Down and Out in San Diego

iVillage Member
Registered: 02-19-2008
Down and Out in San Diego
246
Wed, 06-03-2009 - 8:43pm

Poor Maggie, America is such a cruel and inhospitable place.

http://www.latimes.com/news/local/la-fi-lazarus27-2009may27,0,819761.column?track=rss

Canada's healthcare saved her; Ours won't cover her
David Lazarus
May 27, 2009
San Marcos resident Maggie Yount wasn't surprised when the letter from insurance giant Anthem Blue Cross arrived the other day. Yet she couldn't help but be frustrated.

"Some medical conditions, either alone or in combination with the cost of medication, present uncertain medical underwriting risks," Anthem informed her. "In view of these risks, we find we are unable to offer you enrollment at this time."

In other words, no health coverage for you.

Yount, 24, finds herself in that cloudy area in which a "preexisting condition" makes her too great a risk in the eyes of money-minded insurance companies. And so she's being excluded from the system.

"It looks like I'll just have to be very, very careful about everything," Yount told me. "But what kind of way is that to live your life?"

If that were all there was to it, her story would still be worth telling as the Obama administration embarks on an ambitious effort to reform the woefully dysfunctional U.S. healthcare system.

But Yount's tale runs even deeper.

In November 2007, she was rushed to the emergency room after a drunk driver crashed into her car on a Nova Scotia highway.

Yount awoke from a coma four days later. She had suffered a brain injury in the head-on collision. Thirteen bones were broken, from her leg to her cheek. The other driver was killed.

Yount, a Canadian citizen, spent three months in a Halifax hospital, receiving treatment and rehab that must have cost a small fortune.

"I have no idea how much it cost," she said. "It's not something I've ever needed to know."

So who paid the bill?

"The government of Canada."

The United States is the only industrialized democracy that doesn't have a government-run insurance system. Under such systems, universal coverage is provided through tax revenue. There are no premiums, co-pays or deductibles.

It's not a perfect system -- people often end up waiting for nonessential treatment. But it won't leave you destitute if things go bad. Basically, you're covered. For everything.

In Yount's case, that ended when she moved to San Marcos in northern San Diego County a year ago to be with her fiance. They were married last July.

She then tried to obtain health coverage under the U.S. system. Her American husband works as a software engineer on a contract basis and doesn't have employer-provided coverage.

Before applying to Anthem, Yount applied for an individual policy offered by Aetna Inc. She received a letter a couple of months ago informing her that her application had been rejected.

The letter noted that Yount's medical record includes "a history of traumatic brain injury with multiple fractures treated with hospitalization." It concluded that "this condition exceeds the allowable limits provided by our underwriting guidelines."

That's a fancy way of saying there's a pretty good chance Yount will require medical care of one sort or another in the future. This would be bad for Aetna's business.

"If anybody from Aetna had actually spoken to me, they'd see I'm not mentally challenged because of the brain injury," Yount said. "I still have some issues related to it, such as short-term memory loss, but I no longer have the need for acute medical care."

As for all those broken bones: "They've healed," Yount said. "That's over. What, are they going to deny people coverage because they once had a broken arm?"

Anjanette Coplin, an Aetna spokeswoman, was unable to discuss Yount's case. But she said the company considers a variety of factors before rejecting an applicant for coverage. These can include a person's overall condition, medical history and prospects for ongoing treatment.

"We feel that our underwriting guidelines give the greatest number of consumers the opportunity to purchase affordable, quality health insurance products," Coplin said.

Yount's response: Companies like Aetna and Anthem are denying coverage based solely on history rather than a reasonable expectation of what could happen down the road.

"I want insurance for what could happen in the future -- just in case," she said. "That's what insurance is for. But I can't get it."

I don't blame Aetna or Anthem. If you offer health insurance as a for-profit business, it goes without saying that you'll do everything you can to avoid making payouts. That means you'll shun anyone with even a whiff of medical trouble.

But this is no way to run an insurance system, let alone to protect people from financial ruin due to catastrophic events such as being sent to the hospital by a drunk driver.

The Obama administration has already rejected the idea of a single-payer system similar to Canada's -- a mistake, in my opinion. Instead, it wants a smaller public program that would compete with private insurers and keep costs down.

Private insurers, not surprisingly, are lobbying aggressively to kill off that idea. They'd rather have a national mandate that would require all Americans to buy their product.

In return, they say, they'd stop sending rejection letters to people like Yount with preexisting conditions. But policyholders would still be subject to the companies' various terms and conditions.

Maybe one compromise would be to let private insurers handle the small stuff and to have a public program that could tackle the catastrophic stuff.

I asked Yount what would have happened if she'd gotten into her accident in Southern California instead of Nova Scotia.

"I can't say whether my care would have been better or worse," she replied. "But I know this: I'd be bankrupt now."

"I'm not a religious person," Yount added. "But I thank God my accident happened where it did."

