So, I have a problem. My student health insurance from Notre Dame expires today, and my group health insurance from the State of Tennessee doesn’t kick in until October 1. That leaves me with a 46-day gap in coverage, which is less than ideal. It’s not a 63-day gap, thankfully, but still, being uninsured is never a terribly good idea. What if, heaven forbid, I get in a car accident or something? Even a plan with a large deductible would be mighty helpful if something catastrophic were to occur. So, I figured I would apply for some basic short-term insurance to tide me over. No big deal, right?
Ah, but it turns out it is a big deal. Every time I try to apply for a policy, I’m encountered with a question like this:
And when I click “yes” (because I’m an “expectant parent,” and my spouse is “now pregnant”) and try to continue, I’m told, “Thank you for your interest in Short Term Medical insurance. At this time, we are unable to issue you a policy because you do not meet the eligibility requirements.”
Huh? I’m “ineligible” for insurance because… my wife is pregnant? WTF?!?
Mind you, I’m not applying for family insurance. Becky wouldn’t be covered under my plan, so maternity costs aren’t an issue. Nor would our child be covered. (Indeed, there’s no child to cover — my requested term ends three months before the kid is due!) But for some reason, just being an expectant dad is enough to render me off-limits from the reach of private health insurance. I am persona non grata, as far as the insurance industry is concerned, because I made the grave mistake of doing my part to propagate the human race.
As it happens, a consumer watchdog group put out a press release about this very issue back in January. It states: “Firefighters, police officers, steel workers, expectant fathers, pregnant women and patients with asthma, acne, allergies, and toe nail fungus will not be sold health insurance policies in California, according to internal insurer underwriting guidelines made public today by the Foundation for Taxpayer and Consumer Rights (FTCR).” Well, I guess it’s not just California. I’m in Tennessee, and it seems I, like those Golden State firefighters and fungus sufferers, have been placed in the seventh circle of health-insurance hell known as “Uninsurable.”
This is ridiculous on several different levels. First of all, how in the bloody hell is being an “expectant father” even a medical condition at all, let alone one that should render me uninsurable? Last time I checked, there are no medical costs associated with being the male in this situation. I’ve accompanied Becky to the gynecologist’s office three times now, and the gyno has yet to examine, or perform any tests on, me. So I really fail to see how it should affect my health-insurance status that my wife is gestating. Don’t get me wrong, I’ve very excited about being a dad — but from a medical standpoint, I’m not the one who’s pregnant! Isn’t that kinda obvious?
Secondly, it is just totally outrageous that these relatively mundane, everyday sorts of conditions — like acne, allergies and asthma — are being used to put whole swaths of patients beyond the reach of the insurance industry. I understand the concept of adverse selection, and as such, I accept the need for pre-existing condition limitations. If a healthy person can get sick on Monday, sign up for insurance on Tuesday, get treated on Wednesday for the illness he contracted on Monday, and get the insurance company to pay for it, then the whole basis of insurance as a risk allocation system falls apart; people will (at least in theory) wait till they get sick to buy insurance, so there won’t be any healthy insured people paying the premiums that cover the sick insured people’s medical bills. I get that. But if that person who got sick on Monday gets into a car accident on Wednesday, totally unrelated to the Monday illness, why on earth shouldn’t he be insurable for that? It makes no sense to me that individual, specific conditions should render people entirely uninsurable. They should be insurable for everything except the pre-existing condition!
Alas, this isn’t the first run-in I’ve had with the “uninsurability” problem. Becky basically cannot get individual health insurance anymore — ever since she was diagnosed with bipolar disorder, she is always rejected. I would understand if they said, “We’ll cover you, but the bipolar is a pre-existing condition, so we won’t cover that.” But that’s not what they say. Instead, they just refuse to cover her at all. Thus, she is left vulnerable not just to the whims of bipolar disorder, but also to the whims of any other medical problem that she might have, no matter how unrelated.
Luckily, Becky will be covered under my state group insurance plan starting in October (and it’ll include maternity coverage, with no pre-existing limitation — thank you, HIPAA!). But it’s quite frankly immoral that she has been unable to get insurance for several years, and it’s equally immoral that I can’t get it now.
