Skip to comments.Insurers shun those taking certain meds
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?
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 isnt news. Its 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?
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!
Every application includes a privacy waiver.
Mortgages for alcoholic crack heads on food stamps who smoke cigarettes and use food stamps.
Free Health insurance, of course, for the same people!
Absolutely correct. Two of those chronic conditions mean absolutely no insurance of any kind, period, and no possibility of employment.
“Every application includes a privacy waiver.”
Yes. And you’re in a Catch-22.
I also don’t think people are really aware of what they’re giving access to and for how long.
I think you’re missing points to the article.
It’s not only private insurance that people are denied. You will also be denied employment.
Easily found if you became overwhelmed in medical bills and went to collections.
When healthcare was funded by a single family, funds were necessarily limited; a family would not starve its children to treat the sick or aged. The amount of effort to save a single life that could be spent has changed for two reasons:
1. Technology has vastly increased the amount that could be spent on any one case.
2. Pooling healthcare resources has vastly increased the money available to be spent on any one case.
As the pool enlarges to a global perspective, the moral problem takes on a new dimension, and "the least of mine," takes on a whole new meaning. The money spent on Terri Shiavo could feed, clothe, medicate, and educate ten thousand children who will otherwise die.
We have to find ways to make hard moral choices in order to contain costs. It's inescapable.
Seventy percent of your medical dollar (or nearly eight percent of the national economy)is spent upon people who die within six months. Meanwhile, pregnant mothers still don't get decent prenatal care that would prevent life-long medical expenses and aliens enter the country carrying hepatitis, parasites, and antibiotic-resistant strains of infectious diseases that go untreated. Hospitals are on the verge of bankruptcy caring for the indigent. Private insurance rates bear much of that cost as a hidden tax in hospital charges.
Distorted treatment priorities are only part of the picture. The system provides few financial incentives to promote health. Proper diet, regular exercise, and annual check-ups do not reduce the price of coverage. Similarly, there are few penalties for high-risk behavior.
The system is insane. Government is the problem and socializing medicine will make it worse.
In a free market, there are usually two underlying factors determining the scope of coverage:
2. The cost-effectiveness and extent of the adjustment: whether it's risky or experimental or if less expensive substitutes exist.
The cost of coverage is determined by the scope of covered risks, the probability of a claim, and the average expense of the treatment. The price of coverage is offset by investment returns on the cash in the coverage pool.
For example, insurers may charge more to cover high-risk activities such as smoking or skydiving. A policy may also limit the extent of elective procedures such as certain forms of cosmetic surgery. Unfortunately, pricing many other distinguishing risks is not allowed because the State enlarges the pool paying into the system to the point of the absurd. It closely regulates the terms of the contracts based upon the political power of the groups at risk: those seeking to get others to subsidize the cost of their choices.
It doesn't matter if the risk is riding a motorcycle without a helmet, not taking prescribed medication, or bare-backing in a bath-house, high-risk individual choices cost the insurance pool that pays for the treatment and poses additional risks to the public at large. A State-financed or regulated system, heavily influenced by political interests, is unlikely to assess those risks objectively.
Once those risks are assumed, there is the additional unnecessary legal overhead associated with malpractice settlements. Since humans will probably never know everything about their bodies, there always will be uncertainty and risk associated with the delivery of medical products and services. The assumption that anything less than a perfect cure constitutes medical malpractice is one expensive fantasy. At some point, the choice exercised by those who make healthcare choices must bring its own responsibilities.
As a result of regulation, the insurer has motive to lose that lawsuit. First, the settlement is often less than the cost of a court battle. That means that more such cases will be brought because a new precedent, whether due to the cause of the loss, the size of the settlement, or the type of restorative measures demanded, means that all such cases must be covered the same way by all insurers. They must then raise rates and the total industry cash flow then increases. Insurers make money on that cash flow, as well as on investments in companies that treat covered losses. If that sounds like a conflict of interest, it can be.
