Sunday, October 01, 2006

Another Reason for National Health Care:

Pre-Existing Conditions

A very common insurance industry tactic to deny access to health care is to claim that any injury or illness is the result of a "pre-existing condition." I recently bought a new health insurance policy. The salesman told me that I would be covered the very first day. However, I know this isn't true. Insurance companies have lots of ways to deny care.

If we had a national health care system, the issue of "pre-existing conditions" would no longer have any relevance. The reason is that there would be a public policy of guaranteeing access to health care. Health care would be a right, rather than a privilege.

Another side note about my current health insurance policy: while I was on the phone with my current health insurance company, whose policy was sold to me while I was self-sufficiently self-employed (by a company that supposedly caters to self-employed persons), the salesman told me to ask them what my lifetime coverage was (I was told $1 million at the time it was sold to me), the lady on the phone asked me to hold; upon returning, she told me I had a lifetime benefit of $24,000.00. There is a big difference between $24K and $1 million. In other words, if I had come down with a severe injury or illness, the total amount of coverage I would have received after the payment of my deductible was $24,000.00 over my lifetime.

The insurance companies will rely on a rule of evidence called the
parol evidence rule. In theory, there is an exception for fraud, but that is very hard to prove.

Now I am sure that the contract that I signed Thursday with the new insurance company has some "weasel words" that limit their obligation (instead of the $6 million they told me).

The only way to avoid the half-truths and lies used to sell health insurance to people is to just do away with the profit motive completely. The profit motive gives too much motive for abuse. Our health is just too important to allow trickery by insurance companies to deny Americans care.


Teri said...

The biggest problem I have with our current system is the amount of CYA involved. Last year, my husband and I both had totally useless MRIs performed. The only reason for them was to rule out a condition like a tumor (in my case) or the need for surgery (in my husband's). There wasn't a tumor in my case and I was pretty sure that would be the findings. In my husband's case, they recommended surgery for a ruptured calf muscle. We got the results about the time that the muscle healed on its own. We see the same situation when it comes to prescriptions. They are clearly over prescribed in many cases. If you want an alternative, even one that may be cheaper like vitamins or herbs, you have to pay for that out of your own pocket. The prescriptions are subsidized and advertised.

I literally don't use my medical benefits because I do not get any paid days off the first year at this job. I would have to miss work and take a hit to my paycheck. I would truly prefer to have insurance for medical emergencies only. I would prefer for us to go back to a time when we take more control over our health and try to avoid the doctor's office whenever possible.

OkieLawyer said...

You are not the first person to mention excessive lab tests to confirm what doctors already suspect. The tests are done to prevent potential medical malpractice claims, or so it is said.

Medical malpractice lawsuits cost anywhere from $50K to $100K per case. So, realistically, medical malpractice claims are pretty rare -- even if they are justified.

I also don't doubt that we rely too readily on pills to solve any real or perceived medical problems. Our society relies to little on "preventive maintenance" (myself included). However, it is also true that we spend too much time chasing the almighty dollar, and too little time relaxing and "stopping to smell the flowers" so to speak.

Which brings me to your last point: Americans receive too little vacation and sick leave to tend to the other aspects of life. Requiring employers to allow more vacation and sick leave would require a sea change in our society and our priorities.

I see a problem with your last point as many medical problems must be treated before symptoms become manifest. Otherwise, your points are well taken.