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Tell Your Healthcare Insurance Story

I’m hearing quite a bit these days both in the media and in the blogosphere about “rescission”, the term that’s being used for summary cancellation of people’s healthcare insurance, presumably due to pre-existing conditions unreported at the time the policy was written or some other reason or pretext.

I’ve carried healthcare insurance, been insured by my employer, or been covered under my family’s healthcare insurance over a period of well over a half century. Neither, I, my family, my siblings or their families, nor, to the best of my knowledge, anybody I know has had this experience even though hundreds of thousands of dollars in claims have been paid by their insurance companies over the years.

Contrariwise, the insurance companies insist that those whose insurance is cancelled for anything other than non-payment is very, very small: 1% or less. I have personal first-hand experience of insurance companies bending their rules in favor of insureds rather than the other way around.

However, I’d like to get some idea of the scale and scope of the problem. So, in a completely non-scientifiic, unverifiable, and biased study, I’m going to ask for readers to contribute their own experiences with having their health insurance cancelled for any reason other than non-payment.

Please tell your story. First-hand experiences only, please. No hearsay.

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About Dave Schuler
Over the years Dave Schuler has worked as a martial arts instructor, a handyman, a musician, a cook, and a translator. He's owned his own company for the last thirty years and has a post-graduate degree in his field. He comes from a family of politicians, teachers, and vaudeville entertainers. All-in-all a pretty good preparation for blogging.

Comments

  1. Drew says:

    Looks like I might be the leadoff. But sorry, my story is similar to yours. I’ve carried insurance all my life. I’ve filed claims, including two serious neursurgical procedures, and all the usual. No problems.

    My sister, a cancer patient, has not had claims problems. My mother, a former cancer patient, did not have claims problems.

    The only thing I’ve been denied is life insurance. Why? I have a horrific hyperlipidemia problem. But I can’t blame them. The numbers are so awful. Its insurance, not call on my neighbor to cover my issues.

    Hence the only query I would have is should there not be high premium/high risk pools for people like me?

    PS – I also know of no one who has had their insurance cancelled after disease presents itself, or for misrepresenting their situation going in.

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  2. odograph says:

    I’ve told my story before, and don’t have energy now to do a long version. Short form:

    I went from employer group, through COBRA, to individual, as I went to semi-retirement. I was refused individual by my group/COBRA insurer for BS reasons. I was refused by my alternate, until I made the case in writing that each point was BS.

    I don’t think they really want (many) individual policies.

    One weird incident was that my insurer said my US COBRA would expire in June, and Cal-COBRA said they would start in August. What happened to July? Each told me that the other was wrong, but that they would not talk directly. I had to convince one or the other myself. That was impossible, so I took my exit to an individual policy at that point, with luck.

    California does have an insurance helpline which is helpful, but not of course to the point of actually talking to the insurers.

    … I guess that ended up long-form after all.

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  3. just me says:

    Well I am 40 and have a 12 year old son with autism and we have never had any problems with insurance.

    The only glitch was when we had my son evaluated and there weren’t any OT’s within their defined 50 miles that contracted with them. I called and had to get special approval to go out of the PPO network. Somehow that approval got screwed up but it was eventually worked out and the claim was paid.

    About 6 months later the insurance company changed through the employer and it has been smooth sailing ever since. In almost 9 years i haven’t even had to call the insurance company to dispute a claim. Everything we have needed insurance has paid for without any objections.

    I can’t say the same for dh’s VA care though.

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  4. Triumph says:

    However, I’d like to get some idea of the scale and scope of the problem. So, in a completely non-scientifiic, unverifiable, and biased study, I’m going to ask for readers to contribute their own experiences with having their health insurance cancelled for any reason other than non-payment.

    It is impossible to get “some idea of the scale and scope of the problem” with your (self-admittedly) dim-witted “methodology.”

    I love how you don’t want “hearsay”–as if it would make your exercise more “valid.”

    You should rather avoid wasting your time and read the study by Himmelstein, et. al. published in June in the American Journal of Medicine.

