@SpeakerBoehner Let #hcr be and move the country forward to avoid #fail

Another election. Another pledge to end “business as usual.” President Obama got elected on that “change” platform, and so how John Boehner and the Republican party.

Will someone please explain to me, then, how repealing health care reform, effectively giving back power to the insurance companies and their lobbyists, puts an end to “business as usual”? Will someone please explain to me how making health insurance unaffordable will help cut costs and reduce the federal deficit? People can’t afford health insurance, they aren’t going to buy it. They don’t buy it, insurance companies raise the rates on everyone else because the pool from which to earn revenue is now smaller. Now people are taking home even less money, and we haven’t even touched on higher taxes to cover state budget deficits. And if people need health care, they’ll forgo it, or take on debt to cover it. How, exactly, does that help our economy?

Will someone please explain how repealing health care reform will create jobs? Part of the reform requires instituting electronic medical records. To do that means hiring people to convert paper charts into electronic charts, hiring people to manage and network the systems, hiring people to train on the systems, hiring people to build applications to better leverage data and provide optimal treatment. And will someone please explain to me how repealing health care reform will bring stability to the economy so companies want to hire again? Companies know it’s coming, they’ve spent money preparing for it. Repealing it means that money has now been wasted. They’ll need to recoup, so they’ll need to cut somewhere and laying people off has proven to be a quick way to do that.

I’m all for giving newly elected officials the opportunity to deliver on their talk of “change” and “transparency” and “ending business as usual,” but it seems as if Boehner and the Republican partly have a disconnect between those three “magic” words and reality. We, the people, are better at paying attention to both hands now. Waving the “change” and “transparency” cards on one side so we ignore the slash and burn and return to “business as usual” on the other is not effective this time.

If you really are bringing “change” then move the country forward. Let health care reform be. It hasn’t completely taken effect yet, so you can’t effectively and honestly analyze its impact, good and bad. Let it be. And if it turns out to be a failure, repealing it will be that much easier.

If you repeal it now, then you have failed to deliver an end to “business as usual” and already closed the “new chapter” you just opened. So let health care reform be, and demonstrate your commitment to “government that is honest, accountable and responsive to their needs” through attention to jobs, alternative energy, technology, infrastructure and a host of other needs that have been ignored.

Privacy is about Context

I admit to being one to say that privacy is dead. At a presentation I gave to lawyers on social networking a few weeks ago, the first thing I said is that there is no such thing as privacy…in the context of the Internet. With Facebook’s recent changes to its policies, people are claiming (again) that privacy is dead. Robert Scoble says we’re an inch closer now, thanks to Facebook, and many seem to agree.

At this point, privacy has become one of those polarizing topics. You are either on the side of it existing and thus demand more controls from companies or through federal regulation, or you are on the side that it’s dead so people should shut up and move on already.

I think there is a middle ground, called Context.

To say privacy is completely dead, that it is an illusion, leads me to think that identity fraud must also be an illusion. If privacy is dead, then every snippet of information about me, from my third grade teacher to my calculus grade in undergrad to my complete medical history is available to the public. My credit card information, anything I have purchased in the last three days, three months or three years. Where I’ve lived. Who my car insurance provider is, who my health care insurance provider is, whether or not I have been to the dentist, last time I got gas and where and anything else that can be tracked is publicly available, if privacy is dead.

If privacy exists, then none of that information is available.

Clearly, neither side is completely correct. Companies like Facebook, it can be argued, are forcing us closer to non-existent privacy, but that, too, leaves out context. We forget, in this world of over sharing, there is still some information that is private, by law or because we choose not to share it.

Medical histories, prescription drugs, genetic predispositions…they are still private because the context of that information keeps it that way. Now, that context may change. There’s an article in the Chicago Tribune today about therapsits Facebooking or Googling patients, and vise versa. But for now, the context remains the same.

