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Archive for Tuesday, March 31, 2009

Insurers shun people taking certain meds and keep blacklist

March 31, 2009

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Data firms

By law, data-mining companies are required to tell you what they’re telling health insurers about you. To ask for your file, contact:

• Ingenix MedPoint Compliance, 2525 Lake Park Blvd., West Valley City, UT 84120, MedpointComplianceingenix.com • Milliman Intelliscript, 877-211-4816, IntelliScriptSupportmilliman.com • Medical Information Bureau, 866-692-6901

NOTE: Milliman and Medical Information Bureau say they will have files on you only if you have applied for individual insurance.

— Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take Metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

This confidential information on some insurers’ practices is available on the Web — if you know where to look.

What’s more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

These issues are moving to the forefront as the Obama administration and Congress gear up for discussions about how to reform the health care system so that Americans won’t be rejected for insurance.

It’s especially timely because growing numbers are looking for individual health insurance after losing their jobs. On top of that, small businesses are frequently finding health policies too expensive and are dropping coverage, sending even more people shopping for insurance.

The problem is, material available on the Web shows that people who have specific illnesses or use certain drugs can’t buy coverage.

“This is absolutely the standard way of doing business,” said Santiago Leon, a health insurance broker in Miami. Being denied for preexisting conditions is well known, but when a person sees the usually confidential list of automatic denials for himself, “that’s a eureka moment. That shows you how harsh the system is.”

A 50-year-old Broward County, Fla., man, with two long-standing medical conditions, saw the harshness for himself when surfing the Web trying to learn why insurers kept denying him coverage. He was shocked to find several insurers’ instructions to sales personnel, usually called the Guide to Medical Underwriting and often marked “confidential and proprietary.”

“I think it’s atrocious what’s going on,” he said. “Basically, they’re taking only the healthy so they can get the fattest profits. If you really need insurance, then you can’t get it.”

The man, a self-employed consultant, didn’t want his name or pre-existing conditions identified for fear that the information might frighten away potential employers.

Insurers don’t want to talk about the guides. Sunrise, Fla.-based Vista, which has its 35-page “confidential and proprietary” guide tucked away within its Web site, refused to make executives available for an interview and instead issued a brief statement:

“The medical underwriting guidelines used by VISTA are based on industry standards, comply with all regulations and are subject to review by the Florida Department of Insurance. VISTA’s Guide to Medical Underwriting is an educational tool intended to assist agents and brokers who are selling VISTA individual plans. We do not comment on our specific underwriting processes and practices.”

Sandra Foertsch, who sells individual policies, says the fundamental concern of insurers is clear: “They don’t want to buy a claim,” meaning that they would start to collect $500 monthly premiums from a person and quickly pay out more than that to doctors and other providers.

Vista’s Guide to Medical Underwriting is now on The Miami Herald Web site: http://www.miamiherald.com/business/story/973158.html.

Comments

jaywalker 5 years, 9 months ago

"A 50-year-old Broward County, Fla., man, with two long-standing medical conditions, saw the harshness for himself... I think it’s atrocious what’s going on,” he said. “Basically, they’re taking only the healthy so they can get the fattest profits. If you really need insurance, then you can’t get it.”

Yes, because all businesses should take on 'assets' that are guaranteed to lose a LOT of money. Poor health is a bummer, but insurers aren't evil 'cuz they don't insure someone who'll cost them 10x more than their monthly premium.

just_another_bozo_on_this_bus 5 years, 9 months ago

A perfect example of why the current system has to go.

geniusmannumber1 5 years, 9 months ago

Those first two comments, read back to back, perfectly sum up the situation.

Chris Ogle 5 years, 9 months ago

I have coverage, but (for the reasons stated above) I don't dare ask BC/BS to pay for my blood pressure meds.... Hell, I may need the health insurance some day.

jaywalker 5 years, 9 months ago

xbus,

You shouldn't have much trouble getting insurance w/ blood pressure problems as proper meds control the situation. I tell all my friends to stay away from anti-depressants and the like. Unless used for a short period of time for a reason such as you're depressed from the death of a loved one, it's an instant red flag and heightens denial. Blood thinners are auto denial. Stuff like that. Of course, you're always on shaky ground w/BC, they'll drop you like a bad habit for anything. And Lord help ya if you're forced to use them outside their network!