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  5. Stan says:

    I believe collecting anecdotal evidence in this way is useless, particularly since people who have experienced recission are unlikely to read a blog so devoted to upholding the status quo. A discussion of recission (including statistics) can be found in this post:

    http://www.hhropenforum.org/2009/07/insurance-companies-refuse-to-end-practice-of-rescission/

    I couldn’t find the study by Himmelstein et al. mentioned by Triumph. The most recent paper of Himmelstein’s I found in the American Journal of Medicine is devoted to medical bankruptcy, an unfortunately common result of our health care system.

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  6. Dave,

    BCBS tried to cancel my health insurance in 1994. The stated reason was lack of payment, but since I hadn’t missed a payment, the real reason was total incompetence in two of their offices or an effort to stop paying medical bills for a person with cancer.

    In late 1993 my employer closed its door. I wasn’t eligible for Cobra, but employer’s coverage had a conversion policy clause. I took advantage of it. The same month I was told my employer was closing, I also learned I had malignant melanoma. In 1994 I had surgery for 4 separate melanomas on my body and had numerous other lesions removed.

    Some of my experience is related in this OTB post. I’ve twice guest blogged here and am pretty much the whole show over at OTB Sports.

    Back to my insurance. Beginning in Feb 1994 I was solely responsible for paying my insurance premiums. They were due the 1st of each month. I would mail payment from South Florida to Jacksonville FL, some 7-10 days before my premium was due by certified mail every month. Some months I would not receive a bill, so I would make a copy of the previous month’s bill and write the correct month on it plus include payment.

    Then in January 1995 I got a certified mail on a Friday afternoon. BCBS was informing me they were going to suspend my insurance effective the next Monday and then cancel it a week later. The reason given- failure to pay my premiums.

    I had the canceled checks for all my due premiums up through December 1st and had the certified mail return receipt for January. Lack of payment wasn’t an issue. I contacted BCBS offices in Miami and Jacksonville. They requested a copy of all my canceled checks. I mailed them on Friday afternoon along with a copy of the certified mail receipt for January(BTW premiums were due the first of each month but there was also a 10-day grace period before BCBS had the right to cancel. The certified letter I received was mailed January 9th.)

    BCBS received the letters of mine, my insurance wasn’t canceled, and I was told the matter was resolved.

    Less than three months later I got again another cancellation letter. BCBS then got a volley of missiles back from me. In a terse letter I told BCBS they are to fix their ‘billing problem’ at once, not in 5 minutes, or 10 min, or a half hour, or an hour, etc etc but now. If they didn’t, I would

    Consult an attorney for possible legal action
    File a complaint with a state regulatory agency
    Go to the local news media with my story.

    A lawyer friend called BCBS for me, as did a news producer for a west palm beach television station. I got a very apologetic series of phone calls and a letter of apology from BCBS with promises they would take care of the billing issues at once. Which they did, but my business with them was soon finished. A few months later I was able to get on my wife’s insurance thanks to an open enrollment period.

    My insurance was about to be canceled but not for non-payment but instead either due to billing department incompetence or something more sinister. The second try at cancellation makes me believe the later.

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  7. ggr says:

    I agree that you’re not going to learn much from this kind of question on a blog. I’m a Canadian, and I don’t know anyone who’s had to wait more than a few weeks to see a specialist or have a major operation, and just a week ago a friend had to go to emergency with a chest condition and was immediately seen by doctors.

    Doesn’t mean it doesn’t happen though … which is why you need medical studies. Most of these things aren’t common enough that anyone will know of someone who’s gone through it. You need statistics to pick up outliers.

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  8. Michael says:

    Well I am 40 and have a 12 year old son with autism and we have never had any problems with insurance.

    Have you ever tried getting a private policy? Every single one I talked to refused to cover my son because of Autism.

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  9. Michael says:

    While my story isn’t about cancellation of a policy, it is about how holes leave you less covered than you are led to believe.

    When my wife was pregnant with our first child, her employer’s insurance was very good, it claimed to cover 100% of labor and delivery costs. I changed job and we ended up moving halfway across the state, but we opted to continue her coverage under COBRA, paying about $900 a month for the last 4 months of her pregnancy.

    My wife ended up with extraordinarily high blood pressure, and had to have an emergency C-section at 35 weeks. Now, when we moved we selected an Ob/Gyn that was covered by our insurance. We selected the hospital for delivery that was covered by our insurance. However, when the time came for the C-section, performed by the covered doctor in the covered hospital, the only on-call anesthesiologist was not covered. So, we got stuck with the entire bill, even though we had no way of knowing or choosing who the anesthesiologist was going to be.