So as the arguments over privacy continue to rage, take a minute to think about context. Under what context is information considered private? And should it remain that way, or is the context changing for whatever reason? I imagine there are people who wouldn’t mind having their complete medical history public, but then you have to think about the social implications of such an action. Whether or not we admit it, we make judgments about people. Knowing your medical history may provide the wrong impression because assumptions are made.

Just take a minute and consider the context. Privacy doesn’t have to be an all-or-nothing issue. We are clearly better served in a context where our information is useful and beneficial when publicly available, but in another context, we may be irreparably harmed. Companies like Facebook and Google are forcing us to look at privacy in context, and we would be wise to oblige.

TopTierMD: An Entrant in Health Care Transparency?

Health care remains a hot topic these days. And having health insurance seems to have done little to curb my ire. It still stirs a great deal of passion inside me, especially as more and more people find themselves in the same situation I did. The government does not seem too keen on helping, either.

Such passion stirred when I read Ann Meyer’s column in the Chicago Tribune Small Business section, “As more explore business ownership, ask yourself: Do you have what it takes?” A fair, and common question these days. Some of us start businesses out of necessity, some of us because we just always blaze our own trail and some of us because we think we can improve areas where others fall (or have fallen) short.

The focus of the article is a new site, TopTierMD.com, which seems to be tossing its hat in the health care transparency ring, but with a focus on physicians. I say “health care transparency ring” because Illinois finally decided to abide by the Illinois Hospital Report Card Act. It launched the Illinois Hospital Report Card and Consumer Guide to Health Care at the end of last year. The goal is to provide “information about the quality of health care provided in Illinois hospitals,” which is a fancy way of saying Illinois hospitals are in dire need of quality improvement. And just to put things in perspective, the state passed the Act in 2004. The site launched near the end of 2009. Go figure.

So, TopTierMD.com. The site provides a list of doctors (currently limited to specialists) based solely on the recommendation of other physicians. They ask a simple question: “If you needed one doctor for yourself or a loved one, who would you see?”

Here is their explanation:

To be included as a TopTierMD, doctors must receive the overwhelming endorsement of their peers through a Three-Tiered Selection Process.  The first step in this process begins with a review of “referring” doctors.  Next this group of qualified physicians initiates a thorough evaluation of all physicians within their hospitals.  Finally, once a provisional list of candidates emerges, they are subjected to a final review of peers within their particular specialty.

In the interest of full disclosure, my father is a well established doctor in the local community, and I have asked him a similar question (on more than one occasion) that the founders of TopTierMD.com pose. His answers are based more on experience and a rather unique perspective. He approaches his practice from as much a business perspective as a medical one, a point that became clear as I start my own company.

First off, I think it’s good that TopTierMD.com is going through the trouble of thoroughly vetting physicians, essentially culling data and putting it all in one spot. In a way, it skips the step of a Google search, which produces a torrent of results that can take you forever to review, and sometimes take you off course. TopTierMD looks to take some of the guesswork out of choosing a physician, which is no easy feat regardless of whether you’re on an HMO or PPO plan, or have no health insurance at all. There are any number of “bad apples” out there, and medicine is one of those areas you really don’t want to experience a “bad apple” first hand.

However, when hospitals factor into the vetting process, I get cautious. Why? Because hospitals have become more like businesses that consider medicine, the act of helping and healing people, an after thought. Health care reform has shed light on it. And not all hospitals consider medicine an after thought, either. The site also assumes people trust (and believe) their own doctors, let alone doctors recommended by other doctors. I have the benefit of having a father as a doctor, and have known doctors in the community for most of my life so trust is a non-issue for me.

When forced to look outside the community (in college out-of-state), I’m skeptical and use an abundance of caution. Which is not to say people don’t trust their doctors; but with health care reform, doctors seem to be getting their share of skepticism and sometimes anger, along with politicians, insurance companies and pharmaceutical companies. I don’t know that it is wise to assume such explicit trust, but at the moment, I can’t come up with a viable alternative.