Yes, I said immoral. At the risk of sounding like Michael Moore, I do believe this is a moral issue. I’m not sure when we reached the point where the health insurance industry started refusing to provide any coverage to broad swaths of people for no other reason than that they’re sick (or have acne, or are expecting a baby, etc.), but whenever we crossed that line, I believe the very nature of the health insurance industry fundamentally changed. It is no longer actually a health insurance industry. It is now simply a money-collecting industry that sells health insurance on the side — but only to people who don’t need it (i.e., to healthy people… and not even all of them, as my case proves!). Everyone else is put into a modern-day version of the Untouchables caste, and there’s nothing they can do about it. They can’t even pay more to buy their way into the system; they’re stuck on the outside looking in, unless they’re lucky enough to get a job with group insurance, or unless they qualify for some gap-filling government program. (And if it’s the government’s job to fill such fundamental “gaps,” then why do we have a private insurance industry at all?)
Health insurance is obviously a huge issue politically, and it seems like everyone has their pet sub-issue. Some people want to lower premiums; some people want to increase prescription drug coverage; some people want to shift the structure of who pays (e.g., the government pays, or individuals pay instead of employers, etc.); and so on, and so forth. There are many different reform proposals, covering many different aspects of the insurance issue. But for me, this “uninsurability” thing is really the most central issue of all. When people who can afford coverage, and are willing to pay for it, and are ready to accept reasonable pre-existing condition limitations, are nevertheless denied coverage because they’re “uninsurable” for various stupid reasons… that is just totally unconscionable, and I would have no problem abandoning my normal libertarian stance if this problem can be solved through government action. There is simply no defense, market-based or otherwise, for the insurance companies’ behavior in this instance. They need to find a better way to cut costs and make profits. If the only way they can figure to stay afloat is to deny coverage to such broad swaths of people for such idiotic reasons, then they have no business calling themselves insurance companies in the first place. It would be like a baseball team that cuts costs by letting all its players go and canceling all its games. Even if it finds a way to keep making a profit, it’s not really a “baseball team” anymore, is it?
(Now, somebody come in and tell me why I’m wrong. I’m no expert in this stuff. My analysis is based not on some deep understanding of the insurance industry, but on simple common sense. I think I’m right, but I’ll listen to reason if someone has a good argument for why I’m not.)
UPDATE: This website suggests that the source of the “expectant father” rule is what I suspected — government regulation leading to the law of unintended consequences:
Expectant mothers AND expectant fathers are ineligible to apply for a new individual health insurance policy until AFTER the baby is born; This is due to the risk involved with the possibility of giving birth to an unhealthy child. Since, by law, a newborn child is given guaranteed issue onto either parent’s healthplan, insurance carriers must disqualify expectant parents from coverage in order to protect themselves from the risk of an unhealthy newborn. If you are already expecting a child, your only option for NEW health insurance and maternity coverage would be in the group market under an employer sponsored health insurance plan or through [a state insurance plan].”
I vigorously dispute the notion that insurance companies “must disqualify” expectant parents; they are making a choice to do so, and I believe it is an immoral choice, fundamentally inconsistent with their nature as insurance companies. They are in the business of managing and distributing risk, and it is simply not true that they must (or should) shy away from all risks. However, I recognize that this is a case where the government has altered the calculus without fully thinking through the consequences of doing so. That doesn’t mean I agree with the insurance companies’ decision (if they would simply raise premiums for expectant parents, that would be a lot more forgivable IMHO), but it at least explains the rationale behind it, and makes it seem less nonsensical. (However, even with these rules in place, there really ought to be some sort of exception for short-term coverage that will expire before the third trimester even begins! Good grief!)
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Categories: Our baby, Health Care & Medicine
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August 15th, 2007 at 8:21:00 am
Say what you will about universal healthcare, but this is exactly the kind of problem a minimum level of government-provided health benefits helps people avoid. If an entirely privatized health insurance system results in an inability for some (or, really, many, many) people to buy health insurance at any price, we have a serious problem.
August 15th, 2007 at 8:27:53 am
Buying insurance over the internet sucks. You need to go talk, face to face, with an agent. Trust me, I work for an insurance company and we don’t even try and sell insurance over the internet. It’s where you usually get the “less than desirable clients” who are high risk clients. I’m not saying you are, but that’s the general feeling.
