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1 in 7 Denied Health Insurance Based on Medical History

1 in 7 Denied Health Insurance Based on Medical History

In a few years, health insurers will not be able to use pre-existing conditions as grounds for denying health coverage to individuals. But until then, many people will continue to be subject to the financial and health-related burdens of coverage-denial based on health status.

Data collected during a congressional investigation recently revealed that one out of every seven applicants who applied for health insurance with one of the four largest for-profit insurance providers in the U.S. was denied coverage due to a pre-existing condition.  This means 651,000 people were denied coverage by Humana, Aetna, UnitedHealth Group and WellPoint during a three-year time period from 2007 to 2009.

During the same three-year time period, the companies refused to pay 212,800 claims for medical treatment due to pre-existing conditions. Pregnancy, diabetes, heart disease and high Body Mass Index are among the many reasons for coverage denial.

In an article on WSJ.com, Aetna Spokesman Mohit Ghose said the congressional findings “document what many health insurers, including Aetna, have been saying for years — that the individual market needs to be reformed so we can improve access for all consumers.”

The health reform bill mandates that insurers cannot deny coverage to children based on their medical history, but the rest of the population will have to wait until January 1, 2014, to be included in the rule. Additionally, at that time, insurers will not be allowed to charge higher premiums for covering individuals with pre-existing conditions.

“By 2014, health insurance companies selling coverage in the individual market will be allowed to set their rates based only on geography, whether the plan covers an individual or family, age, and tobacco use,” the congressional memo states. “Insurance companies will no longer use medical histories to calculate premium rates.”

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93 comments

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6:03AM PST on Mar 12, 2011

I am sickened by Humana Insurance. What gives them to right to deny people surgeries that are necessary, per the doctors? You have insurance with them for 6 years and my brother needed a surgery to relieve his horrible back pain and they denied him twice. He was in so much pain for over a year, not knowing what was wrong, finally a diskogram revealed he had a ruptured disk with the gel leaking into his body, he needed to get this repaired to help him. Well HUMANA denied him twice and he lost his will to live and commited suicide. He was bedridden, needed help to shower, couldn't stand up on his own, had no feeling left in his back/spine and had to wear diapers, can you imagine! 46 year old man living like this? My dear brother was an athlete, the man of the house, a family man who loved his family more than anything, he endured the pain for as long as he could and he couldn't take anymore. As much as he loved his family, he knew we would be OK eventually but he said he felt like he was living in a dark tunnel and had no way out. He felt like he was a prisioner in IRAQ. Our family is devestated by the loss of our beloved brother, especially when this could have been avoided by allowing my brother the surgery that was NEEDED to help him. The worse thing that could have possibly happened has happened and now there is no turning time, I just hope this does not happen to anyone else's family. In horor of my brother, Dave.

7:53AM PDT on Nov 5, 2010

I too would like to be in a business where I collect money and never need to spend any on my clients.
People need insurance when their sick. That's the whole point. We pay when we're healthy so it's there when we need it.

11:41AM PDT on Oct 28, 2010

This article and most of the comments made here make the case for establishment of a universal government-run NONPROFIT health care system, just like Medicare. Nothing further needs to be said.

12:53PM PDT on Oct 24, 2010

Look at the salaries of Insurance companies CEO's that will give you some idea on the "maneuvering" going on right now. They are not going to want to "change their lifestyles" from growing rich off the backs of middle class Americans! I have used healthcare in UK and was not treated any differently than anyone. Yes, America is the the third world as far as taking care of people. My brother was dr/surgeon and was so disgusted he opened his own clinic just to treat people, money or not, insurance or not. Wake up! Al the comments here are so valid they would fill a book. Having worked for a health insurance company for many years, I just couldn't take it any longer. The tears, the stories, the PREMIUMS, the high deductiions, the pre-existing, the cancelling policies....it was too much for me. I am with everyone in this country trying to have some modicum of dignity as far as their healthcare is concerned. I don't know what the outcome will be, but hopefully it will be about "we the people" and not the CEO's salaries!

5:40PM PDT on Oct 21, 2010

Know someone whose child was denied health insurance coverage due to a pre-existing condition or had a pre-existing condition excluded from coverage? Give them the link to this survey being conducted by The Georgetown University Center for Children and Families. Their answers will help lawmakers figure out how to improve access to healthcare for kids. http://www.surveymonkey.com/s/LGC2Q9R?ak_proof=1

9:23PM PDT on Oct 19, 2010

OK

4:28PM PDT on Oct 19, 2010

My employer doesn't offer health insurance so I have to buy my own. Boy have the insurance companies royally SCREWED me over. I currently pay $700/month for basic coverage that doesn't even include dental. My deductable is 5,000. It's OUTRAGEOUS! I just applied for more affordable coverage with another company (yeah, one of the four listed above) and guess what? I was DENIED. F*ckers!! I have appealed it an hope to get insurance soon. Otherwise, I simply cannot afford it. This "healthcare" system is SO WARPED! Oh, and did I mention that I'm under 40 and in good health?

4:13AM PDT on Oct 19, 2010

It would not be fair to the insurance companies to require them to insure all applicants until all residents are required to buy insurance. And it is impossible to require everyone to buy insurance until we can afford the subsidies that will be needed to help those who just miss being eligible for Medicaid. And we have to save some money from the health care reforms that are cheap to implement like national health care records to afford the sliding scale subsidies to make up the difference between what people can afford to pay for health insurance and what it costs.

3:41PM PDT on Oct 18, 2010

Ok so how will they be allowed to decide premium rates? Actually will they be allowed?

The child only policy field has collapsed in the insurance world. As predicted of course. Companies are winnowing their rolls now while they can to try and offset the flood of people with pre conditions they will have to take on soon. How long will that take to crush smaller companies and crimp larger ones?

The world is not magic. Congress, the President, and some in the media really think that you can increase the number to be cared for and it won't really cost those doing so, a thing. They also fail to understand that costs will have to shift onto the decreasing number on private insurance in a vicious cycle-a much worse repeat of what we've suffered for years as Medicare costs are shifted onto private policy holders.

When do the mandates start to force private providers to take on Medicare/Aid patients despite the lack of funding? The traffic is flowing faster and it looks just like they all are going to hit about the same time. When things go boom, what will be your plan then?

1:51PM PDT on Oct 18, 2010

I am fortunate to live in Canada. No one is denied medical care if they need it; and, there are no costs involved other than the price of the medical plan if you end up in hospital. The cost of the medical plan is very reasonable; and, there is a sliding scale for those who are low-income (many of whom don't pay a premium).

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