While central planning in healthcare works no better than it did in the Soviet Union, the United States is effectively torn between socialized medicine and corporate welfare. We have the finest care available, but by far the most expensive. While the US bears much of the research and product development costs for the rest of the world, in no way can it be considered a cost-effective system by world standards. There is a lot that can be done to improve its efficiency without resorting to the mediocre treatment characteristic of socialized medicine.
When the level of free service is equivalent to what can be purchased by private parties, there is then no reason to invest in private care. Socialized medicine makes all healthcare policy decisions political thus masking the cost of individual decisions by placing the burden for their consequences upon everybody. That's why AIDS research is starving the search to cure cancer even though the latter clearly costs society far more, which destroys the wealth that funds AIDS research. Government intervention into free-market risk management distorts the cost assessments that help industry identify costly health risks to invest in eliminating them. Treating medical problems is a human need capable of virtually infinite costs, simply because life is fatal. As medical technologies proliferate no insurance pool will be able to afford all the treatments its users could desire.
The best way to reduce the cost of treatment is to prevent the need, a focus upon which our physician-dominated system is lacking. These activities include personal habits that preclude problems (exercise, diet, posture, marriage, oral hygiene), mitigating measures designed to keep a problem from getting worse (special diets, spinal correction, dental care), and diagnostic tools to detect potential problems.
Many nutritional supplements dont get onto the market as substitutes for prescription drugs because food is not patentable. Decades later, expensive drugs are qualified by the FDA that have side effects the natural products don't have! The fix starts with private property rights. Many of these nutrients are only in unique local habitats. In that respect, the combination of resources and processes that support production of a particular nutrient should be patentable just like a mining claim. It certainly provides reason to understand and care for that habitat instead of ruthlessly exploiting it. You saw it here first.
It is within the preventative realm that the market has operated with relative freedom, but it has suffered from the distortions of treatment costs downstream. New preventative technology usually lacks physician or insurer acceptance, has high initial costs, or suffers from the perverse result of providing insurers reason to cancel coverage as is the case with diagnostic equipment. This is because minimizing total cost to the patient does not drive the profit motives to coverage providers, indeed, quite the opposite.
Only patients can have their own best interests at heart. That's why individual payment systems are the least expensive in delivered cost across total populations as long as each patient understands and is motivated to adopt the least cost option.
Unfortunately, the patient has no idea what a competitive price for most medical services might be, in part because of the distortions due to the buying power of large pools. HMOs, MediCare, and hospital bills (padded to cover the cost of services to the indigent) have absolutely destroyed the patient's ability to weigh competing prices of medical services. Have you ever looked at an Explanation of Benefits form? Did the prices bear any resemblance to reality? Have you ever asked your physician what he or she might take for the service in cash? If so, were you surprised at the difference? So how can anyone objectively judge what is in their own best interest?
You now know why the system is insane.
Treatment of the medically indigent is totally dependent upon the insurance pool of last resort: the taxpayer. Although minimal free healthcare services cost taxpayers, confining infectious diseases and preventing lifelong problems in children saves taxpayers money in the long run. There is an obvious peril, however, in making free health care services available to anyone.
Controlling healthcare costs thus faces an inherent conflict, regardless of whether healthcare services are private or socialized: A high price at the initial point-of-service inhibits people from seeking help early, when most medical problems are less expensive to confine or treat. Conversely, pricing medical care free of charge would make containing costs impossible. The key to resolving that paradox is in managing the triage function in a manner that serves more purposes than the system does now.
Triage is the process of evaluating patients and determining what kind of diagnostic work or treatment they need. It is done by firemen or EMTs in an emergency. It should be performed a qualified technician or nurse before any person makes it into an emergency room. Any person who doesn't qualify for emergency treatment could then be directed to an urgent care facility or asked to make an appointment.
Triage should be free. The provider must have no relationship to any downstream medical provider. They would provide pricing information on the various alternatives in the process, whether a visit with a doctor, chiropractor, nutritionist, or purchasing lab tests. Triage would thus be little different than walking into a store and deciding what to buy, if anything.