Talk to an agent and explain what’s going on.
August 15th, 2007 at 8:34:29 am
You realize that you can elect to continue your student health insurance for up to six months, right? Go here and select one of the continuation forms:
http://uhs.nd.edu/html/insure_bill.html
You can choose how long you want the coverage to continue. It might not be a realistic option for you (covering the spouse is very expensive), but if you’re only looking to continue insurance on yourself it’s probably the easiest option out there. Plus, you have a 14-day grace period from the time of expiration (yesterday) to elect the continuance.
Why wouldn’t this work for you?
August 15th, 2007 at 10:27:00 am
Removing state regulation of health insurance and setting a single national standard for policy would be a big move forward.
In many states, you can get a basic level of coverage by joining a professional association and then buying the association’s health plan. Usually such plans cost around $125/month, and have fairly high deductibles ($2000 or more), but what you’re really buying is peace of mind (you won’t go bankrupt over a medical problem).
However, association plans are unavailable in some states.
Why? Because, since each state gets to regulate insurance, some states put absurd laws into effect which make the low-cost plans impossible to offer. These are usually in the form of “mandated coverages” into which the clever lobbyists have inserted “universal coverage” language. So, in the state of New Jersey (an example), all policies have maternity coverage. Even a single male must pay premiums for pre-natal care!! It’s the Law!
There was a move in the last Congress to override state regulators and offer catastrophic (read: high deductible) health insurance on a national level, but the state’s rights crowd got it killed. I don’t think they even understood the issue.
You might want to check and see if you can get association coverage… it just might be the ticket for your short-term needs.
August 15th, 2007 at 11:08:24 am
The problem is that “insurance” is being used for something which makes no sense at all: daily routine. The POINT of insurance is to hope one never needs it! That is, the basic, underlying principle of insurance can be exemplified like this: Ten people get together, determine that it is likely that one of their houses will burn down in the next ten years, and pools their money, each paying one percent of the value of a new home each year. The one whose home burns down gets it rebuilt, but everyone hopes it isn’t them.
When insurance is used routinely, all you are doing is paying another person to touch your money.
Yes, much of the problem is caused by the government (Medicare/Medicaid, primarily - their rules for what they will pay for things drive fees up, so that M/M will pay something close to the actual costs, which screws the rest of us… unless we are part of an insuring group with a negotiated rate, which allows them to charge a more reasonable rate to begin with).
There are actually a few doctors in major cities who take NO insurance at all… do you know what an office visit costs? About $20. Most insured people end up paying close to that AFTER insurance, in addition to their premiums. That’s what I was talking about above - all that extra money just goes into paying more people to push paperwork and touch your money.
Unfortunately, for procedures beyond a simple office visit, there aren’t any doctors (that I know of) that take NO insurance, so that loophole doesn’t help much.
For MOST people, MOST of the time, if you are buying your own insurance, get a VERY high deductible (say, $1000+), then SAVE the difference in premium over a low-deductible plan and use it to pay your medical bills out of pocket, and you come our ahead at the end of the year.
But basically, “don’t blame the players for the game” - the government has set the rules (both in terms of regulation and regulation-by-lawsuit, where the government sets the rules as well), and insurers and health care providers just have to do their best to work within them.
August 15th, 2007 at 11:12:57 am
In my personal opinion the health insurance system is fundamentally and fatally broken in this country. Let’s separate quality of care and insurance. Assuming you have the money to pay for it this country has the best health care in the world I don’t think anyone would really argue that–if you have unlimited resources to keep paying there is nothing you can’t get done in this country, probably by the absolute best person in the world at doing it. The operative point here is, if you can pay for it. If I had the money, I’d just self insure and go to the Mayo Clinic once a year for a full check up and have them fix whatever happened to be wrong at the time. The problem arises for people with normal means. They can’t pay for it. And the system they use for paying for it fundamentally does not want to pay for it. Health insurance companies are in business to make money full stop. In this country they have no other fundamental cause for existence than to take in as much money as possible and spend as little as possible. This is fundamentally opposed to actually providing their clients with quality health care. Now, forcing heath insurance to be a not for profit industry might reduce some of the symptoms. But I don’t think it would solve the problems. The reality, again in my opinion, is that the health insurance industry has outlived it’s usefulness and it’s immoral, bureaucratic, and reckless behavior are cause enough for them to go quietly into the night.
