Posted on 03/29/2009 6:28:56 AM PDT by nuconvert
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, which make up the bulk of South Florida's economy, 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.''
(Excerpt) Read more at miamiherald.com ...
Not to mention that it is fraud.
these plans don’t usually cover Rx.
They don’t want to cover the medical care costs for the condition.
And you believe that Government health care will be the answer?
How?
Don’t know if you’re addressing me or the writer.
If you’re addressing me, NO, I don’t think a nationalized healthcare system is the answer.
I post articles for peoples’ information, not necessarily because I agree with it. I think this article had some imporatant information for people who are trying to get private insurance.
Trying to make life fair, simply makes it unfair for everybody.
Interesting. They only want to insure people that will never need the coverage. It’s a great way to make money.
This isn’t news. It’s been common practice in the health insurance industry for decades.
“This isn’t news. It’s been common practice in the health insurance industry for decades.”
“The medications, of course, are indications of specific health problems. To make sure that applicants are not lying, insurers hire a data-gathering service — Medical Information Bureau, Milliman’s Intelliscript or Ingenix Medpoint.
Intelliscript and Medpoint do computerized searches of a person’s drug use, gleaned from pharmacy benefits managers and other databases. The two companies say they comply with privacy laws. ‘’Ingenix requires each Medpoint client to obtain the authorization of the individual applicant or insured person,’’ said Ingenix spokeswoman Karin Olson.
Last year, the Federal Trade Commission accused both companies of violating the Fair Credit Reporting Act by not offering to provide consumers with information about them. The companies agreed to settlements in which they promised to let people see their personal information.”
Computerized searches like this haven’t been around for decades
The whole idea of insurance is that it provides indemnification for a possible, future event ... not an ongoing, current event. You can’t buy life insurance for a person who has already died, auto insurance to pay for a collision you had last week, or health insurance to cover an illness you’ve already contracted or surgery that’s in the past.
There are mechanisms to get someone else to pay for these occurences (tort law, government handouts) but those are not “insurance,” simply confiscation from someone else by force.
Also, with the newer medical privacy regulations, I think people are fooled into believing that their medical history is more private than it really is.
Maybe the best solution is don't keep the records. The DB cannot be mined if it does not exist. That's what I hate about the proposed national info clearing house. Anyone who believes that "confidential" information won't be plundered as a matter of routine is naive or lying.
“How much in the past do they go?”
They come up with their own number of yrs for each condition/medication. The companies don’t want people to know what parameters they’re using.
“The Miami Herald asked several other major Florida insurers — Aetna, Humana and Blue Cross Blue Shield of Florida — for copies of their underwriting guides. All refused, saying they contained propriety information and were confidential.”
“Searching the Web, The Miami Herald found underwriting guidelines for Coventry Health Care, which owns Vista; Wellpoint; Assurant Health; and Blue Cross Blue Shield of Nebraska.”
Companies that offer group ins will sort out the ones they don't want in pre-employment physicals.
They can always find a non-medical reason to cover it up and justify it.
Actually the insurance system is so broken and overregulated that for all practical purpose we have have ‘government health care’, with two slight differences:
(1) Private insurance companies make a profit that is a lot the like the guaranteed profit made by private utility companies.
(2) The bureaucrats at private insurers are slightly more competent and responsive than government bureaucrats.
One problem is that health ‘insurance’ is not insurance at all. Insurance is intended to help people manage unpredictable risks: fires, floods, unexpected loss of life. The most common and costly health conditions are fairly predictable based on a persons age, genetics, current health and habits. For the most part health insurance doesn’t pay for unpredictable risks, it pays for predictable recurring costs.
The whole idea of insurance is large groups of people pooling their resources to provide for unpredictable risks. Events that are significant enough to allow people to collect from the common pool (death of an person, a home burning down, a ship sinking) are sufficently severe, that’s there’s relatively small danger of individuals needlessly drawing from the pool.
However, for the case of health ‘insurance’ where people regularly make use of the services, we are just paying into the system to have a set of bureacrats pay our recurring expenses. Not only is it inefficient, but individuals lose control of their health care. Doctors and hospitals no longer thing of patients as the customers that they aim to please; their customers are now the insurance companies that control the payments. Imagine a world where we all buy electricity, gas, water, and sewer insurance, to pay our monthly bills in those areas. There would be a huge costly bureaucracy to support, we’d have to deal with cancelation notices every month because the insurance company and the water company were debating fair payment, and our helpful insurance companies would undoubtedly be trying to offer advice and control of our utlity usage habits.
The current system is almost as bad as the nationalized system that Obama wants to foist on us. What we need to do is:
* Decide what minimal level of health care we want everyone in society to have regardless of ability to pay. Most people are not prepared to see kids being denied vaccinations, mothers in labor not having access to hospitals hospitals, broken bones not being set, or critically ill patients being turned away from emergency rooms. Costs for those expenses need to be covered by government or a quasi-public identity.
* For all other expenses, go back to the system where the individual pays their doctor or hospital directly. Give me back the thousands of dollars taken from my paycheck for helath insurance and add the thousands of dollars my employer contributes in ‘matching’, and let me decide to do with that money. Maybe I want to try to treat my mild diabetes with diet and exercise; maybe I want to take Metformin to manage blood sugar. Maybe I want laser surgery to improve my vision to 20-20, or maybe I like my glasses just fine. Give individuals the responsibility and power to look after themselves. Oh and if I’m the one paying the $100 for my checkup out of my own pocket, I kind of doubt I’ll have to wait an hour after my scheduled appointment.
Not really an accurate description. This implies that they are gathering this information in some quasi legal manner, as if they are trying to hide the fact they are doing it.
When one applies for med ins, one has to sign an authorization giving them carte blanch to get information from all medical providers and previous insurance companies. Should come as no surprise that is exactly what they do.
As much as I despise insurance companies, which is a great deal, the reality is that much of what they do is the result of governmental meddling.
My wife and I are well past child bearing age. Yet the government mandates that everyone's policy include maternity coverage. Back in the late 70s we bought that a la carte as a separate rider. I well recall that when insurers were required to cover it on all policies, delivery room fees quadrupled the next year.
My brother in law paid $400 for one kid, and two years later $1600 for the next. Guess what happened in between?
Insurance companies should be forced to take all comers at the same rate even if they know that their costs are guaranteed to be higher than the premiums collected.
While we are at it, let's force insurers to do the same with auto coverage. They should be forced to cover repairing damages even if the damage already existed before the policy was written.
What could possibly go wrong?
Exactly!
If we had REAL investigative journalism, in this country, the public would know that Medicare, Medicaid and the VA, as well as Civil Service health plans, DENY CLAIMS ALL THE TIME, for various reasons.
But, the goal is larger government, not better care!
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