The one problem with putting triage in front of a physician visit is that when most people get sick they want to see a doctor right away. The way to meet that demand is by automating the triage function. Many people have the education to make confined medical choices. An insurer could provide qualified subscribers access to online diagnostic information that would help them research their medical problem, select the appropriate specialist, make an appointment, or communicate about problem to a triage specialist. The software might also test the users' comprehension by which to qualify for the option to make more decisions for themselves. They could schedule diagnostic tests so that a physician could make a decision without a visit. Putting test and treatment protocols online thus would improve both patient education and physician accountability.
Such testing also assesses the effectiveness of the educational tools by which to market better services, reason to research, develop, and improve the quality of online education tools. If copyright for such information bundling and testing were confined for, let's say, five to seven years, the provider has reason to invest in improving proprietary tools, while the benefits are not retained from the public at large for an unreasonable period.
Increasing use of nurse practitioners to screen incoming patients would save both time and money as well as handle the indigent patient fairly. Here we come to the manner in which the scope of patient care for the indigent must be confined to a rational minimum. We have a right to be free, but we don't have a right to free care. The only way to manage the cost of medical treatment for the indigent is to define what kind of services they may have very carefully. It is a political decision.
Where the healthcare industry is truly responsible to the public is in informing our representatives of the relative cost of various healthcare options by which they can then define the scope of coverage in budgetary legislation. Providers should effectively give us a budget for what they can accomplish for a given amount of money, what would be effectively indigent healthcare for bid.
Most healthcare purchases today are not made by the user, but by an interest without accountability for acting as the user's agent: their employer. To combine the benefits of pooling with visible pricing means more than making the purchase price of healthcare options visible, it is to return to the user control of the buying decision. We need to expand the concept of the Medical Savings Account to include pretax purchase of healthcare on the part of the employee and end employer purchase of healthcare.
One way to resolve that customer alienation from reality, and provide private providers a way to contain costs, would be to market coverage from a menu of narrowly defined policies. Consumers would combine these policies into a package to suit their individual preferences. By defining coverage pools according to the choices people make, those behaviors that unnecessarily cost the total system would be borne by those who choose to incur those costs.
For example, people who don't want extreme measures taken to save their lives or don't need coverage to treat STDs, obesity, infertility treatments, or caring for children, wouldn't have to pay for them. Those who dont want elective cosmetic surgery wouldn't buy that policy. If getting regular exercise assured a lower cost of coverage it would motivate the sedentary to start working to qualify for that pool. Forcing people to confront the cost of their choices is an important way to prevent expensive problems. That process reduces the total cost of the entire system.
Pricing each distinct need focuses research dollars to fix the problems that have the most potential, whether glamorous university-research or a simple educational tool. It may be true that America's research is carrying much of the rest of the world stuck with socialized medical care, but it is product development that pays for it. No political system is as efficient at optimizing competing demands on capital as is the marketplace.
There will still need to be restrictions on customized customer pools for the sale of health insurance to preclude exclusion of people who had no choice in their ailments, such as those who suffer congenital diseases. That such groups exist does not discount the value of pricing services by behavior because it motivates healthy decisions that increase the total wealth that ultimately must pay for those who can't.
I posted this in 2002, copyright by Mark Vande Pol, as I was tired of Republicans droning on over the same ideas that never sold for years when there are more options.
Insurance companies, hospitals, and doctors are really into it for the money, what a news flash!!!! LOL!!!
Thanks for posting that.
Here’s another if you haven’t seen it yet:
I don't think so. I think I just went to the crux of the issue.
Or if you just fill out the questions in a pre-employment phyicial questionnaire.
List all Rx drugs you are currently taking.
List all Rx drugs you have taken in the past.
List all operations you have had.
List all medical conditions you, or a family member, currently are being treated for, or have been treated for in the past.
Bla Bla Bla.
Failure to answer truthfully on every question is cause for immediate discharge, and or, rejection of employment.
