
as in most states, are free to reject individual applicants for almost
any reason. My experience, while borderline absurd, is symptomatic.
For example, a woman in Minneapolis recently told a newspaper there that her application was rejected because she used a topical acne medication. "They actually wrote 'acne'" in the rejection letter, she told the paper. Another article in USA Today said one family couldn't get coverage for their five-year old because a doctor once noted that he was short for his age. And the stories of insurance companies rejecting applicants who take widely prescribed drugs abound, like the California woman who told a newspaper she was denied because she took Prevacid for acid reflux. Detecting a pattern? Insurance companies use any excuse to turn down customers, just to avoid the possibility that they might have to pay a medical claim.
In California, we don't know how bad the problem is because our major health insurance companies have declined to tell us their rejection rates. A recent study by the Commonwealth Fund, though, found that across the country, one in five who apply for individual coverage is rejected. The results from earlier research by the Georgetown Health Policy Institute were even worse - they found that nearly 40 percent of applicants were turned down. In both cases, the chance of rejection grew as the applicant's age rose. And if you suffer from a real health problem, like diabetes or HIV, well, good luck to you.
For those who get group coverage through their employers, the insurance company has to accept them, regardless of their health. Instead of putting the same requirement on the individual market, California created a high-risk pool for those who've been denied coverage. But the program is so underfunded that administrators have capped enrollment far below the number Californians who need it. Also, like a lot of individual plans, the premiums are too expensive. According to the LA Times, the cheapest plan the state offers costs almost $1,000 a month.
The real answer is to insist that insurance companies sell policies to everyone regardless of health, as President Obama has proposed. Or, we need to set strict limits on the reasons applicants can be rejected. Acne medication and benign cysts - let alone being too short - for example, shouldn't be sufficient to deny someone health insurance.
Insurance companies, though, argue that forced coverage would only raise costs for all of us. They say rejecting the sickest customers is the only way to keep their businesses viable. But five states -- Maine, Massachusetts, New Jersey, New York and Vermont -- already require insurers to sell policies to everyone. There's been no market meltdown there and studies suggest the stricter regulations have made coverage in that part of the country more affordable, particularly for those who have actual health problems.
In the end, I was lucky. I found an insurer willing to cover me, benign cyst and all, for a low premium. I was on the plan for a month when they told me they were dropping prescription drug benefits and raising my rate 20 percent. I could, they said, apply for one of their more expensive plans to keep my prescription coverage. I declined.
For example, a woman in Minneapolis recently told a newspaper there that her application was rejected because she used a topical acne medication. "They actually wrote 'acne'" in the rejection letter, she told the paper. Another article in USA Today said one family couldn't get coverage for their five-year old because a doctor once noted that he was short for his age. And the stories of insurance companies rejecting applicants who take widely prescribed drugs abound, like the California woman who told a newspaper she was denied because she took Prevacid for acid reflux. Detecting a pattern? Insurance companies use any excuse to turn down customers, just to avoid the possibility that they might have to pay a medical claim.
In California, we don't know how bad the problem is because our major health insurance companies have declined to tell us their rejection rates. A recent study by the Commonwealth Fund, though, found that across the country, one in five who apply for individual coverage is rejected. The results from earlier research by the Georgetown Health Policy Institute were even worse - they found that nearly 40 percent of applicants were turned down. In both cases, the chance of rejection grew as the applicant's age rose. And if you suffer from a real health problem, like diabetes or HIV, well, good luck to you.
For those who get group coverage through their employers, the insurance company has to accept them, regardless of their health. Instead of putting the same requirement on the individual market, California created a high-risk pool for those who've been denied coverage. But the program is so underfunded that administrators have capped enrollment far below the number Californians who need it. Also, like a lot of individual plans, the premiums are too expensive. According to the LA Times, the cheapest plan the state offers costs almost $1,000 a month.
The real answer is to insist that insurance companies sell policies to everyone regardless of health, as President Obama has proposed. Or, we need to set strict limits on the reasons applicants can be rejected. Acne medication and benign cysts - let alone being too short - for example, shouldn't be sufficient to deny someone health insurance.
Insurance companies, though, argue that forced coverage would only raise costs for all of us. They say rejecting the sickest customers is the only way to keep their businesses viable. But five states -- Maine, Massachusetts, New Jersey, New York and Vermont -- already require insurers to sell policies to everyone. There's been no market meltdown there and studies suggest the stricter regulations have made coverage in that part of the country more affordable, particularly for those who have actual health problems.
In the end, I was lucky. I found an insurer willing to cover me, benign cyst and all, for a low premium. I was on the plan for a month when they told me they were dropping prescription drug benefits and raising my rate 20 percent. I could, they said, apply for one of their more expensive plans to keep my prescription coverage. I declined.