It’s too early to tell how well TopTierMD.com will do. For now, it just shows you standard information like medical school, board certifications, office locations and hours of operation. Nothing about what makes them stand out above the rest. No qualities or “testimonials,” so it seems more like a glorified yellow pages than a comprehensive directory. It’s only distinguishing feature is saving you the trouble of Googling something like “chicago pulmonary specialist” and then sorting through the results.

There is opportunity for TopTierMD.com, though, to provide a real service. I think it will need to do more, from the patients perspective, but culling a seemingly endless list of doctors is a start. Suffice to say, there is the potential for it to offer more than you’ll get by Googling “chicago pulmonary specialist” so we’ll have to wait and see.

Another Use for Google Wave: Therapy

There the article, “Poll Reveals Havoc of Unemployment  on Workers and Family”, in the New York Times that reminded me of an article I read awhile ago about video conference or virtual therapy for soldiers, which has been a topic in the news lately. More often, it seems, in the wake of the Fort Hood shootings. There are also been articles on the long-term unemployed struggling under burdens no one expected, and then a Wall Street Journal article out today, “Studies: Mental Ills are Often Overtreated, Undertreated” that got me thinking: What about Google Wave as a tool for counseling?

Let that sit for a minute while you think of what normally qualifies as “counseling” or, to be less confusing, therapy. “Counseling” is a term that gets tossed around by many different groups, and thus has many different meanings. College counseling. Credit counseling. Legal counseling. You get the idea. “Therapy” is usually distinguished by another description or qualifier, like “physical therapy.” Without such a distinction, it usually means psychotherapy.

Therapy falls under a favorite health care insurance term: “pre-existing condition.” And seeking treatment for even the most minor of issues, like job transition stress, can be considered grounds for denial. Most health insurance plans don’t cover therapy anyway, or cover such a small number of sessions it is not worth submitting claims. Psychologists and other therapists still take insurance, though, but many do not for a variety of reasons. I never quite understood that until my own battle with individual insurance coverage, which you know has been an enlightening experience on many levels. It’s kind of ridiculous that “health” is not an all-encompassing phrase. It has to be divided into “physical health” and “mental health,” with “physical health” receiving the majority of coverage and “mental health” being an after thought.

After coming across the above mentioned articles, meshed with the chaotic mess of health insurance, I found myself thinking Google Wave, along with Skype, might provide a low-cost, not to mention more convenient, alternative to the standard form of therapy. Standard form as in showing up at an office at a specific time to discuss a topic (or topics) for a 50 minutes (though you pay for 60, I think). And there is that potential hazard of being “seen” though I think in this day and age, no one would pass judgment. We could all benefit, on some level, from therapy, no?

Continued talk of budget cuts, especially in Illinois, make people nervous. Some service is other is always on the chopping block, and our support systems are failing, failed or on life support. Take the CTA, the way most people get around in Chicago. Instead of worrying about your bus route getting cut, or service reductions, both of which would impact your ability to get to the office of a therapist, making therapy a “luxury” instead of a “necessity,” wouldn’t it be nice to just plop down in front of your computer at home? Log into Wave or Skype and start chatting for 50 minutes, then sign off and move on with your day. Or call it a night.

Of course, there are a few barriers. Not everyone has access to the Internet, and probably wouldn’t feel comfortable Skyping from the library (if Skype is even accessible from the library). Or even using Wave since, well, Google would know more than you care to admit. Yes. That’s right, the big “P” as in “privacy.” Patient confidentiality. Not necessarily a guarantee if using Skype or Wave or any other form of electronic communication. That is precisely why the profession is slow to adopt email. But if people willing type information into Google that they wouldn’t dare share with anyone else (so claimed a CNBC segment about Google), then using Wave for therapy does not seem that far a stretch.

