Posted on 10/07/2009 12:03:26 PM PDT by ElenaM
How many women wanted to go out and buy health insurance the moment that the ept test came back positive.
They are lobbying to cover any and all preexisting because if you’re noncovered for more than 63 days HIPAA doesn’t cover it. Also, if your company is self-insured the HIPAA portability clause doesn’t apply. Only fully insured plans are subject to that part of HIPAA.
Actually, private catastrophic insurance (with a deductible like in the olden days) and medical savings accounts that can roll year to year with a very large cap.
One of the reasons we find ourselves in the mess we’re in today is that many people have *health insurance* that covers things they really could afford to pay for (doctors visits would be cheaper if people were paying for them out of pocket). We don’t really have health insurance. We have plans that pick up some of your health costs. It’s not the same thing.
The company would have a group, say for age 18-29. All members between those ages would fall into that group and the claims risk calculated regardless of employer. Right now that’s illegal.
ALL OF THEM!!! ;-)
But, the media makes it sound as if you can never get coverage for a pre existing condition....
Risk assessment is an actuarial/statistical LOGICAL process. IF today I have Type 2 diabetes, and thus am excluded for certain risks becasue of that, and two years later I still have Type 2 diabetes and have a relatively unchanged phenotype, then my risks have not changed, and an insurer does not OWE me insurance. They are in the business of covering risk for a profit.
Lastly, insurance is a substitute for cash. Insurance takes a ‘gamble’ on covering the distance between YOUR cash and the RISK of having to come up with CASH to cover the gap. Pre-existing conditions are pre-existing risks. Unless the risk goes away, the insurance is likely not to be offered. It doesn’t make actuarial sense.
I am pretty sure when my husband took a new job (5 years ago) my pre-existing condition was not covered for something like 3 months. I could be wrong tho, I may misremember.
Many good points, thanks
I can’t say I have ever heard of a fully self-insured plan applying a pre-ex in a manner differnet from HIPAA, regardless of whether they technically could. Of course, I am sure this will largely be driven by the states’ insurance commissions as well as the contractal language with the third-party administrator.
I do not view health insurance as a moral matter. I view it as a commodity and one that should be less regulated, not more. To try to tie it to morality seems curious to me, especially when much of the prevailing thought is that there is no absolute morality.
Thus, moral obligation to provide pre-ex coverage based upon what, exactly?
I have a pre-existing condition (MS) and we are covered through group insurance from my husband’s employer. If medical payments for my pre-existing condition were denied, we’d be in the “poor house” because the cost of the med I take would break us, so I probably wouldn’t take it. However, if I don’t take the med, I’m taking the risk that the disease will progress more rapidly and cost more to treat.
It’s easy to talk of how to deal with pre-existing conditions as long as you’re winning the “health” lottery, but if you lose to cancer, or a neurological disease, etc. then the pre-existing illness problem becomes very real.
Truth...I paid into group insurance for 25 years and never had to use it. So for the past 10 years, I’ve had to use it. In that light I really don’t see anything wrong with the system. I paid for someone else’s care for years, someone else it now pitching in for mine. Wish I didn’t have to use the insurance to pay for meds, but at $2900 per month, I don’t see a way around it. Wish my friend with breast cancer didn’t have to get those $1400 shots to help her fight the effects of the chemo, but she does.
Nobody with a pre-existing disease wants it...it just happens. It’s easy to find all the faults with the system till you’re on the other side of the argument. Like the guy in the parking lot as he eyed the disabled parking places up close to the store...”Those handicapped people have all the luck!”
I’m not sure why you posted that to me, but my pre-existing condition was indeed covered after a waiting time, so your last paragraph, at least in part, appears to be wrong. Maybe I misunderstand the point you are making.
It’s interesting that, as far as I know, NO ONE is suggesting the simple solution. There would still need to be something in place for the truly needy (but then again, there already is). But otherwise, get people back in charge of their healthcare and in charge of paying for it. The system today is almost nonsensical and very difficult to understand.
That’s absolutely misleading. If intentional, it’s an outright lie. I broke my back in 2001 and have 2.5 lb of titanium holding my spine together. When I moved from my hubby’s insurance to my employer’s, I had no break in coverage for my pain doc, injections, prescriptions, etc.
Wow, excellent point!
I can see why a healthcare company would happily provide ( for a fee or otherwise) health care to a child with a ‘condition.’ But *WHY* should an insurance company (they are in the business of covering risk) be required to cover a 100% risk? THAT’s what YOUR CASH is for.
If you are at AT RISK (obesity, adult-onset diabetes, COPD, etc) of potentially developing a ‘condition’ then I can sell you insurance at a rate I deem worthy of the risk. Tough nuts if it’s not affordable. THAT is the logical issue.
Now MORALLY, if society wants to decide to provide FREE or lower-cost healthcare to people with ‘conditions’ then THAT IS a MORAL and SOCIETAL question.
Just don’t try to argue that insurance companies OWE people coverage. (not that you are doing that) To do so is antithetical.
Lunacy. Demanding fire insurance as your house is in flames, car insurance after your accident. Typical liberalism in pursuit of votes through the destruction of free enterprise. And of course that great staple of leftist thought—personal responsibility is irrelevant and unnecessary as Big Brother will pass laws to bail you out!
Because the media and politicians are FOS.
Now, it does take the person applying for coverage to do a little work and I’m sure mistakes happen, which of course, will both be described as ‘failures of the system’ and a ‘crisis’.
Agreed. I don’t work in actuarial and I tried to keep it high-level so no one gets bogged down in the gory details.
It depends on how long it was between insurance. If you’re covered within 60+ days, the length of preexisting exclusion is 12 months minus the number of months one had coverage with the previous company.
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