Thursday, December 27, 2007

The crux of the problem with health insurance

Bloomberg.com: Exclusive: A woman who carried private health insurance (her employer didn't offer insurance) "She had bought medical coverage through a subsidiary of Assurant Inc. for consecutive six-month terms without interruption since December 2003.

Her insurance company, John Alden Life Insurance, rejected her claim for lymphoma treatment, saying she had the cancer symptoms before signing her then current six-month policy and should have sought diagnosis or treatment earlier."

The insurance company was arguing that the insured's good health at the time she first bought insurance from them, in 2003, was not at issue. At issue was the state of her health at the time she renewed the policy most recently. They claimed she should have known then, at renewal that she had cancer. The fact that she was healthy all the years she paid them premiums was irrelevant - all that mattered was that she might have been unhealthy when she renewed the policy.

This is why American voters are ticked off about health insurance. High costs stink, employers not offering insurance stinks, but living in fear that a properly purchased insurance policy won't pay is terrifying. If legislators and insurers want to stop the train wreck of socialized medicine, this is the problem they need to solve now. There is no excuse for allowing insurers to pull this kind of B.S. stunt on honest citizens.

The story has a sort of happy ending. The hospital appealed to the insurance commissioner, and the insurance commissioner refused to help. The hospital then involved the state's attorney general, who did intervene. The insurance commissioner was sacked, the patient's care was covered, and the insurance company is now being investigated by the new, apparently more honest, insurance commissioner. The patient survived, although the cancer has recurred twice. Hard to heal when you're fighting your insurance company.

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