To bozo and genius: I don't disagree.

salad 5 years, 9 months ago

" Poor health is a bummer, but insurers aren't evil 'cuz they don't insure someone who'll cost them 10x more than their monthly premium."

Yes they are. You, Jaywalker, will be squealing like a stuck pig when it's your turn to get a raw deal from our lousy healthcare system. The staus quo has to go.

average 5 years, 9 months ago

I know people who see doctors and bought meds with cash in border towns in Mexico, so they don't risk losing their catastrophic coverage in the US. I might consider it, if I needed to (haven't seen a doctor in 12 years, knock on wood).

"Greatest system in the world" my hind foot.

just_another_bozo_on_this_bus 5 years, 9 months ago

" what is this, the 53 year old club?"

That's the club I belong to, as well. Although only for few more weeks.

G_E 5 years, 9 months ago

I'm dreading the day when I'm kicked off my parents' insurance. I'm a healthy 20-year-old who takes no medications aside from the Pill, but I simply can't afford it. So I'll either have to A) cope without insurance for a few years until I get out of college and into the "real world," praying that I don't get too sick (or wind up in the hospital with some freak thing, like I did last fall with a ruptured ovarian cyst) or B) get money from my parents to help pay for health coverage. Neither option is all that desirable.

Confrontation 5 years, 9 months ago

The only ones who are okay with the current system are those with millions in the bank or those who are stupid enough to believe that they'll never get really sick. No one is safe. Insurers will get rid of you as fast as they can. It gets worse every year, and something needs to be done.

Chris Ogle 5 years, 9 months ago

I take a baby aspirin each day, and every once in a great while (loosely stated) I might have a beer with a refill or two. But.... don't tell on me, I might kicked out of BC.

By the way, fishing is good for your health, as well as bitching online....I don't know if BC would give any brownie points for that preventive health care, but it works for me.

Godot 5 years, 9 months ago

This article is pure propaganda. One sided; omitting pertinant facts; twisting others. The Obama machine is in full swing with this distortion of the truth.

akt2 5 years, 9 months ago

I hope Obama starts at the top by yanking all of the big buck bonuses that the executives are taking in. He can make an example of them just like he has the AIG execs.

jaywalker 5 years, 9 months ago

"Yes they are. You, Jaywalker, will be squealing like a stuck pig when it's your turn to get a raw deal"

Salad: insurance companies are 'evil' if they don't accept a person who's monthly cost to the company is going to be 10x more than they pay in premiums? I'm afraid you don't have a clue, friend, nor do you own a business.
I don't disagree that the system needs to change. But currently, if an insurer took on that high risk/high cost customer, 1) that customer could never afford the premium that would offset the cost, and 2) if they insured that customer and gave them a raised but manageable premium the remainder of the cost would be dispersed amongst their insured pool, which means you and me. Example: Say you're in a pool of 95 people and all of you are relatively healthy. Your insurer goes ahead and writes 5 high risk people, all of whom will rack up 100k in medical bills in a year. They sure as hell aren't going to be collecting 8500k/mo. in premiums for each of them, but let's say they can get 'em to pay 1k/mo. So out of a 500k bill for those 5 for the year, they pay 60k of it. That leaves the other 440k for you and the 94 others in your pool. You gonna be liking your 'nice', business illiterate insurer once they take on the uninsurable and stick you with another 5k in premiums per year?

Insurance is a money making private business, and it virtually has to be. A health insurance provider must by law hold in reserve 4x their monthly average in paid out claims. For a national company with millions of customers, that number is staggering. There are numerous reasons why our current system needs a drastic fix, but it ain't 'cuz the insurers are 'evil'. I'm aware there are plenty horror stories out there, but the biggest reasons for them is customers don't read, understand, or follow their policy; they expect everything to be covered just because they pay a premium, especially if they had a great company group policy previously; they overuse their policy for every little hangnail; and they sue nurses, doctors, hospitals, administrations, or insurers at the drop of a hat. And then malpractice suits add on, and then overprescribed medications, testing, therapy, treatments, visits add on to avoid the malpractice suits, and on and on. There are bad and unscrupulous insurers out there, but for the most part they're run the way they're supposed to, and they certainly aren't 'evil'.