This aversion to technology is bothersome and annoying. Don’t get me wrong; I understand why. However, it is time to overcome that aversion in the name of better care and better service. Someone, undoubtedly, will play the “eye contact/facial expression” card, arguing that you just can’t provide effective therapy if you aren’t able to read the nonverbal cues, or hear the tone of voice. I beg to differ, especially since Skype has video capability.

And not all therapists have an aversion to technology. Do a couple Google searches and you’ll find those who have built sites around email therapy, or some kind of online talk therapy. Moving to Wave wouldn’t be too difficult, especially if Wave can be hosted on their own servers instead of Google. May not matter. No doubt all email communication contains a lengthy disclaimer at the bottom.

Perhaps Wave and Skype are not the best tools for long term therapy, but I’d wager them to be effective for short term therapy. Alas, we won’t know until some people somewhere try it out. And that requires a therapist and a patient (participant?), or a few, to try it and see what happens.

I’ll let them figure out the whole issue of billing/payment. PayPal seems the obvious choice, or perhaps industry standard billing methods still apply. I bet there’s a way to better qualify (quantify?) that, and streamline it as well. Now wouldn’t that be something?

I’m curious to see what people think of this. No doubt there are other uses for Wave in the medical profession, and many other professionals, as well. Merely scratching the surface, as they say, no?

About Shopping Around for Health Insurance

There is a helpful article in the New York Times today, “Steps to Take Before Cobra Subsidy Ends”, which lays out some tips or suggestions to maintain your coverage while Congress debates on whether or not to extend the subsidy. It points out that your COBRA payments will go up, and that it is better to pay the full amount than let it lapse.

That’s good advice. Letting your insurance lapse creates a new set of issues that are next to impossible to avoid or untangle. There is a grace period, usually not more than 90 days, which is about three months. Remember, though, that applying for an individual or family health plan can take 30-40 days to process, and applying does not guarantee you will be given coverage.

And it is the lack of guarantee that gives me pause when I read:

time to shop around for health insurance alternatives that may be more affordable.Check ehealthinsurance.com and healthplanone.com for general pricing information from carriers that provide individual policies in your area.

You may find a plan that is perfect for you (and your family) at an affordable price, apply and get denied. The denial puts you right back at square one. And that is a frustrating, demoralizing place to be.

To avoid, or at least improve your chances of getting coverage, apply to more than one plan that you like and/or find a respectable health insurance broker. Or check out organizations like MediaBistro, the Freelancers Union, the National Association for the Self-Employed or something similar that offers health insurance to members. They have often brokered good deals for members already, much like your former employer. And if you’re a lawyer, try the American Bar Association.

When it comes to health insurance, there is something to be said about being part of a large group. MediaBistro, Freelancers Union, NASE, ABA and others put you back in a group, and sometimes that can lead to more than just health insurance coverage.

Take the time now to investigate your options and get the ball rolling on applications. It will make a difference.

Lessons for Getting Individual Health Insurance Coverage

This blog has become a little less about open source for lawyers and legal professionals, in the strictest sense, and more about my own struggles as a laid off individual turned entrepreneur. I have been applying the philosophy of open source to this blog, and on all fronts, it remains a WorkInProgress. One thing about blogging is that you can easily shift it to apply to any given situation, such as unemployment and the myriad of challenges people don’t tell you about, let alone offer any kind of guidance on how to overcome them, other than to simply press on.

One of those challenges is obtaining health care coverage. You may recall my previous post on denial of coverage, and the absurdity of “pre-existing conditions.” I had about given up, holding onto a thin thread of hope that the government would pass health care reform that, among other things, might stream line the application process. I find it difficult to believe that 30 million or so Americans will be given health coverage without a simplified health insurance application process. Silly me. Congress is not interested in bringing down the cost of health care by streamlining the ridiculous application process. It’d rather demand the adoption of electronic medical records, which is a good idea but will not solve the problem.