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iVillage Member
Registered: 03-03-2009
Tue, 06-09-2009 - 3:11pm

I looked at the USCIS website and see nothing which states that "her husband was supposed to provide for her healthcare needs as her sponsor". It does state the following:
<In order for a relative to sponsor you to immigrate to the United States, they must meet the following criteria:
*
They must be a citizen or lawful permanent resident of the U.S. and be able to provide documentation providing that status.
*
They must prove that they can support you at 125% above the mandated poverty line, by filling out an Affidavit of Support>>

Here's the link for the Affidavit of Support form:
http://www.uscis.gov/files/form/i-134.pdf
It doesn't say anything about providing for health care needs either.

The claim regarding health care specifically might be another attempt to fabricate much out of nothing.

Jabberwocka

iVillage Member
Registered: 01-22-2009
Tue, 06-09-2009 - 3:29pm

So not only hasn't he had medical bills to pay, he wouldn't have to pay future ones anyway?

iVillage Member
Registered: 02-19-2008
Tue, 06-09-2009 - 4:08pm
Yep, real responsible ... sit there unless something happens ...
iVillage Member
Registered: 02-19-2008
Tue, 06-09-2009 - 4:17pm

"In the meantime, there are millions of people who didn't immigrate who are STILL in straits as bad, or worse, than those of Maggie Yount. If you ignore them (as seems to be the current trend), it will look suspiciously like spin. But that's nothing new either."

I have invited people to post these stories. But have also said it isn't likely to alter my advice. Maggie should enter th ehigh risk pool. Were she not an immigrant I'd tell her the same thing.

iVillage Member
Registered: 02-19-2008
Tue, 06-09-2009 - 4:20pm

"You've done as much as possible to paint the Younts in a negative light. Hasn't been terribly successful because their cardinal "sin" appears to have been that they didn't anticipate the antiquated state of the U.S. health care coverage and payment system."

So after 20 plus years of residing in the US Mr Yount didn't know how the US health care system works?

iVillage Member
Registered: 01-22-2009
Tue, 06-09-2009 - 4:48pm

You claimed that he hasn't been providing for her healthcare needs.
iVillage Member
Registered: 03-03-2009
Tue, 06-09-2009 - 5:17pm

If Doran Yount had ever applied for coverage, been in steady good health, and never had anything which was defined as "pre-existing" he wouldn't know that insurance companies can use previous illnesses, congenital defects, or injuries as grounds for refusal to cover.

Nor are insurance companies straightforward in their definitions so that you know in advance what might be a red flag and what would not. Seems to be "evolving" depending on the bottom line of the company. Near as I can tell, they operate by having applicants submit forms, then picking and choosing who will get coverage, at what premium, and who will be denied altogether. Very opaque.

My DH recently looked into getting a new provider for his employees. The prospective company told him they could give the same coverage for significantly less than Alliance Choice's PPO (which is darn good coverage, if pricey, for a small company). He asked repeatedly whether that included coverage for "pre-existing" conditions. "Oh yes", said they, "we just need health histories, and then you're good for coverage". So he had all of his employees fill out their own and their families' histories and prepared to make the switch. When the insurance company got all those forms and looked them over, they "changed their minds" and gave him a much higher quote for coverage. Presumably, all that very personal information is now in the computer/hard-copy innards of a company which has no need for it and may not protect it adequately. DH was royally ticked about what he considered to be "bait and switch" tactics. And he's also furious at the time they wasted since he's a very busy person.

The insurance companies appear to be lightly and quixotically regulated. No rules but the ones they make as they go. Damn easy to be unaware of their ultimate decisions.

Jabberwocka

iVillage Member
Registered: 03-03-2009
Tue, 06-09-2009 - 5:28pm
What part of "waiting list" do you not understand?

Jabberwocka

iVillage Member
Registered: 02-19-2008
Tue, 06-09-2009 - 5:48pm
What part of the time will not grow shorter whilst you sit on the beach and kvetch to journalists does Maggie not understand?
iVillage Member
Registered: 03-03-2009
Tue, 06-09-2009 - 6:11pm

Neither of your characterizations are necessarily correct. One picture on the beach and a beachfront wedding do NOT mean that one is sitting on the beach regularly. Maggie talked about her future plans in the OP. Beach sitting? Not in there. Nor do two interviews with a journalist mean that she's "kvetching".

It would be jumping to conclusions (again) to assume that she has not applied to that high-risk pool. Were all facts of her life, her future plans, and her past actions covered in the two interviews she's given?

Frankly, I don't understand what seems to be an obsession with this one individual. She's not a miscreant, she's not abusive, not notorious, not really seeking the limelight. In point of fact, Maggie sounds like a remarkably resilient and optimistic young woman.

If she's the best that conservatives can do to muster opposition to health care/payment reform, y'all are gonna be hurting in ways which NO amount of insurance coverage will ameliorate.

Jabberwocka

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