Alia Ahmed 5 years, 9 months ago

keebler1rk (Anonymous) says…

You think the system sucks now, Throw in a few federal employees! How in the hell are they gonna shut down the entire health care system on Martin Luther King Day! Welcome to the new americaski comrades

I worked for a private insurance company and we had Martin Luther King's birthday off. What's your point? The actual caregivers will not be government employees. A single payor system streamlines the administrative paperwork and billing. Currently most care providers take days off, like every Saturday and Sunday, Christmas, New Years, Thanksgiving, 4th of July, Memorial Day.

gilly 5 years, 9 months ago

I love it when the profit motive is used to decide who lives and dies. Forget morality, compassion, or even a smidgen of understanding that a healthy populace is more productive and less expensive than an unhealthy one.

Have you taken a look at the medical underwriting guide that accompanies this article? If you're anorexic or bulemic, diabetic, have high blood pressure or a chemical dependency, Crohn's disease, macular degeneration, Tourette's disease, gastric bypass, or any kind of heart ailment, you won't get coverage. If you've broken a hip or had one replaced, you won't get coverage.

If you take Accutane, Heparin, Tamoxifen, Lithium, Wayfarin, or Plavix, you won't be covered.

The American populace has let for-profits run medical care in this country for a very long time, and what we've gotten for it is the cruel and extravagantly expensive state of non-health care we have now. I'm all for letting the government put reins on businesses that take your money when you're healthy and that cut you loose when you're not.

And for all you bean counters who think that the status quo is just the way it should be--I hope you never find yourself sick or hurt and in need of coverage. It will be a sorry way for you to learn that you should have included some other factors in your analyses besides the bottom line.

salad 5 years, 9 months ago

"I'm afraid you don't have a clue, friend, nor do you own a business. "

Jaywalker, I'm not your friend, and you, sir/madam, are the one without a clue. Why don't you go to one of your preciou$ bu$$ine$$e$ and buy one.

Gilly succinctly gutted all your rancid profit-centered arguments. Here's one more: insurance companies make money by collecting premiums and denying claims: end of story. That's evil in my book.

average 5 years, 9 months ago

"nor do you own a business"

Nor, I expect, do you. I know several small businessmen. I don't know one who wouldn't jump at the chance to be free of the hassle of insurance, to get off the 'health care arms race' with bigger employers, to hire without worrying what the potential employee's health costs will be, and to lay off (as need be) without the fear that they are condemning an employee's child to medical poverty.

RoeDapple 5 years, 9 months ago

jaywalker (Anonymous) says… "Yes, because all businesses should take on 'assets' that are guaranteed to lose a LOT of money. Poor health is a bummer, but insurers aren't evil 'cuz they don't insure someone who'll cost them 10x more than their monthly premium."

The cost of insurance is based on making a profit on the average health of the population covered.

Profit.

So if the insurance companies refuse to insure you based on age, general health, race or for whatever reason why aren't they brought up on discrimination charges? Their base is profitable with everyone figured into the equation. By law they cannot discriminate in hiring their employees, do they then refuse to insure employees who are not in perfect health? You may or may not have the answers to these questions, I do not. Could it be a "We reserve the right to refuse service" kind of thing?

RedwoodCoast 5 years, 9 months ago

Simply amazing. Gotta chase the almighty dollar. Who cares if you're sick; you'll cut into someone's profit margins. Unregulated capitalism is obviously more important than the health of any one person. Stupid, stupid, stupid, and more of it.

tolawdjk 5 years, 9 months ago

Looking at the denials on that list it seems to be that the only way you could get insurance is if you didn't need insurance. How is that a defensable position to take?