Congress is still haggling over health care reform. Sure, the House has passed its bill and the Senate seems intent to pass its own before the year is over, but the two still have to be reconciled and then that rather innocuous word, “implementation,” must occur. No one seems to know how long that will take.

So for those of you who find yourself staring at the end of your COBRA coverage, or are otherwise on the hunt for health insurance but have struck out much like myself, I offer some advice that helped me obtain coverage:

1. Do not apply for an individual plan, or a health plan, with whatever health insurance company you currently have through COBRA
2. Find a good health insurance broker, either through a family member, family friend or other trusted source
3. Apply for coverage under whatever state program is offered

Find a Different Insurance Company

The logic that switching from COBRA to an individual plan with the same insurance company  will be easy and simplify things is poor logic. I learned this one the hard way, so let me explain.

When you apply for an individual plan, or a different plan than the one you had through your employer or COBRA, you effectively become a new “customer.” However, you are a new “customer” with a history, so the insurance company has a wealth of information it can sift through to find any reason, however mild, to deny coverage. The forms requesting permission to obtain medical records is merely a formality, in case there is a challenge. You are better off applying for a plan with a different insurance company.

Do some research, especially since plans vary widely by state. Check consumer watch websites, too. Though few people have anything good to say about health insurance companies, you’ll get an idea of what people have to say, which is likely to be more honest than what you find on the corporate websites. Also talk to family, friends and others about their health insurance coverage. Had I done so, I would not have applied for an individual plan with the same company I had for the past 4 years. I wasn’t a fan of it, to be sure. The best health insurance plan I ever had was with a Taiwanese container shipping company, and which I fully understand I may never get again. But, at the time, it seemed better to go with the devil I knew than venture out into the unknown. That was foolish. So even though it may be a hassle, and it will all start to sound the same, shop around.

And shopping around brings me to point #2: find a good health insurance broker.

Find a Good Health Insurance Broker

I’m was skeptical about using an insurance broker. I looked into it briefly, and found information for and against but not enough to persuade me to find one. I was a bit stumped on how to find a good one, too. If I call them up, they’ll give me some song and dance sales pitch. I’m not interested in a sales pitch. I’m interested in results. And who is to say the broker won’t cut and run when the deal is done?

So I continued on my way, working my way through various applications and applying for coverage through the state as well.

The questionnaires were endless, asking for every little medical detail. I discovered that if you were still covered, they only asked for information going back five years. When I applied after my coverage had expired, meaning I was not covered, they asked for information going back 10 years. It was starting to make more sense to wait for Congress to get its act together and pass some semblance of health care reform, or apply for the state plan.

Then I got an email from my uncle, who recommended an insurance broker whom he had used before, and recommended to others. I thought it a kind gesture, but didn’t think much of it. I was starting to question whether I really needed health insurance at all. There was no pressing need. Except that accidents happen, and I cannot shake the logic that the point of insurance is to guard against accidents. And the accident that always pops into my head is the “bus incident” that wasn’t as bad as it could have been, but who is to say the next accident, sans-bus or otherwise, will turn out that way?

So I called the broker, explained my situation which he said was common these days. That was surprising, but what was surprising was the application process. The number of questions was considerably diminished, and when I was contacted for more information, it was via phone. There wasn’t a separate mountain of permission forms to sign; just a series of questions to further enlighten the new insurance company. However, there was a difference in tone.

When I had called up my now former insurance company to switch to an individual plan, the woman on the phone was cheery and confident that I’d be approved. Nothing raised red flags, which at the time struck me as odd and later was infuriating. Clearly my former insurance company needs to change its in-take process as red flags should have stopped my application cold.

The tone was quite different with this broker application process. The representative asked similar questions, requested clarification of claims but did it in a manner that seemed to imply a genuine desire to help, or a deep understanding of insurance company processes and how best to present information to achieve an objective. Granted, that may or may not be true, I really have no way of knowing. But I do know that the approach was decidedly different, the response much faster and the overall experience less frustrating.

