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
Thu, 06-18-2009 - 12:43am

Sorry, still the same stuff--a little appearance of science (take a fact and act as though it proves a pre-determined point even when it does not) then throw in a LOT of innuendo and supposition--like the fluoride and thyroid "link".

Look at the words used in your quotes: "potential" "could contribute", "if you have a thyroid problem". The words indicate not what is, but what might be if all the negative contributing variables were in place. Pointed out in my earlier post and links that fluoride only seemed to be a problem if it had been contaminated or if water was not being monitored for too-high TOTAL fluoride levels--both naturally occurring and added.

The CDC link I found did NOT indicate that such was the case for the vast majority of people in the U.S.

I've seen this before. It was hysterical hokum then. And son of a gun, it looks to have changed little between then and now!

Jabberwocka

iVillage Member
Registered: 02-19-2008
Thu, 06-18-2009 - 12:51am

Don't know why you'd be struck speechless .... it's already happening in countries with nationalized healthcare.

http://www.telegraph.co.uk/news/uknews/1576704/Dont-treat-the-old-and-unhealthy-say-doctors.html

iVillage Member
Registered: 03-03-2009
Thu, 06-18-2009 - 12:57am

Still deceptive because of this part: "I don't want to insure my neighbor...."

In any event, I certainly hope the pool works for his son. BTW, repeating a year of school, if it helps a child achieve mastery, ought not be a stigma.

You do know that when the child grows up and applies for insurance of his own, unless the system has changed, he too will be up against the "pre-existing condition" dreck of that ADHD/ADD "diagnosis" if it is put in his medical records now. As will your own children. Your neighbor may be more long-sighted than you give him credit for.

Pray the system changes because there is no reason to inflict the worst of today on a hopeful tomorrow.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Thu, 06-18-2009 - 1:05am

I'd rather have it diagnosed and treated than bury my head in the sand and hope it goes away. Though the insurance scenario you predicted for my children may not be inevitable as I've already put them on individual policies at adult rates.

iVillage Member
Registered: 03-03-2009
Thu, 06-18-2009 - 1:07am

Most medical doctors make judgment calls every day about whether a patient is a fit candidate for certain procedures (and they're not God so we all ought to be far more questioning about their pronouncements when our own bodies are at stake).

Age, physical condition, daily living challenges go into that determination by medical care providers. Your own insurance company probably has a nurse, doctor or some other "qualified" staff members who do precisely the same thing. The pertinent questions are "who" and "why".

You did not stipulate either which made it sound like just about anybody could stick a nose where it had no bloody business being.

Jabberwocka

iVillage Member
Registered: 03-03-2009
Thu, 06-18-2009 - 1:24am

Choosing not to treat with powerful stimulants is not the same as burying one's head in the sand and hoping ADHD/ADD goes away. I recommend Howard Gardner's books on multiple intelligences and teaching/learning styles. Also Melvin Levine's book Developmental Variation and Learning Disorders. Both authors are sympathetic to styles of learning which are not within the commonly accepted parameters of "normal".

Your children might be less vulnerable with the health insurance policies you took out for them but insurance companies are prone to rewriting rules and policies when they perceive a negative impact on their bottom line.

And your children would always have to live in the state where you are now located, or risk the "pre-existing" garbage when they become adults and apply for insurance in another state.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Thu, 06-18-2009 - 1:26am
I'll take my doctors and private insurance companies over da gabamint any day of the week, thank you.
iVillage Member
Registered: 02-19-2008
Thu, 06-18-2009 - 1:37am

"Your children might be less vulnerable with the health insurance policies you took out for them but insurance companies are prone to rewriting rules and policies when they perceive a negative impact on their bottom line."

So's da gubamint ... recently they tried to pass on medical care of veterans to the private sector, for example.

"And your children would always have to live in the state where you are now located, or risk the "pre-existing" garbage when they become adults and apply for insurance in another state."

A situation quite familiar to residents of Great Britain with their zip code lottery system.

Avatar for ddnlj
iVillage Member
Registered: 03-26-2003
Thu, 06-18-2009 - 7:43am
Health insurers refuse to limit rescission of coverage

By Lisa Girion
June 17, 2009


Executives of three of the nation's largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.

The hearing on the controversial action known as rescission, which has left thousands of Americans burdened with costly medical bills despite paying insurance premiums, began a day after President Obama outlined his proposals for revamping the nation's healthcare system.

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Avatar for claddagh49
iVillage Member
Registered: 07-20-2004
Thu, 06-18-2009 - 8:23am

Yes, but in many cases it can be a life long medical condition, ADD/ADHD as bi-polar is. When you children get older and get jobs and fill out medical/ins forms, they will HAVE to list ADD/ADHD on that form! Whether or not they are still being treated for it.


We can no longer stand ididly by and let Insurance companies run things, run our lives, because they certainly are now! there are many uninsured out there who are not poor, or deadbeats as some put them in that catagory, they are people who are DENIED insurance because of pre-exhisting conditions!


If Obama does anything, I hope he grows the cajones to tell Ins companies that, YOU ARE DONE inless you take pre-exhisting conditions, ALL of them! this billion dollar profiteering on people's lives has to stop!


I hear over and over the cost, the cost, yet were Consrrvatives and some Liberals worrying about the costs of Bush's unnecessary war in Iraq? all the money blown on Halliburton on Blackwater, all the money un accounted for? the shoddy work our troops getting electrocuted by this faulty work?

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