Documents Show How Insurance Companies Misuse Pre-Existing Conditions To Deny Coverage Based On Trivial Problems

Pre-existing conditions often prevent those who are sick from receiving medical coverage, but they can also limit the ability of those who believe they are generally healthy from obtaining insurance. Documents released on Friday show that those with acne, hemorrhoids and bunions have been prevented from receiving coverage due to these pre-existing conditions:

A proposal to make preexisting health conditions irrelevant in the sale of insurance policies could help not just the seriously ill but also people who might consider themselves healthy, documents released Friday by a California-based advocacy group illustrate.

Health insurers have issued guidelines saying they could deny coverage to people suffering from such conditions as acne, hemorrhoids and bunions.

One big insurer refused to issue individual policies to police officers and firefighters, along with people in other hazardous occupations.

Some treated pregnancy or the intention to adopt as a reason for rejection.

As Congress and President Obama work on legislation to overhaul the nation’s health-care system, one of their main objectives is to stop insurers from denying coverage on the basis of health status. Proposed legislation would prohibit insurers from denying coverage to individuals with preexisting conditions or charging them higher premiums because of their medical history — practices known as medical underwriting.

Even the insurance lobby has endorsed that goal as part of a larger reform package in which the government would extend coverage to the uninsured, greatly expanding the market for insurance.

Guidelines that insurance companies have written for professionals involved in selling policies offer a glimpse inside the underwriting process.

“What these documents show is the lengths to which insurance companies are willing to go to make a profit,” said Jerry Flanagan, health-care policy director of the advocacy group Consumer Watchdog, which distributed the documents Friday. “What it shows is that insurance companies want premiums without any risk.”

Consumer Watchdog argues that consumers should be given the option of enrolling in a government-run health plan. It obtained the documents from a California insurance broker, Flanagan said.

A PacifiCare “Medical Underwriting Guidelines” document from 2003 lists under “Ineligible Occupations” such risk-takers as stunt people, test pilots and circus workers — along with police officers, firefighters and migrant workers.

Uninsurable conditions included pregnancy, and being an “expectant father” was grounds for “automatic rejection.” So was having received “therapy/counseling” within six months of the application. There was also this more general disqualifier: “currently experiencing/experienced within the last 12 months symptoms for which a physician has not been consulted.”

If you saw a doctor you might be denied coverage, and you also might be denied coverage if you did not see a doctor but had trivial problems. Insurance companies also engage in a practice called rescission by which they can retroactively cancel a policy if they found someone had a pre-existing condition which was not reported. This does not even have to be related to the problems at the time the policy is revoked. If someone develops cancer, some insurance companies will cancel their coverage if they (or even a family member) had not disclosed a previous case of acne or hemorrhoids  on their initial application.

United Health Care, one of the companies with the worst track records for paying claims, says that these documents are “completely outdated.” Not surprisingly they “declined to provide current underwriting documents.”

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