Still, there was no guarantee, so I decided to cover all the bases and submit my application or the state plan.

Apply for State Health Insurance

State health insurance is no less bureaucratic than private health insurance, and it is much more expensive, at least in Illinois. However, they’re rules are a little less strict, so more people can be covered. It was the least desirable, but with options dwindling, I bit the bullet and sent in my application. Apparently I forgot to answer one question. It had to do with whether or not my parents have health insurance and whether or not I am eligible to be covered under their plan. Since I am over the eligibility age of their plan, I didn’t think the question applied to me. Even the phone call I got about the question said I was over the age, but I still had to answer it anyway.

And then there was this interesting little piece.

Under “employment,” I said was “self employed” since, well, I am. Turns out that you have to send in a letter, on your “corporate letter head,”stating that you do not offer yourself health insurance coverage. Sounds silly to me. If I provided health insurance, why would I be applying for state coverage? After some thought, though, I can understand. Budgets are tight all around so they want to provide coverage to those that absolutely cannot get it anywhere else.

I was working on fulfilling a couple other requirements to complete my state application when I receive a surprise email: my health insurance application had been accepted and I had been granted coverage. That was followed by an email from the insurance broker, confirming my health coverage. So I stopped my state health insurance application.

Final Thought(s)

There is no doubt that the health insurance industry is a mess, and I’m skeptical that any reform out of Washington will address it in any meaningful manner. Of course, that is predicated on the assumption that health care reform passes.

So if you find yourself staring at the COBRA finish line, and still want health insurance, I suggest finding a broker through a family member, friend or other trusted source, and applying for state health insurance in the mean time, if your state offers a health insurance plan. Speaking from experience, it is a relief to have some coverage. One less thing to worry about as the “what ifs” shrink, and create space for other, happier things.

Demand Openness from Health Insurance Industry

One of the things I liked about Obama’s campaign was his seemingly relentless pursuit of opening government up to the people. It wasn’t hard to sell that point. It’s clear that under Bush, the people were kept in the dark so some light was more than needed with a new president.

Obama has made strides in his efforts to bring “transparency” to government by bringing in smart tech people and creating sites like data.gov. Though not perfect, it is a step in the right direction. People have more access to raw government data than before, which helps educate the public. We should count our blessings we not only elected a leader who believes in an educated public, but also takes such visible steps to help educate the public.

As health care continues to dominate headlines and debates both in Congress, at local hang outs and even around the dinner table, one thing is missing: health care transparency.

Open standards for electronic medical records: OK. Coverage for more Americans: on the table. Eliminating “pre-existing” conditions as grounds for denial: on the table. Giving Americans more choice/control over their health care: on the table.

Except how can we make informed choices without access to the data that determines those choices? How can we make informed decisions on anything related to health care if the data remains obscured by government and health insurance bureaucracy?

Simple answer: we can’t. But, as we’ve all come to realize, any issue around health care is anything but simple.

A start would be to provide standard definitions for “pre-existing” conditions and for what constitutes a “history,” and make those definitions universal. If one incident, even if not repeated, constitutes a “history,” then say so. If the “pre-existing” condition list is so expansive as to include any trip to the doctor that resulted in “recommended treatment,” even for the common cold, then say so.

By leaving such things undefined, or rather leaving it up to insurance companies to define, creates wide-spread confusion and denial of coverage in one state but approval in another. People will be more likely to gravitate towards the states where they are more likely to get coverage, sucking states dominated by money-hungry insurance companies dry. Loss of population leads to loss of tax revenue. Loss of population means companies have a smaller pool to help shore up their work force, so they will look to move where there are people. Small businesses will gravitate towards states that are more kind to them. An imbalance will be created that will only exacerbate existing budget falls.