RoeDapple 5 years, 9 months ago

exbusguy, If you are taking prescription blood pressure meds, or ANY prescription meds, believe me, BCBS already knows....

yankeelady 5 years, 9 months ago

Insurance is almost as profitable for their CEO's, etc as AIG was until recently. It is very big business that is in it for the money. Look at Humana or Kaiser Permante. I don't much care for Michael Moore, but he hit it on the head with Sicko. As long as there is money to be made, there is an automatic conflict between the healthcare consumer and the insurance companies. And it is painfully obvious who is coming out ahead.

Ryan Neuhofel 5 years, 8 months ago

I think we can all agree that most health insurance (more appropriately "management") companies provide terrible quality and value for the service they "provide" in return for your premium. But to blame this solely on "greed" or "profit" of the companies is intellectually lazy or dishonest.

Why does a carton of a dozen eggs only cost $1.49? Is it because the chicken farmer is "altruistic" and will only set prices at an "affordable" level? Not to criticize chicken farmers, but they are trying to maximize profits just as much as anyone! (BUT HEALTH CARE AIN'T EGGS DUMMY!)

The system is rigged in the favor of private insurers and they have taken advantage of an unfair market - created by employer-purchasing and socializing losses while privatizing gains. Of course, people with chronic medical conditions will have a higher risk of expensive care in the future - but to say that someone with "gallstones" (more than half of adults in American) is "un-insurable" is ridiculous. This would actually be a terrible business decision in a truly free market - since you would reject nearly every single person!

RedwoodCoast 5 years, 8 months ago

neuhofel: The contradiction between profiting as a health insurance company and enabling people's medical treatment is only a symptom of the problem. The structure of the entire system is the problem. Yeah, insurance agencies obviously need to make profits, but I think they engage in the health care market, along with pharmaceutical companies, in a heinous and egregious manner. I agree with the notion that bringing down the cost of health care will not only help the individual, but it will also free up money that the individual can actually spend on other industries.

America: land of privileged healthcare. And everyone else can just go fly a kite because they are obviously looking for handouts and, therefore, don't even deserve medical treatment.

Chris Ogle 5 years, 8 months ago

believe me, BCBS already knows

Roe- how do they find out?

RoeDapple 5 years, 8 months ago

xbusguy Through cross referencing with claims paid to M.D.s, access to records paid on other medications possible access you have unknowingly allowed

RoeDapple 5 years, 8 months ago

My doctor receives info from other doctors as to what has been prescribed. My insurance company notifies me if I am buying prescriptions (even if cash paid) if I could save money by ordering online. It's a conspiracy.

;-)

jaywalker 5 years, 8 months ago

Salad: So sorry you feel you need to be that way. And sorry you think that way. I believe you've watched "Rainmaker" one too many times, but whatever makes ya bitter. I'd respect your position a little more if it was based in just a dab of reality, or your own opinion. But nice job piggybacking gilly.

To everyone else who misunderstands my point: I'm not a fan of the current system and we do need to change it drastically. My point was only that, based on the way they're supposed to operate, health insurance does just that.

"So what options does someone who doesn't fit a profitable health profile have?"

To add to that list by logicsound, many states including Kansas have state backed policies for those that are routinely denied. Another decent option is to get a job with one of the big companies like Starbucks, Home Depot, UPS, etc. You get full benefits working 20 hours.

"I love it when the profit motive is used to decide who lives and dies. Forget morality, compassion, or even a smidgen of understanding that a healthy populace is more productive and less expensive than an unhealthy one."

To that end and to all who feel nationalized health care is the answer, what parameters exactly do you think our bureaucracy will use to decide who lives and dies?

RoeDapple: For exactly the scenario I stated above. No company can be forced to take on an automatic money drain. And since their business model is based on making a profit............. I guess it kinda is a 'right to refuse service thing', that's about accurate.

just_another_bozo_on_this_bus 5 years, 8 months ago

"Salad—the slave moralist. The morality of the weak is one of altruism—the concept that the individual has an unchosen positive obligation to serve others and that their fundamental purpose in life is to serve others. If you don't, then you are “evil.”"

