Clinical Train Wrecks and Hangnail Underwriting

In reading this article about health insurance in the LA Times called “An eroding model for health insurance“, it reminded me a lot of the movie Sicko. It is a scary reflection on some of the issues with our healthcare market although I think it does a good job of bringing some interesting perspectives forward.

When people are rejected for coverage, a logical question that someone would ask is why wouldn’t any insurer cover them. The article talks about the fact that if one changed their underwriting rules without the industry doing it then they would get flooded with the sickest patients. Since it’s not a charity model (or a government model), that’s understandable (but very frustrating).

A few things from the article:

  • A story about a baby born to a couple that had coverage but the baby was refused coverage due to a temporary condition. The baby was covered 6 months later when the condition went away. [I guess I always assumed a child born to a couple with coverage would be covered…foolish me.]

“Insurers can reject applicants for even mild preexisting conditions. People have been turned down for individual policies because they have hay fever, have suffered from jock itch or use common medicines such as cholesterol-lowering drugs, records and interviews show. Even those lucky enough to have insurance are uncertain they can keep it or count on it in a crisis.”

  • A story about a woman who couldn’t get coverage because she took Prevacid. [Would she have been better off taking an Over-The-Counter (OTC) medication like PrilosecOTC or an older medication?]
  • Stories about companies auditing individuals trying to find reasons to terminate their plans.

BTW – The title is from two terms used in the article.

Here’s to figuring this out at some time in the near future. The stories are a sad reflection on our country.

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