Requiring health care companies to show where exactly premium dollars are spent is another starting point. How much goes towards claims? How much goes towards advertising? Payroll? They are run like companies, so all the money goes somewhere. It comes out of our pocket and goes into someone else’s, and we should be allowed to know who.

So if the government is truly set on health care reform, and truly wants Americans to be able to make their own health care decisions, then demand insurance companies become more transparent than the government. Clearly no one can rely on studies conducted by groups, even if the groups claim to be “neutral.” Americans must be given access to the very information used to decided whether or not they can receive coverage, whether or not a particular procedure or visit is covered and whether or not their health is really that important.

Health care reform may force insurance companies to cover more people than they’d like (despite their claims that they will have access to a broader base, which they already do but choose to deny), but until Americans are given more than a cursory view of how the system works, health care reform won’t do much good in the long run.

Pre-Existing Condition is Any Visit to the Doctor?

I’ve come to the realization that universal health coverage is actually a good thing, if the whole point of health coverage is “just in case,” like auto insurance. And the people who tag “universal health coverage” as being “socialist” clearly have never applied for an individual health plan.

Currently, I have 2 options:

1. Apply to as many individual plans as possible and hope that the law of averages tips in my favor and one of them will grant me coverage
2. Apply for coverage under the Illinois Comprehensive Health Insurance Plan (CHIP)

I am perfectly OK with applying for as high-deductible a plan as I can find. I don’t really need coverage, as I’ve said before, but experience has taught me that it is good to have “just in case.” Call it a security blanket if you want. There is comfort in knowing that it is there, and a great deal of discomfort with the knowledge that, right now, it is not.

Both options require time, so I went online and filled out the “Online Application” for CHIP. The Illinois state government definition of “online application” means that you fill out a form which converts to a PDF that you then must print out, sign in ink (they specifically state ink) and then mail to the address provided with all supporting documentation. That supporting documentation must come from the former employer and/or insurance company to officially verify that:

• Yes, I was laid off
• Yes, I was covered under COBRA for 18 months
• Yes, all options have been exhausted and other coverage denied or exhausted
• No, coverage has not lapsed for more than 90 days

So I had to contact my former employer and now I have to wait, though not too long as an email from CHIP said “We received your application. Please mail the signed application, along with all supporting documents, no later than 21 days after submission.” And then I have to wait 2-4 weeks for the application to process, and there is no guarantee that I will be covered. Isn’t that nice? Apply for state coverage and the state may deny you as well.

When I called to inquire about the process and told them I had been on COBRA and received an individual plan rejection letter that included the CHIP phone number, they said I was a “high risk” applicant and should apply for coverage under the HIPPA CHIP plan since it has no “pre-existing” condition clause. I bit my tongue and hung up since, as far as I have been able to find on any number of “pre-existing” condition lists, I don’t have any.

So imagine my surprise when I read Step 11: Important Information on the CHIP application. It states:

A pre-existing condition is any condition for which medical advice, diagnosis, care or treatment was recommended or received within the six-month period immediately preceding the effective date. Medical treatment includes prescription drugs.

By that definition, a doctor’s visit for the common cold six months before the effective date means a pre-existing condition exists.

That is a considerably more expansive list than any list I have been able to find so far. Reminds me of “SiCKO” where a former health insurance employee said the “pre-existing condition list” was quite expansive, followed by the theme from Star-Wars as an alphabetized list appears like the opening of the Star-Wars back story.

Or am I missing something?

Individual Health Coverage Denied

Since being denied an individual health insurance plan from the SAME INSURANCE COMPANY I have used for the past 4 years, albeit under an employer plan (not to mention COBRA, twice), my view of insurance companies has changed.

I used to think they were a necessary evil that, in the end, were there when you needed it. That’s the point of insurance in this day and age, after all. You don’t need it until you do, and then you’re glad to have it. But you don’t need it until you do because the insurance companies make it so. That’s how they make money. They charge high premiums just in case you need something from them.

