Soon you’ll be able to buy health insurance if you don’t have it—but can you keep it?  Even though the ACA did make it clear that health insurance companies can’t rescind a person’s insurance except for outright fraud, an insurer can still cancel your contract for a variety of reasons.

Rescission is a very specific type of action—it means an insurer cancels your contract retroactively.  Say you are insured but they find out you lied on your application, maybe about your age to get a better rate.  That would still be fraud under the ACA.  They can go back and cancel your contract for the whole time, so that anything they’ve already paid for is now your bill.    But they can’t rescind it for frivolous reasons—the example everyone likes to bring up is rescissions because a person forgot to mention teenage acne, not relevant to their current cancer.

Can they cancel it though, going forward?  Yes.  Nothing I see in the ACA says they can’t cancel your insurance, as long as you are given 30 days notice.  If I’ve missed it, let me know please!  It is long and I’m sure my memory isn’t perfect.

This might be a good time to pull out your insurance booklet (or go online) and see what things can get your policy canceled.  There are a couple on mine I thought you might be interested in.

Here’s one:  “if, after reasonable efforts, a Participating Physician is unable to establish or maintain a satisfactory Physician-patient relationship with a Member, coverage of the Member may be terminated upon fifteen (15) days written notice.  Examples of unsatisfactory physician-patient relationships include, but are not limited to, abusive or disruptive behavior in a physician’s office, repeated refusals by the Member to accept procedures or treatment recommended by a Participating Physician, and a Member’s securing services in a manner that impairs the ability of the Personal Care Provider to coordinate the Member’s care.”

Really?  If a person with my insurance can’t get along with her doc or doesn’t want to do what the doc recommends and my insurer finds out, the policy itself can be cancelled?

I have discharged a small handful of families over the years for that kind of thing—maybe 4 or 5 in 16 years.  If a parent is rude because of stress/ fear, I think it is better to be understanding—but if they curse at or threaten my staff (very very rare), I have to protect my staff.  If I find out they are lying to me about information that could cause me to do the wrong thing for a child, this scares me enough to let them find another doctor they trust enough to be honest with.  But these events are highly uncommon.  I should be able to dismiss those patients without endangering their insurance coverage.

The very idea that a person should lose insurance because of not wanting to do what I recommend for treatment is outrageous!  I have to document when a parent chooses not to follow advice (or forgets to give the asthma medicine, the more common scenario with busy families), partly so I’ll remember and partly for my own protection.   I need to remember later if the medicine didn’t work only because it stayed in the bottle, not because it wasn’t the right thing for the patient, since that can affect my treatment advice in the future.

Practices that take non-vaccinating families often use a detailed signature form documenting the possible risks of that decision (because doctors have been successfully sued by parents who said the doctors didn’t try hard enough to persuade them to do shots, followed by a child’s death from the preventable disease).  I had to do a deposition once in a divorce case, when one parent alleged the other didn’t follow my advice, standard, on limiting junk food and TV time.  I was very plain with the attorney that I tell everyone this and most people don’t listen.  In fact, some insurers require us to document specific preventive advice.  Will that now be a reason to lose insurance coverage?  How can doctors write accurate, useful records without putting our patients at risk?

Here’s another one:  “If a Member fails to pay a required Copayment, Coinsurance or Deductible, coverage may be terminated upon thirty (30) days written notice.”

Someone seeing a doctor or multiple doctors frequently for treatment of a serious illness would be expected to run short of co-pay money at times, especially if the illness caused that person to be unable to work.  Some doctor contracts with insurers say we are required to notify the insurer if a patient doesn’t pay the co-pay.  No time limit is given—what if the patient pays a month late?  90 days late?  Since insurers can’t cancel based on a person’s health status, will we see contract language like this being used for cancellations?  Naturally, an insurer would be unlikely to investigate co-pays by a patient who was inexpensive to them.

We must expect to see ever more creative ways of dropping expensive patients, as we go forward with healthcare reform.  Maybe you think it sounds unlikely, but remember that frivolous rescissions were common in the past.  An insurer that has the nerve to say leaving acne off a form is fraud will do other bad things.  If you get sick and are dropped from your employer policy, I guess you can immediately get one on the Exchange—and when that one drops you, you can get another one.  Each time, you may have to switch doctors and medications based on the insurer’s preferred lists.

You know I have to say it—we could avoid all this policy termination and intimidation by moving quickly towards Improved, Expanded Medicare for All.

Posted with permission from Pippa Abston’s blog.