Yes, all you have to do is look at military health care for families of service personnel.
Family members go to the base dispensary and are told to take a number.
Interesting. They only want to insure people that will never need the coverage. Its a great way to make money.
No, they only want to insure people who don’t ALREADY need the coverage. Would you sell fire insurance on a house that is already burning? Would you sell life insurance to someone with pancreatic cancer? It is tough, I know but insurance companies who go broke can’t help anyone.
The irony is that most people have a condition of some sort by their 30s or 40s.
The whole concept of insurance was developed during an age of “incomplete information”. The internet has changed this, just as it has been changing a number of paradigms and associated enterprises for years now.
We have all heard of marriages staged to get into the US. Has anyone heard of people getting married so that a spouse or stepchild can get medical coverage?
These new so-called privacy regulations (HIPPA, etc) are extremely helpful: they enable some shadow corporation you’ve never heard of to buy your medical history from a pharmacy chain. BUT if you’re in the ER bleeding to death from a car accident and your mother runs in asking to see you, they respond, “I”m sorry ma’am, we cannot disclose the identity of our patients.” You’re screaming from ER, “Mom? Mom is that you?” Your Mom: “Please, I’m really her mother, let me in.” Suddenly hospital security guard is dragging Mom out and threatening to call the cops if she does not desist “invading the patient’s privacy.” Think I exaggerate?
Yeah, that’s what “civil unions” (”gay marriage”) are all about.
The insurance companies go too far, though. Gallbladder disease, for example, is not a life-threatening complication. Just about everyone in my husband's family has had their gallbladder removed. His dad just turned 70 and is fit and active. What's going on here is that the insurance companies are maximizing their quest for the almighty dollar.
This is why healthcare can never be completely free market, because there's no profit incentive in taking care of the sick. On the other hand, the moment government involves itself in healthcare, only the foundational limitations of that government's intrinsic power can stop it from taking over everything and destroying it.
So the real discussion of healthcare should be about whether we have any effective checks on the government left to us (hint: Britain doesn't, and that's why it's state healthcare system is a nightmare - no recourse).
Where we are headed, looks a lot like Nazi Germany.
1. Britain's leading moral philosopher looks forward to the day when licensed euthanists can put old people whose existence is a burden on the welfare state out of their -- er, our -- misery:
The veteran Government adviser said pensioners in mental decline are "wasting people's lives" because of the care they require and should be allowed to opt for euthanasia even if they are not in pain. She insisted there was "nothing wrong" with people being helped to die for the sake of their loved ones or society.
The 84-year-old added that she hoped people will soon be "licensed to put others down" if they are unable to look after themselves.
Either we have a respect for life, or we don't. Maybe you don't remember the Third Reich?
Would you care to explain how you inferred a my statement to be a comment on abortion?
Care to answer why you think my comment inferred anything at all about abortion?
My statement was meant to say; We either respect human life or we don't, everything in life has a cost, trying to amortize health are as a business only makes a statement.
Hospitals were originally set up in most communities by churches, and were non profit, today they are all owned by corporations. Corporations have no heart, or obligation, other than to the bottom line.
Refusing to take pre-existing conditions is going to buy us government health care. Wait and see.
Or don't create a record in the first place.
You can get meds from other countries, like making a trip just over the border to Juarez or Algodones, Mexico (where prescriptions aren't required) or at various places in Canada or the Caribbean.
Or you can use an untrackable prepaid Visa card to shop on the Internet (using another name, and having packages delivered to another address, like a friend or a UPS store).
How common is this, and how does it shake out by white collar vs. blue collar, or by state?
Last time I was hired (white collar) the company didn’t do a physical at all. Only a screening for illicit drugs or abuse of Rx drugs (i.e. habitual usage at higher than normal prescribed dosage), and the screening company only gave the hiring company a Yes or No.
Originally the idea must have been something like, if you’re well enough to work a steady job, the average benefit can’t be outrageous. Except with families that’s a dicey assumption.