You're a through-and-through cynic, LO.

just_another_bozo_on_this_bus 5 years, 8 months ago

"To that end and to all who feel nationalized health care is the answer, what parameters exactly do you think our bureaucracy will use to decide who lives and dies?"

If you want the perfect, easy answer that will satisfy everyone in every circumstance, you need to move to some alternate universe. Medicine and healthcare will always be our imperfect struggle against our inevitable mortality. Any time any of us is confronted with a debilitating disease or imminent death, the possibility exists that either the resources or the technology to cure or save us will be lacking.

The simple fact is that in countries where there is some form of national healthcare, especially if it's single-payer, all citizens have some assurance that they'll have the same access to the same resources and technology as everyone else, at an aggregate cost considerably less than our system, in which "the parameters that decide who lives and dies" are determined almost solely on how wealthy you are.

compmd 5 years, 8 months ago

America, the richest country in the world, with the most advanced science in the world, and yet we have this.

I'm lucky I have my no-premium, full coverage BCBSKC plan through work that didn't require any medical history or background check. That is what health insurance in this country should be.

Ryan Neuhofel 5 years, 8 months ago

compmd: "no-premium, full coverage BCBSKC plan"?

I have heard of "sticking your head in the sand", but you have taken it to a whole other level . . . "the bottom of the Sahara desert"

Do you not realize your employer (that greedy person you call boss) calculates the "cost" of employing you (your compensation) by adding the cost of your benefits to your salary?

Or maybe you work for the U.S. Mint or Federal Reserve where you can just print a few bucks to buy your "no premium" health insurance. Maybe that is where we should all work.

jaywalker 5 years, 8 months ago

" where there is some form of national healthcare, especially if it's single-payer, all citizens have some assurance that they'll have the same access to the same resources and technology as everyone else,"

With all due respect, you must be high.

"in which “the parameters that decide who lives and dies” are determined almost solely on how wealthy you are."

First of all, that's a ridiculous assessment of the current system. Wealth always has advantages, but the system is not nearly as biased toward the wealthy like the courts, and that's what you seem to be basing that opinion on.
Fact is, many of the non-wealthy have their lives saved on a daily basis in our current system. Putting the decision of who lives and who dies into the hands of our government? Again, you must be high.

just_another_bozo_on_this_bus 5 years, 8 months ago

"With all due respect, you must be high."

This doesn't indicate any level of respect. But it does indicate that you have no argument to make, so you resort to ad hominem attack. And it doesn't get any better through the rest of your post. You had nothing to say, but rather than saying nothing, you puked that trash of post out instead.

With all due respect, just sayin.

jaywalker 5 years, 8 months ago

"This doesn't indicate any level of respect"

And there you have it.

"But it does indicate that you have no argument to make"

Uh, yeah, my counter was clearly printed. And enough with the 'ad hominem' blah blah, beside that being your stock in trade you apparently don't understand the phrase. That last post is nothing but an attack on me, not on what I had to say. Saying I said nothing don't count, brain trust. My post, on the other hand, addressed your points. The fact you can't or won't respond to them doesn't make the post an ad hominem attack. Check the def and get back to me.

just_another_bozo_on_this_bus 5 years, 8 months ago

"Check the def and get back to me."

Your intent and primary content was ad hominem attack. Did you imbed a sliver of an argument, albeit unsupported and incomplete? Yes. But for such a self-proclaimed "intellectual," it's embarrassingly inadequate, at best.

RedwoodCoast 5 years, 8 months ago

jawalker, I would feel much better about health care if the government, which is directly accountable to citizens, controlled health care, rather than the current system that relies on a business model operating in complete contradiction to the primary purpose of the insurance industry. Privatize it and the biggest thing that might happen is a congressional hearing. It usually stops there.

And don't play the "wealth is health" card when it comes to this issue. I don't understand how any human being can defend a system that denies help--or cheap help for that matter--to many of the people who need it most. There are many aspects of living here on Earth as a citizen of the USA in which wealth serves us quite well as a determining factor, but I think we are extremely misguided if we continue to support our current health care system. It isn't the insurance companies, it isn't the pharmaceutical companies, it isn't the cost of health care; the problem is the structure of the system, itself.

jaywalker 5 years, 8 months ago

"Your intent and primary content was ad hominem attack"

Three words makes for primary content? Uh huh. And now you've posted two in a row which do nothing more than what you accuse of me. What was the line? Oh, the hypocrisy.