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  10. just me says:

    Have you ever tried getting a private policy? Every single one I talked to refused to cover my son because of Autism.

    No, I haven’t needed to. Although my son qualifies for and receives Katie Beckett supplemental insurance (it acts as a second payer for primary insurance, but if we lost our primary insurance it would become his primary insurance). He has had Katie Beckett for about 5 years now.

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  11. Pete Burgess says:

    I’ve come away from reading these comments with re-affirmation that health care/insurance is complex and costly. Turning it over to eventually be run by the federal govt is insanity. Just think IRS and its regulations, the Post Office, promises made to enact social security, medicare and medicaid, $400 hammers for the Pentagon, the war on poverty (which still exists), the war on drugs, ad nauseum. I say scrap the bill and start over. There are plenty of other better ideas being floated.

    For those out there who decry special interests trying to defeat this insane plan, I say there are just as many other special interests trying to get it enacted. As with most govt hatched ideas, it’s well intentioned, but poorly thought through.

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  12. anjin-san says:

    A few years ago I gave up an employee position to take a contractor gig with a large upside potential. Panned out too :)

    At the time I was a healthy 47 year old. No serious illnesses, ever. Non smoker/drinker. I do have high blood pressure and cholesterol, both under control with medication. I am not overweight. There are not too many middle aged guys who are healthier than I am.

    Could not get HMO insurance as in individual with the large insure res in our state because of “pre-existing conditions”. Luckily I was able to get on my wife’s plan at work.

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  13. Brian says:

    When we lived in the UK, no problems for family knee surgery (wife) and reconstructive hand surgery (son) using National Health. When we lived in the US, no problems for several major surgeries using company insurance, but we did have a problem when a school took our son to a non-preferred hospital emergency room – I ended up paying the entire amount. Moral of that story: do not deviate from the rules, no matter what with US insurance companies.

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  14. Stan says:

    I do not understand the comments made by Pete Burgess about Social Security and Medicare. They’re efficiently run, they’re immensely popular, and they’ve accomplished what FDR and LBJ set as their goals, to end poverty among the elderly. Like other public programs they suffer from our unwillingness as a country to raise taxes when necessary, but I shudder to think of what would happen if they were eliminated, particularly in times like now when our retirement accounts are in free fall.

    If Social Security and Medicare count among the programs Burgess feels are poorly thought out, what does he suggest we do about them? Eliminate them outright? Or kill them slowly, as suggested by Newt Gingrich? I’m curious to see what he suggests.

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  15. B. Minich says:

    I really don’t have any stories whatsoever with insurance, however, I can hopefully help point you in the right direction. Recision tends to be found when people are paying for their own insurance – self employment types of situations. I haven’t heard too much in the way of employed people getting this. Basically, I think that if you have a corporation backing your insurance, they are willing to pay – it is the cases when its all about you paying that they really try to get you. But that’s my impression from the media, so I’m not sure how accurate that is.

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  16. odograph says:

    B. Minich’s comments dovetail with my experience. It figures that insurance companies are going to try harder to keep a group policy that may make money even with some sick individuals. Jettisoning the group, when the group as a whole is still a money maker, would be illogical.

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  17. Michael says:

    No, I haven’t needed to. Although my son qualifies for and receives Katie Beckett supplemental insurance (it acts as a second payer for primary insurance, but if we lost our primary insurance it would become his primary insurance). He has had Katie Beckett for about 5 years now.

    Sounds like a good program, alas it doesn’t seem we’ve implemented a Katie Beckett program in Florida.

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  18. just me says:

    Sounds like a good program, alas it doesn’t seem we’ve implemented a Katie Beckett program in Florida.

    It is a federally funded program, but I think qualifications vary from state to state. It was designed specifically to help middle income families that don’t qualify for medicaid to keep their children at home with needed therapy support and avoid having to have them hospitalized. Some states will approve only the most severely disabled children, other states will approve other disabilities that my need more extensive therapies.

    It is paid for through medicaid, but medicaid acts as a second payer with the program. It did make it hard to find a dentist though-many of the dentists up here refuse to take medicaid patients, and it didn’t matter that we had Delta as a primary payer (so for a while the medicaid actually kept my son from getting dental care). The state eventually renegotiated the reimbursement rates and we were able to get him in to a dentist.