August 15th, 2007 at 11:27:34 am
Brendan,
I totally feel you. I bought short-term health insurance after graduation, but it barely covers anything. It’s basically catastrophe insurance. The only policy I could afford has a pretty high deductible. I’m 99% sure I have some major depression issues, but I can’t afford to get treated because the deductible is so high. Once I have a job and can afford to get treated, it won’t be a big deal. But you know what interferes with finding a job? Depression. It’s a vicious cycle. I’m one of the lucky ones who has substantial family support, so I won’t end up out on the street, but I’m beginning to understand how it happens.
August 15th, 2007 at 12:37:16 pm
Hey Brendan,
My son was born severely prematurely and we were just coming out of Chiropractic college. I had multiple people tell me that we were “uninsurable”. That was not true. At a women’s business forum I met a woman who brokered health insurance and she hooked us up right away.
Because we are self-employed, we are not in a huge pool so don’t get the benefits of large group insurance so we have a very high deductible insurance plan. But I figured our premiums and percentages and it works out. We have a medical savings account so we’re not too shocked financially when we need medical care. Interestingly our yearly care rarely goes over the deductible. How convenient.
Also, if you’re in a car accident (the most likely risk for your age group), your car insurance will cover it. So don’t sweat it too much. The chance of a bad health crisis at your age is very slim since you’re not an IV drug user (presumably), in a gang, and you’re monogamous (presumably). Those are risk factors for young men.
Solving the insurance mess is another problem entirely. Our office has shifted from insurance-based to about 87% cash, the rest insurance. We have always refused Medicare and Medicaid. The government has a myriad regulations and paperwork that hinder actually helping people. And if you do not comply with every jot and tittle, watch out!
Insurance companies these days follow the government’s lead as far as coverage and reimbursement. The government is not the most progressive taskmaster. Insurance companies have been reducing coverage and increasing premiums. Doctors are squeezed. Patients don’t get the treatment they need.
We were losing money with some of our insurance patients. It was crazy. It cost more in work-hours and paperwok to get paid than we would get paid.
And here’s another thing: many insurance companies have limited enrollment, so the oldest doctors are on the insurance get included. And the insurance board is controlled by certain doctors, so new doctors aren’t even included. Patients get the rusty old guys as docs who essentially control the market.
And here’s another thing: insurance will pay for procedures that have no documented value while not covering treatments proven to help. So guess what doctors do? That’s right. Perform the procedures for which they’ll actually get paid.
The solution is a cash system, primarily. Patients pay for what works. Insurance should be catastrophic only. People have little incentive to care for their machine when insurance covers their stupidity. It is well documented that people recover faster when they pay their own bills.
As for pregnancy and childbirth, in the U.S. the ob/gyns have a veritable monopoly. Most of their interventions cause problems not prevent them. Be very selective with your prenatal care. You don’t just want a healthy baby and mom, you want a happy experience. Believe me, Becky will remember, in minute detail, the events surrounding her birth. A doula can be very helpful to both parents during the birth and greatly reduce the chance of c-section and other interventions.
I could write about the insurance/health care industry all day and I almost have :) Don’t fret, find a good broker. You’ll get insurance, such as it is. And don’t expect monumental changes too soon. The medical and insurance establishment along with overindulgent Americans have too much invested in the current system. Americans don’t want to change their behavior and become responsible, they want to be fixed. Insurance companies want to make money. And doctors are afraid a change will further damage their business.
Almost everyone fears change.
August 15th, 2007 at 12:45:42 pm
And actually, Brendan, I thought of one more thing. Being uninsured can actually be a bonus. If you go into the hospital, they have to treat you. Give them a bogus address and a bogus name: bingo, you’ll never have to pay a cent. And you’ll get damn good care, too. Also, the hospital and doctor will likely negotiate with you to get some money.
It is the rare doctor who turns away a patient. We don’t. For the patient’s benefit, we have them pay a little something otherwise they start to feel bad. Most doctors are the same.
