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: 02-19-2008
Thu, 06-04-2009 - 8:11pm
As she has not applied we can't say. But I'll look into it.
iVillage Member
Registered: 02-19-2008
Thu, 06-04-2009 - 8:13pm

"Here is some info on state high risk pools. Californias pool has a waiting list due to high demand. You must also be declined by 3 different insurance sompanies before you are eligible to qualify. It is not easy to get insurance companies or agents to even process your application if you have a pre-existing condition."

Maggie has 2 out of the three rejection letters needed.

iVillage Member
Registered: 01-22-2009
Thu, 06-04-2009 - 8:24pm

Can Canadians access it?
iVillage Member
Registered: 02-19-2008
Thu, 06-04-2009 - 9:05pm

Have sent an Email to inquire.

In the meantime, another option for Maggie.

http://www.immigrationhealth.com/plans.htm

iVillage Member
Registered: 08-30-2002
Thu, 06-04-2009 - 9:22pm

Eligibility requirements. No longer require 3 rejections, but the can't be rejections from an internet application or an agent. Also, look who the first insurance company listed is-Anthem Blue Cross, on eof the ones that rejected her (and just about everyone else on the program)



iVillage Member
Registered: 01-22-2009
Thu, 06-04-2009 - 9:32pm
Interesting, thanks! :)

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iVillage Member
Registered: 03-03-2009
Fri, 06-05-2009 - 1:04am

Of course Bush didn't "tell Maggie to come here". Not my point at all. Bush, for that matter, didn't do much of anything but eff things up. Led so badly that he gave "government" a bad name.

As has been pointed out more than once in this thread, Maggie's situation is not isolated or unique; and is in fact becoming increasingly common. Therefore, a sweeping statement that health costs are not relevant to businesses, is totally ludicrous. When businesses can no longer afford to pay for all or part of an employee's premium, that employee has to foot an often-exorbitant bill--either for insurance or for medical care.

As has also been pointed out repeatedly, Maggie didn't know that the U.S. had such a lousy system and therefore didn't "expect" anything different from the apparently considerably more civilized and civil Canadian system.

BTW, we all foot the bill for a number of items. National defense, federal roadways, etc. Surely you have "expectations" about those. Must be wrong, huh?

Jabberwocka

iVillage Member
Registered: 02-19-2008
Fri, 06-05-2009 - 10:11am

BO is planning to tax health care. That will certainly help to make it more affordable ... NOT. I guess you must hate his leadership. Isn't he giving government an even worse name?

Regarding Maggie's discovery that the Canadian health care system is more civilized ... the road to Canada runs in 2 directions. She can always live in the country she really seems to love. It was Maggie who moved here. Perhaps her DH can move with her to Canada. They can enjoy wait lists together with the cool Canadian climate. Nothing says beach quite like rocks and ice (well at least in Canada :)

iVillage Member
Registered: 03-03-2009
Fri, 06-05-2009 - 10:46am

For the umpteenth time, the same issue which affected Maggie is also hitting many other people. We can't all choose to move to Canada since SOME of us are small business owners who have our clientèle established here.

Are you sure you meant to write that Obama is planning to tax health care? Or did you perhaps mean that he plans to tax health BENEFITS? Big difference. No, I wouldn't be happy about that tax. Who would? I still think the man is 100 times better in his leadership than Dumbya. FYI, I gave Bush benefit of the doubt in the dark days after 9/11. That trust was betrayed, not once but over and over again--mostly in the context of the "war on terror".

An op-ed on the issue of the health insurance industry: http://www.nytimes.com/2009/06/05/opinion/05krugman.html?ref=opinion

I've also said repeatedly that we don't need the insurance industry at all. If you're sick or injured, you need affordable, accessible, quality care. PERIOD.

Edited to insert a previously-missing verb.




Edited 6/5/2009 1:22 pm ET by jabberwocka

Jabberwocka

iVillage Member
Registered: 08-30-2002
Fri, 06-05-2009 - 11:35am

**For the umpteenth time, the same issue which affected Maggie is also hitting many other people. **


This pinpoint focus of ops is what I call, having blinders on. They put blinders on racehorses so they can't see anything else but what is right in front of them. It keeps them from being distracted and frigtened



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