    It is a good program, and the goals of the program are worthwhile, but it appears that in NH they have a broader definition for who qualifies. So far our primary, private insurance hasn’t ever balked at paying out for any therapies, but if it did, it is nice to know that it is there.

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  19. Matt says:

    My GF has been rejected by every insurance company she has approached due to having Idiopathic thrombocytopenic purpura for 3 years as a teenager. Her platelet count is currently just as high as a normal person but the insurance companies do not care. We’re hoping she’ll be able to get into the group insurance at her new employer but time will tell. My mom is a nurse with +20 years of experience and has hit the highest point possible in education without actually becoming a real doctor. The amount of stories she has about dealing with insurance companies would make your head spin and then explode from sheer anger (some doctors paid her full RN salary just to negotiate with insurance providers).

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  20. I’ve been rejected for having committed a terrible crime: moving from NC to CA while over the age of 50.

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  21. sam says:

    Recision tends to be found when people are paying for their own insurance – self employment types of situations. I haven’t heard too much in the way of employed people getting this. Basically, I think that if you have a corporation backing your insurance, they are willing to pay

    My understanding is that under federal law, if your health insurance is provided by your employer, through a group plan, you cannot be denied for pre-existing condition nor dropped for same.

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  22. sam says:

    I suppose this counts as a recission of sorts. I’ve told this story before, but I’ll repeat it. My sister and brother-in-law had a small construction company. They had a company health insurance policy that covered them and my niece. When my niece graduated from college and went to work, she was then covered under her employer’s health care policy. My sister-in-law asked her insurance company to drop my niece. The company said OK, but you’ll need to send us a letter. She did, and got a letter back from the company saying OK.

    Some months later, my sister-in-law happened to see one of the insurance bills. She did not review the bills as a matter of course, since all the company bills went through her company’s accountant. The bill was very low, she thought. She called the company and discovered that it had dropped her and her husband from the policy and retained the daughter.

    While she was trying to get this reversed, per her original instructions, and the company’s affirmation that her instructions had been followed, she suddenly died. She died after a two-week stay in a hospital. The insurance company refused to pay the claim, a claim of hundreds of thousands of dollars.

    My brother-in-law had to hire a lawyer to sue the insurance company for its refusal to pay. He did prevail, finally, with the insurance company paying a large portion of the medical bills. He had to pay the rest, in addition to his lawyer’s fee (and these were not small sums).

    She had documented proof that the insurance company was in error, yet he had to secure the services of a lawyer to force it to honor its obligation. Does anybody think he should have had to do this?

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  23. Tlaloc says:

    I’ve had endless problems with insurance companies falsely billing, double billing, trying to ill me for things that never happened, etc. A small number of these were due to an unethical dr’s office I suspect but the vast majority were caused by ineptness or criminal behavior on the part of the insurance. Every time we’ve had to waste hours and hours arguing with them over the phone and sending in proof of their fault. It’s extremely draining, especially on top of already dealing with medical issues (I have multiple sclerosis).

    I couldn’t change my provider because it was employer provided. Now I’m on COBRA. I moved away from my old job for personal reasons. I have a decent job but they can’t afford to give me benefits so I’m watching my time on COBRA slowly wind down and facing the very real prospect that by 35 I may have MS and be uninsured and unable to get insurance due to a pre-existing condition. That means there’s a very good chance that before middle age I’ll start a slow degradation of mental and physical abilities that is irreversible. I hope to god you can’t imagine what that feels like.

    What’s even more infuriating is I’m actually saving my insurance company a ton of cash because I’m in a research project for an experimental MS med. That means they are paying nothing for my meds for 2-3 years (the study is 2 years then there is an optional 1 year extension to collect more data which I will likely enter). I’m still waiting for my christmas card from them on that one.

    My wife is consistently denied coverage in large part because she had a brain tumor removed 15 years ago. Obviously a brain tumor is very serious but the Drs don’t think there’s any reason to see any future problems from this kind.

    Beyond which I have a number of immediate family members involved in medicine (my mother is an occupational therapist, my step sister is a general practice doc, my father and step mother are both clinical psychologists). Those who think the system is just fine are generally those with little or no experience with it and no inside connections to hear what really goes on.