There are no uncared for people in the U.S. There are just a lot of middle and upper class people paying for the uninsured through taxes and their own insurance. Already, the uninsured are subsidized.
August 15th, 2007 at 12:50:47 pm
Regardless of the type of healthcare available to Americans - one thing is for certain: America can’t afford unhealthy lifestyles. People need to take responsibility for their own health at some point.
August 15th, 2007 at 1:06:16 pm
Clearly an insurance company run by Shakers. It’s your own fault, Brendan, for having sex within the institution of marriage.
August 15th, 2007 at 1:39:33 pm
LL, I would agree with you there.
August 15th, 2007 at 3:00:15 pm
Brendan - are you not covered under COBRA (which I believe to be a federal thingie) ? (Covered - as in - you should be able to continue your group policy coverage for 18 months after you leave the prior coverage) …
As I understand it, COBRA was introduced to cover people who move from one job to another, since pre-existing conditions are a common reason to deny coverage in most insurance forms that *I* know … medically, most insurances that I have read do not cover pre-existing conditions during the first year of coverage … this protects those already insured with the company from losing their coverage is the company goes out of business due to new insured’s known pre-existing condition(s) … COBRA was designed to cover that ‘gap’, since, for the previous insurer, the pre-existing condition for the new insurance is an existing condition for the previous insurance …
My #2 daughter is going through COBRA forms right now …
I suspect COBRA will cover you (unless the coverage you had was with a group plan with no possibility of coverage in your new city) … your student heralth coverage should have included coverage for when you travel - and you should be able to get that, under COBRA, to cover you until your new coverage kicks in in October, as I understand COBRA …
August 15th, 2007 at 3:04:18 pm
(blush) I should have read the prior comments in detail … I scanned ‘em and didn’t see COBRA, so I replied …
Comment #3 has given a similar option … if you already had Becky covered under your student insurance, then it should not be too expensive to cover that … if she was covered under her own separate insurance, then get COBRA coverage for her under that separate insurance instead …
August 15th, 2007 at 3:08:13 pm
Brendan - are you not covered under COBRA
He’s probably not covered by COBRA unless a student is an “employee” (I don’t know the law here) but it doesn’t matter — Notre Dame’s student policy permits elective continuation up to six months after you’re no longer covered by the policy. It’s not expensive (at least compared to what you pay under the plan as a student) — $175/month for the student, so for Brendan to be covered until Oct 1st it’ll cost him about $300 or so.
I really fail to see why this isn’t an option for Brendan; I’m not sure just how the coverage is outside of the SB area, but it’s certainly sufficient to cover any medical emergencies that might arise, wherever you are.
August 15th, 2007 at 3:27:48 pm
hmm, should it really be this complicated? I mean I’m usually a libertarian, but the way we deal with health care in this country is just nuts. there really must be a better way.
August 15th, 2007 at 3:48:47 pm
I haven’t called the ND insurance people yet, but I will — thanks for the suggestion. However, I have a question. Is this different from, or the same thing as, GradMed? Because if it’s GradMed, I know I can’t get coverage because they, too, have the “expectant father” limitation. I assume it’s something different, though, from what’s been said so far.
August 15th, 2007 at 3:57:10 pm
You should call the student insurance people, but I’m 90% sure that GradMed is something different — that is, a different policy altogether. This is an extension of your current policy with ND, and they can’t deny you due to “expectant father” status since you’re already in the program.
August 15th, 2007 at 6:33:34 pm
Is “Lassie’s stunt double” also a transvestite ? (grin)
COBRA is not just for employees, it is for those covered under a group policy … so my #2 daughter, while not an employee of my employer, can nonetheless get COBRA coverage with the same health insurance after she stops being eligible for coverage as my ‘dependent’ …
The kicker, for Becky, is under which health insurance she had coverage … since that is the one needing to be extended for Becky and Avocado …
August 15th, 2007 at 9:50:20 pm
Brendan, I echo the suggestions being made by many on this board; sure the current system is bizarre and labrynthine, but generally it is almost always possible to get temporary coverage and/or continue your pre-existing coverage. Unfortunately, there’s no “Easy Button”, so many people give up, but in the vast majority of cases, if you do some research you can find an option.