"But for such a self-proclaimed “intellectual,” it's embarrassingly inadequate, at best."

And yet you're unable to respond. Huh. Never proclaimed to be an 'intellectual' ever, bozo, just alot smarter than you.

Redwood,

I agree with you on the last statement, that it's not one aspect of our current system, it's the whole thing. We'll disagree forever on the effectiveness of healthcare once in the governments hands though. The USPS is going bankrupt, public education has scored lower each year since it got in their hands, it costs citizens billions just to comply with the tax code yearly, and social security is on it's way to going bankrupt. I have no desire to see my health in their hands.

"And don't play the “wealth is health” card when it comes to this issue. I don't understand how any human being can defend a system that denies help"

Play the wealth is health card? Don't know what you're referring to. Nor have I defended this system, I've repeatedly stated that we need drastic changes. But if you think govt. run healthcare won't be denying help to those that need it most I believe you're sorely mistaken. It happens in those countries so many wish to emulate right now.
Somethin's gotta change, Red, no doubt. I'm beyond skeptical our bureaucracy is a viable caretaker for the system. I understand it has some positives in England and Canada, but I've heard plenty of scary and disturbing scenarios as well. And since our population is three times theirs combined........no, thanks. These guys have had years to effectively shut our borders and that's not nearly as complex and far-reaching as healthcare, know what I mean?

myvotecounts 5 years, 8 months ago

There is much truth to this article. I've been with BC/BS my whole life, through several jobs, and now on my own. They have made a TON of money off of me and my healthy lifestyle, and they know my entire life's medical history. But, when I became self-employed at middle age, they instantly denied me coverage based on cholesterol medication (that keeps my cholesterol IN CONTROL), and occasional migraines. I too pay for my Rx on my own--without a prescription rider. There IS a blacklist at BCBS and other insurance companies.

At the least, there should be some kind of credit system to allow those who have fed the insurance company's profits and insurance database for decades, to continue to be eligible for coverage and at fair rates.

jaywalker 5 years, 8 months ago

logicsound,

I just don't believe that the insurers are generally 'evil', which is how this all began. I think only a fool would believe the current system is fine, but other than that I don't have the first clue how to re-vamp the system to make it equitable.
The problem with all of this is that people don't take into account the actual costs of care. You want a system where those with pre-existing conditions can't be denied. That is ideal. But so is making sure everyone gets every ounce of care necessary to enable them to live as long as possible regardless of affliction. The costs of a hospital stay are staggering. Testing, surgery, chemo...through the roof. I had a customer who shattered his ankle playing softball. He had 9 surgeries to fully repair his leg and when done the bill surpassed 600k. His share with my company = his 5k deductible, not a penny more. When you have the population we do coupled with the millions who require intensive care I don't believe there's any way to knock down costs under a single-payer system. Our government already controls the VA, and that's a huge, slow, ineffective bureaucratic mess. Adding 300 million to the pot would be miserable. And for all the 'equity' a government run system will supposedly provide, the decision for who gets to keep receiving chemo or life-sustaining drugs is handed off to the bureacracy, not to doctors or the patients themselves.

Personally, I just think health insurance needs to be cut back to catastrophic coverage, testing, and prescriptions.
No more cheap co-pays for doctor visits, massages, dental cleanings, wellness, etc. Those aren't the things that break the bank. It's the expensive tests and hospital stays, surgeries and costly prescriptions that need to be insured. Car insurance doesn't cover a flat tire, bad wiper, or leaky water pump. Home insurance doesn't cover lost shingles, broken windows, or chimney soot build-up. It's not the government's job to insure each citizen lives as long as personally possible, but everyone thinks that since they pay any sort of premium everything from bumper to fender will be made like new again. Doesn't matter what system we have, that can't happen.

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