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  24. Matt says:

    That means there’s a very good chance that before middle age I’ll start a slow degradation of mental and physical abilities that is irreversible. I hope to god you can’t imagine what that feels like.

    I watched ALS do that to my dad years ago :( I sincerely would not wish that on my worst enemy and I hope you figure something out.

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  25. Our Paul says:

    You are asking for a population that is “self” selected, Dave. First of all, you have to be afflicted with a high cost chronic illness, such as a cancer that requires chemotherapy. Second, you have to be under the age of 65, for Medicare will cover preexisting medical conditions and does not recognize it as a valid reason to drop a person from the insurance roles. Third, it rarely is used against a person employed by a large corporation, for obvious reasons. They have human resource people and legal departments that would question such tactics.

    I know of no study with quotable numbers. The common figure quoted in news accounts is 1% or less of policy cancellations are due to discovery of preexisting conditions. Brother Tim Noah takes a whack of the problem here, and gives multiple links germane to the matter on hand. Lisa Girion covers health care for the LA times, and gives numbers here.

    I got a great idea. Take the various complaints in this thread, and characterize them into distinct groups. Pick five European countries, and see if any similar complaints exist. Start with Sweden, they are reputed to be a somber and dour group, beset by those long winters with a few to no hours of sunlight. If so, they could use a good laugh!!!

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  26. Matt says:

    First of all, you have to be afflicted with a high cost chronic illness, such as a cancer that requires chemotherapy.

    The illness doesn’t have to be chronic and my GF would be covered in those “socialist” countries with public options..

    I should clarify that ALS destroys the body but not the mind and in my father’s case it only took a couple years to take his life. He was an extremely intelligent man caught in a body that would not move properly.

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  27. Dustin says:

    First, recision stories are bound to be in the minority, because such a smaller number of us are really subject to that type of game. As noted, recision, as we hear about it, really only happens to people who are on private plans, not employee based plans, which is what the majority of us are covered by. You have far more protection under the law if you’re on an employee based plan. Privately insured individuals/families have little, next to no protection under the law. (I’m self employed, I’m quite versed in my health insurance options. Heck, I’ve informed my insurance agent of changes to state insurance laws.)

    I don’t have a story that is exactly recision, but I could tell a story that I think comes very close to that line.

    The shortish version is about how I was paying $1,350/month in insurance premiums, and still had the insurance company try for months to trip us up so they wouldn’t have to pay for my wife’s childbirth, and our twins stay in the NICU when they were born 7 weeks early. A bill totaling almost $200,000 and they tried for months to wiggle out of responsibility for it and, I believe, trick us into a mistake so they could deny the whole policy.

    Our twins were born 7 weeks early and spent 24 days in the NICU. They were also diagnosed at the time with conditions that would require surgery.

    The insurance company tried for months to claim that we had coverage from another insurance company that was responsible for the delivery and NICU bills, and repeatedly denied every claim related to the deliver and NICU stay, with that rational.

    Almost daily we would receive forms in the mail, requesting us to verify if we had another insurance policy, each form saying the same exact thing, that they determined another insurer was responsible for the claim and they were denying the claim until we could prove otherwise, over and over. We filled out every single one of those forms and mailed them back, for almost 3 months, until they finally cleared all of the claims for the birth and the NICU stay.

    Mind you, claims for routine visits to the pediatrician during this time were never denied, only the bills dealing with the delivery and the NICU. In my opinion, this was completely a tactic designed to force us into a mistake that granted them a reason to deny coverage.

    Or, there’s the story of how they denied our twins a series of shots, because they disagreed with our pediatrician’s recommendation. It wasn’t a case of a treatment they didn’t cover under our policy, it was that they believed it wasn’t the right treatment for our children and we lost the appeal with them and were denied coverage for that treatment.

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  28. Ronald says:

    I am 56 years old and have carried BCBS for as long as I can remember. I have never had any health problems until 18 months ago I became sick.
    I was finally told that I have Discoid and SLE Lupus (Chronic Illness). In the meantime the Lupus has triggered RA, which has hit me very hard. Unable to work full time for the most part of the last 18 months due to this illness, BCBS canceled my insurance because I’m not able to work 50 hrs. a month that they require in order to maintain health care. Can they do this legally?

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