Tuesday, June 23, 2009

Denied

The most difficult part of my position as Vice President of Public Relations for Little People of America are calls and emails about which I can do very little. Often times, the calls and emails are from people whose health care application has been denied because of a pre-existing condition. The first time I received such a note it was from a father who is a little person and has two children who are also short statured. He had recently switched jobs and was denied coverage when he tried to sign up for a new plan. When I heard about it, I thought surely the insurance company was breaking the law. But after asking around, I soon learned that denying coverage because of a pre-existing condition is legal and that being denied coverage is not uncommon in the dwarfism community.

More recently, an email came in from a family with a one-year old who has dwarfism. They also recently switched coverage. Soon after switching coverage, the family was pre-approved for a neurological check-out. After they received pre-approval, the insurance company contacted the family, explaining that the original application was under investigation. Clearly, when the insurance company learned of the one-year-old's dwarfism, it began looking for reasons to drop coverage.

I am not in the health care or insurance industry, but I seen enough documentaries about health care and have read enough about the health care to know that companies look for ways to deny coverage in order to avoid what the companies believe to be the high costs of covering people with pre-existing conditions. What I don't understand is how a health care industry can be established around the goal of low costs and profits rather than support for people and families who need it, i.e. -- everyone. Obviously, that's naive of me. Most every industry and business in this country and else where is founded on the principle of profit. What's difficult to understand though is profit at the expense of infant children, inviduals and families who need coverage. Again, that's naive me. Even so, it's hard to know what to say to people who are perfectly healthy but, like everyone else, need health care. Unfortunately, just because they are not like everyone else in terms of stature, they are denied. There are options for people who are denied -- petition the state insurance board, apply for public health assistance, try to use current law (genetic non-discrimination act - from what I've heard this is difficult to do). Not everyone has time to be an adovocate though, and not all advocacy efforts are successful.

President Obama campaigned on the pledge to make it illegal to deny health coverage based upon pre-existing conditions. Hopefully, that pledge will become a reality soon. Until then, things might get worse for people at risk of losing or not getting health care because of pre-existing conditions. A recent congressional inquiry investigated the practice of insurance companies rescinding coverage. According to the story, congressional inquiry or not, the companies plan to continue the practice.

4 comments:

  1. Hey Gary--check out this link:
    http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

    Specifically: HIPAA prohibits plans from applying a preexisting condition exclusion to pregnancy, genetic information, and certain children.

    That family you describe might have a case?

    ReplyDelete
  2. it only applies when someone who was previously covered by a group plan joins another group plan, perhaps that was the issue.

    ReplyDelete
  3. great Cara,

    thanks. This will be real helpful.

    ReplyDelete
  4. Gary this is an issue that has affected me in the last year! I'm an achondroplasia dwarf that has been through 20 surgeries when I was a young child. Now I'm 22, and I can't get health insurance for the life of me. I was on Medicaid for 20 years with no problems until I turned 21. Now I have fought, fought, and fought for over a year now, and the state is just not giving in. I'm insurable to their eyes, but with a VP shunt, it's impossible!!!!

    ReplyDelete