If you’ve followed me on Twitter, you know I’ve been absolutely livid since I was denied. And it took them a month and a half, a month and a half! to deny me coverage. This after the people who took my information, even read my claims back to me, didn’t see any “red flags” and said since I was a “returning customer” it shouldn’t be more than a couple of weeks. Clearly the company needs to revamp its application process so that “red flags” are used earlier, say during the application process, so the denial comes faster and the applicant, myself, can move on to other options BEFORE current coverage lapses. That obviously makes too much sense and would introduce efficiency into the system. Godforbid there be such a thing as efficiency in insurance.

Turns out health insurance companies find any possible reason to deny individual coverage, though the extent of the denial, or the underwriting process, varies widely by state. Illinois happens to be one of the worst offenders (the insurance companies run the show and thus wrote the laws. Really, in what other state does one health insurance company own 52% of the market?), and I just happen to think staying with one of the sloppiest insurance companies because they had treated me well before was a good idea. Apparently once you switch to an “individual plan,” your present a greater risk than if you are grouped with an “employer plan.” Your medical records get scrutinized, kind of, not by the health insurance company, but by its medical underwriters who may or may not be “in house.” They are looking for “pre-existing” conditions first, and then any hint of a problem, recurring or not. I have claims on file, from 4 and 5 years ago, and that was enough evidence that I have a “history” and thus am to be denied.

The definition of “medical history” is anything “out of the ordinary” that is in your medical file. It only has to happen once, and if it is “out of the ordinary,” you’re denied. And being denied automatically makes you a “high risk” applicant.

Now, if I had any “pre-existing” condition, or was taking any prescription medications at all, then the “high risk” tag probably would apply. I don’t have a “pre-existing” condition, at least not on any of the lists I’ve found, and I take no prescription medications. I don’t take any medications at all. By because I have been denied an individual health plan, I am automatically considered “high risk,” regardless of the lack of criteria for meeting “high risk.”

As irked as I am, I am struck by how ridiculous it seems to deny healthy people coverage, or to deny even reasonably people like myself, coverage. It shrinks the applicant pool, so less money is going in, which means those insured have to pay more so premiums continue to rise.

I would like to point out that I am fully capably of paying for insurance, and that I’d like health insurance just in case. I have been hit by a bus once, and walked away unscathed, but there is nothing that says I will be as fortunate in any other accident. But at least one health insurance company believes I am not worth insuring, and it would thus rather charge its current pool of applicants more to make up for the money it won’t get from me. And it’s not like I’m filing claims left and right. I prefer to stay healthy, get regular check ups and, well, stay healthy. There just used to be an added layer of security that in case of an accident, I was covered.

If this is how one health care insurance company treats “returning customers,” then I wonder what others have to say. And health care reform cannot come soon enough.

Since plans vary widely by state, it’s rather ridiculous how widely they vary, a universal plan is making more sense to me now. There would be an unified standard by which all applicants can be measured, and your premium would go up or down depending on where you fell in relating to that standard. As it stands, a person in Wisconsin who has had major surgeries and been hospitalized can receive individual health coverage while me, who has not had surgeries nor been hospitalized, cannot receive individual health coverage.

They system is clearly broken in ways people have yet to understand.

If the government runs the health care system, profits will not be the main motivation. I didn’t think it was so before, but having gone through this rather aggravating experience, I’m starting to believe a universal plan makes sense. But alas, this seems to be another one of those things you just don’t get unless you’ve experienced it. If it is anything like unemployment, than I am ahead of the pack again and this time next year, the masses will demand the heads of health care insurance companies just as they demanded the heads of Wall Street.

Hopefully the government will deliver better results than it has so far with Wall Street.

And this is more than likely not going to be the final post from me on health care. The more I dig into this issue, the greater the desire to educate people about it. Ignorance may be bliss, but it leads to a rude, maddening awakening.