I think most conservatives have felt for a long time that the current healthcare system is wasteful and a disastrous mix of government and private care. However, the distaste and fear of universal healthcare has always been enough for them to defend the status quo — most successfully in 1993 against “Hillary-care”. Republicans are slowly realizing, though, that the political ground has shifted. Increasingly it is apparent that the electorate believes the status quo is so pathetic, even universal healthcare is preferable. While the GOP has always had some great reform ideas that would seriously improve our country’s healthcare system by leaps and bounds as well as reduce cost — doing far more than a government-run system could ever hope to do — the sad fact has been that too many politicians on both sides of the aisle have been gutless and unwilling to get behind radical change. But even with the major HMO money in play, the GOP is starting to rally around some major reforms, knowing that the status quo is quickly eroding. A lot of Republican politicians are nervous as hell about backing radical reforms coming from the right, but as they see the hatred for the status quo growing, which the Dems are picking up on and thus making healthcare a cornerstone campaign issue, a lot of Republicans have become emboldened by their weakened minority status and are more willing to take the risk of backing real reform. On the other side of the aisle, proponents of universal healthcare have gotten achingly close to a majority on the issue, but there are enough moderate Dems out there (and a complete lack of support from any moderate Republicans) that they just can’t pass their agenda — which is why they’re using the presidential candidates as a cover and hoping the 2008 presidential election delivers a mandate.
The bottom line is, we will finally see major reform soon, one way or the other. What remains to be seen is which direction this country will go.
August 16th, 2007 at 1:47:47 am
*cough cough cough*
Brendan, I hate to say this, but: The health insurance industry is a scam? Are you sure?!
I am stunned and perplexed.
Deoxy: “‘don’t blame the players for the game’ - the government has set the rules […] and insurers and health care providers just have to do their best to work within them” . . . that is so much bullcrap, you must have gone to some truly enormous feeding lot to collect it all. It is health care providers that set the rates and define most of those they will consider “uninsurable” . . . government regulations only serve to limit the number and kinds of “conditions” that health care providers are allowed to blacklist (i.e., thank goodness for government regulation of health care, however shoddy and minimal it is, because otherwise even fewer people would be able to afford or even get health insurance).
August 16th, 2007 at 1:49:04 am
Try the insurance through the ND alumni association, which is linked in the alumni marketplace at alumni.nd.edu. They don’t ask if men are expectant parents, iirc.
August 16th, 2007 at 2:05:48 am
Soren, you can’t absolve the government so easily. If there weren’t 50 different states writing 50 different requirements of what basic insurance must include, insurance companies wouldn’t feel the need to so strictly manage their insurance pools by excluding large segments of the population. Just imagine if government stepped in and said every new car must be a hybrid, have leather interior, and have ten airbags. You don’t think car prices would jump drastically and that scores of Americans would be priced out of the market?
August 16th, 2007 at 10:37:26 am
Yes they do, anon. Well, technically, they ask whether the applicant, the applicant’s spouse, or any of the applicant’s dependants, whether or not they’re applying for coverage, are pregnant or planning to adopt — they don’t use the term “expectant father.” So if my wife (or daughter!?) is pregnant, I’m ineligible, but if I had gotten a girl pregnant out of wedlock, I’d be eligible. I checked with the GradMed representative via phone, and they confirmed this. It seems both irrational and inconsistent with Notre Dame’s values, so I actually complained to the ND alumni association about it. That was before I realized about the broader issue of expectant-father “uninsurability.” I guess GradMed (the company that issues the ND alumni insurance) is just trying to enforce that restriction, albeit in a rather inept way.
August 16th, 2007 at 10:51:29 am
Andrew, I don’t necessarily disagree with your analysis. Though I wonder what it is that a federal health care program would be unable to provide that one based on private insurance would be able to provide. That said, I think that a system that provides a basic standard of care based on a federal health insurance program based somewhat on what you might expect in a European Nation (though through hindsight we should be able to develop a system that works even better). At which point you would be able to supplement government health care with probably a cash based system for other forms of care–it would seem unlikely that insurance would be a valid model for supplemental as I’m not sure what their added value would be.