My son, who graduated from college a year ago in May, has been turned down for an individual health insurance policy by the same company that had insured him for years. He never had a claim beyond an occasional checkup. Johnny is 23, 6’ 2’’, athletic, slim, a non-smoker and doesn’t drink more than an occasional beer.
Because I’m involved in healthcare at my job, I’m aware of the darker side of the big health insurance companies. Daily, I face denials for necessary care, co-pays that prohibit a patient from receiving needed care, and delays in payment. We encounter people who have no insurance who desperately need care. Others have a high deductible that they aren’t aware of, and when their bill comes, they walk away from the charges. They have now received “free” medical care and satisfied their deductible. Walking away from the bill is not uncommon in any medical practice. When you, as a medical practice owner, are faced with losses such as these, your only alternative is to make a profit on those patients with “good” insurance that come for treatment. The system encourages over-treatment of those with “good” insurance. I truly believe that every healthcare provider would welcome a modest, but fair, payment for every patient that came through the doors. Obviously, the system is broken. ….but I’ve digressed from my topic!
I knew my son was going to be applying for individual coverage upon his graduation, so I advised him to have a checkup at his university. I didn’t want coverage delayed in any way, pending a medical exam. The physician “flagged” a lymph node that protruded from Johnny’s neck, something he’d had since birth and is completely benign. Johnny was denied coverage because of the doctor mentioning the lymph node.
The policy Johnny was applying for was a major medical policy and would have cost him about $50 a month. Instead, he was forced to rely on COBRA, which costs us – his parents – about $350 a month. Is it possible that his insurer did the math? I’d hate to think that the reviewers would be so devious, but I do know that employees are rewarded for actions that improve profitability.
Soon he will have to once again seek coverage, and he will have to answer “yes” when the question of whether he’d been denied by another insurance company comes up. Obama’s reforms will help us all, but they won’t control the health insurance industry. By 2014, no one will be turned down for health insurance. If the plan offered to you is six times the cost of that of a healthy person, I don’t think we’ve made progress. We absolutely need to challenge private insurance with Universal Healthcare.