Pre-existing Condition Danger Zone
The uninsured. They’re getting plenty of coverage in the debate about the health care reform bills pending in Congress. How do so many people end up uninsured, anyway?
Lots of reasons, not the least of which is the dreaded “pre-existing condition.” I have one. You may have one, too. If not, you probably will at some point. None of us gets through this life unscathed.
If you have a group insurance policy, and your job is secure, you may not be particularly concerned. But what if you lose your job… and COBRA is beyond your means… or you were able to take advantage of COBRA, but time has run out. What if you haven’t found a job that comes with employer-based coverage… or with few options left, you decide to freelance or are otherwise self-employed.
Through no fault of your own, you find yourself seeking an insurance policy on the individual market. You’ve had medical coverage your whole life and never really thought much about it outside of complaining about your out-of-pocket expenses. But now you’ve got a problem. Your pre-existing condition(s) make you undesirable to insurers. They are not particularly interested in your business or your problems.
In many states, insurance companies can and do discriminate based on pre-existing conditions for those seeking individual policies. They can deny coverage, charge higher premiums, or refuse to cover a particular medical condition.
Some states have a high-risk pool for those who cannot get insurance on the private market, but high-risk pools often have higher rates than healthy people in the individual market. Some pools have annual caps on enrollment or allow only people who had prior group health coverage in the preceding 63 days. High-risk pools also may have pre-existing condition exclusions for six months to a year, during which time that condition is not treatable.
Then there’s the practice of insurers canceling insurance for sick policyholders. Three of the nation’s largest insurers recently told legislators that they did not plan to discontinue the practice. Paying your premiums in good faith in times of health is no guarantee that you will get the medical care you need in times of sickness. Not a very comforting thought.
A Congressional investigation into this practice found nearly 20,000 rescissions from three large insurers over five years, saving them $300 million in medical claims, and at least one insurance company has been found to evaluate employee performance based in part on the amount of money an employee saved the company through rescissions.
The American Cancer Society Cancer Action Network reports that one in four families affected by cancer delayed care due to cost barriers; in the last twelve months, nearly one-third of cancer patients in treatment cut pills or skipped doses; nearly one-quarter delayed a recommended cancer screening or treatment; and one in five did not fill a prescription. It’s hard to fight for your life while fighting your insurance company.
That’s the system we have now – everything’s great — as long as you don’t get sick. If you do, you might just find yourself in the danger zone, branded with the “pre-existing condition” clause. If you think it can’t happen to you, you are overly optimistic — or a member of Congress.
From the Petition Site: