Saturday, April 2, 2011

Insurance and the Preexisting Condition

The fear of a loss of insurance coverage is heightened for anyone who develops that "preexisting condition," to use insurance jargon. If you have reliable, generous health insurance, particularly if it's paid for by your employer, you are golden. But lose that job, and that insurance if you can't cover the COBRA payments, and you are left in a sea of panic.

I am fortunately in the former camp and, after nine years on the job, I have job security. In my current position, I am covered and pay no premiums. Optical and dental coverage too. More than that, my two daughters and husband are also covered 100% by my government employer and we pay a minimal monthly amount for them to have optical and dental coverage.

Without that job, I would be up a creek due to the last three months alone. According to my Explanation of Benefit forms that we receive in the mail every day, my insurance carrier (United Healthcare) has already shelled out somewhere around $75,000 since I was diagnosed on December 15, 2010. That includes consultations, biopsy, MRIs, mammograms, PET Scan, then surgery, reconstruction, chemotherapy, biweekly blood work.

But after nine years in one government position, I realize that I will always be contemplating other career opportunities. That's just the way I am. So, with that thought in mind, and cancer on my records, I started researching the whole health insurance issue.

Should I leave my position, I will either have to get hired by a firm or agency that provides family health insurance, or I will work for myself, and need to apply for a new insurance plan. The problem here is that insurers are allowed to, and routinely do, reject applicants due to preexisting conditions.

A reported 57.2 million people younger than 65 have at least 1 preexisting condition that could mean insurance denial. And cancer is one of the biggest preexisting condition that leads to insurance coverage rejections. Also, there are a whole host of other preexisting conditions that also mean a "no thank you" letter from an insurer, from multiple sclerosis, chronic back injuries, to diabetes.

But, you might ask, what about the whole Obama healthcare plan? Didn't that eliminate the right of insurers to reject applicants pre-existing conditions?

Yes and no. Importantly, the restriction goes into effect in 2014. It is not in effect today, tomorrow, next year, or the year after that. And it will not go into effect in 2014 if the health care bill is amended to eliminate that benefit. Further, the insurers will always have the right to increase charges for pre-existing conditions to a point where insurance is absolutely unaffordable to most people.

So Congress has given individual states the optional opportunity to create a plan to bridge the gap between 2011 and 2014, for those who are residents of those States and have preexisting conditions. I looked up New York's plan, since that is where I live, and was pleased to see there is a plan, but shocked to see how unreasonably inadequate the bridge plan is.

To qualify for a bridge plan in the States that have adopted such plans, according to Federal laws, you need to meet four requirements. You must (1) be a legal U.S. resident; (2) be a resident of that state; (3) have a preexisting medical condition - and be able to prove that you were denied insurance coverage because of it by production of a rejection letter; and (4) not have had health care coverage for the last six months. Then you are eligible for a state-sponsored individual plan.

Note that meeting these requirements. only provides individual coverage - that is after you pay the first $5950 per year of benefits, then your coverage kicks in. You still need to purchase extra insurance for spouse and dependants.

Though we are on the right track, this fourth requirement is offensive on so many levels. It could literally result in your death. It means postponing treatment and diagnosis for six months. Anyone with a preexisting condition needs ongoing health care, not a six month break.

I cannot say enough to explain my distress at this requirement, along with the financial requirements. It's not that I need this bridge coverage right now, but someday I might, and there are millions of people who do need coverage and can't get it.

I read the fears of women on the breastcancer.org website, who post about their lack or loss of health insurance. What can they do? Who can afford to pay upwards of $75,000 in a three month time span for necessary healthcare when diagnosed with cancer? And most of those who need the bridge coverage are either unemployed or self-employed.

As I said, for now I'm golden. But the possibility of losing that status is real, and it is frightening.

No comments: