Not all pregnancies are planned. Incest and rape come readily to mind. That aside, pregnancy itself is not the issue, but the problems that can come along with it, such as toxemia, anemia, post natal care for deformities, Down Syndrome, etc.
While I agree that there are a lot of problems that should be addressed with insurance and I am a big supporter of a public option, this one is something that I can sort of explain.
I get calls every single day that go like this:
potential insurance customer: “Hi, I was hired on 9/6 but I need my coverage to start on 9/1.”
pbbth: “That isn’t possible. The waiting period your group has chosen prevents you from being eligible for coverage until 11/1.”
PIC: “Oh, well just change my hire date on the form then.”
pbbth: “Um, no. First of all that is considered fraud, and second of all if you do that and then you have a major emergency your insurance company will go back and review your enrollment form and compare it to all of the tax documents required to prove your employment. When they see that you lied about your hire date they will deny your coverage. It would be better for you to pay out of pocket until November than chance paying for coverage that will be terminated due to fraud in the future.”
PIC: “No, I’ll just change the date on the form. Thanks!”
pbbth: :smack:
There are lots and lots of people who lie on those forms to get set up on cheap coverage and then get really confused and angry when they find out their coverage is being terminated later. Many people don’t lie and just can’t keep track of their medical history properly or some companies search to find any possible way to cancel coverage but there are huge numbers of people who fraudulently fill out their paperwork with the intention to scam the company. My hope would be that those people, when given the option of a public plan that provides more affordable coverage, would no longer feel the need to lie on their forms and that would solve a whole mess of problems for both the insurance company and the insureds.
Your example is just out and out fraud and that’s wrong, I agree. But your example does not explain why a woman’s policy gets canceled because she didn’t mention prior acne so the company doesn’t have to pay for her breast cancer surgery. I can understand the company saying “well, since you didn’t disclose, we wont pay for your acne medicine.” I cannot see canceling the whole policy when she needs it most. That’s just wrong.
I can see not paying for a procedure or medication for something not disclosed. In the dairy farmer example, I would understand the company not paying for the husband’s cholesterol treatment, but I cannot see why they had to cancel the wife’s policy and just when she needed surgery. That’s just wrong.
I cannot see offering employees bonuses for finding things to cancel policies for once an expensive claim is being considered. All of the above is just wrong and they are creeps to do it. And we are creeps if we continue to allow it.
Being planned or not isn’t the point. It’s still asking the company to take on the costs of an already existing condition.
Discontinuing policies for little problems like acne is indeed wrong and health insurance companies to do that are wrong. I am not denying that. I am just saying from an insurance perspective that many of the clients I deal with have no problem fudging the truth about their prior health problems or other things to save $75 a month and then get pissed when the insurance company tries to twist things so that they can save a little money. People absolutely deserve coverage no matter what their medical history and I can’t wait for the day that we provide coverage to everyone so the lying back and forth between customers and companies can cease to exist.
The problem with citing an advocacy group is that it’s hard to tell how honest they are being.
Obviously if someone has a pre-existing condition as a result of domestic violence it doesn’t cease to be a pre-existing condition, and is no different than any other pre-existing condition, most of which are not the “fault” of the sufferer. If political pressure is being applied to force the insurance companies to distinguish between injuries caused by domestic violence and other types of injuries, then that’s just another example of how politics is not fair, and tends to reward those who are better organized and/or can rile up the populace, at the expense of others.
OTOH, if this means that the mere history of domestic violence counts as a pre-existing condition for purposes of denying coverage for future injuries (i.e. that had not yet happened at the time the coverage began) that’s obviously outrageous. Also illogical.
But it’s so outrageous and illogical that I highly doubt if it’s true altogether. Rather, I suspect, the first scenario is the truth, and the advocacy group wrote it up in an ambiguous way, so that you should mistakenly assume the second.
No, it’s asking the company to accept your monthy premiums so that they can provide the services for which they are being paid. If I can buy insurance for a car with a leaking transmission (certainly a pre-existing condition), why can’t a woman buy insurance for her pregnancy? It’s capricious and arbitrary, which is the whole point.
except for the fact that auto insurance wouldn’t be covering your leaking transmission. If you tried to claim it they would deny you because it happened before the policy was in force. It’s the same principle with the pregnancy. It’s far from arbitrary.
You need to understand the concept of insurance here.
The whole point of insurance is limiting uncertainty by spreading the cost. You don’t know whether your house will burn down or your car will crash or you might become sick. Only a percentage of people have these things. Insurance means that everyone pays more than they would pay if nothing happens to them and less than they would pay if something did, plus a percentage to the carrier for the service. Paying a company money to pay for something that has already occurred is not insurance.
That’s why the cost of cancer insurance is less than the cost of actually having cancer. Because most people don’t actually get cancer, so the cost of the few that get it is spread among the majority that don’t. If the only people who bought cancer insurance already had it, then the cost of the coverage would have to be higher than the cost of the actual medical care for the insurance company to break even.
I’m not sure if you’re saying it’s arbitrary and capricious for insurance companies to refuse to allow people to sign up for premiums that are much lower than the costs that they’ve already incurred, so that the companies can guarentee themselves to lose money, or if you think the companies are wrong for not creating a special category of super-expensive coverage that allows people to lose money by signing up for coverage that costs more than their treatment.
Either way, it’s hard to imagine what you might be saying that makes economic sense.
Now that I’m home, I had the chance to review the list of companies that are said to have denied coverage or based rate decisions based on this. 8 are listed, but only 2 of them even write health insurance. I have some serious doubts about the conclusions that are being drawn about the health insurance industry with this information.
It stands to reason from the companies listed (of course that information is 15 years old now) were making decisions about disability and life insurance. It is well documented that victims of domestic violence miss far more work than the general public and that would be a risk factor for disability coverage. I don’t have stats handy, but it would make some sense that it is also a risk factor for life insurance.
That’s like buying homeowners insurance after your house has already burned down. Under you scenario, nobody would ever buy health insurance until they became sick.