Nicholas Kristof: Is Ay Illness Covered?

[babylonsister]

Is Any Illness Covered?

By NICHOLAS D. KRISTOF
Published: March 20, 2010


Health care is etched on my mind these days not only because of the Capitol Cacophony but also because a husband and wife I know, my former neighbors, are undergoing the kind of heartbreak no family should endure.

Zack Liu and Jan Li, along with their two young daughters, lived a few doors away from me. Then a couple of years ago they moved to Hong Kong, and paid $4,500 per year for a health insurance policy for Jan and the girls (Zack was covered through his job).

Last April 24, their world collapsed: Jan was diagnosed with late-stage stomach cancer.

Opponents of the reform proposals argue: If you like the Department of Motor Vehicles, you’ll love Obamacare. But as the drama of Zack and Jan shows, the only bureaucrats more obdurate than those at the D.M.V. are the ones working for insurance companies. The existing system is preposterous: we rely on insurance companies whose business model is based on accepting premiums from healthy people and devising ways to exclude from coverage those who most desperately need medical care.

Jan’s stomach was removed, and she underwent extensive chemotherapy. Then in October, her doctors discovered that the cancer had spread to her intestines. She has been hospitalized ever since.

The insurance company is InterGlobal, based in London, and the policy ostensibly covered up to $1.7 million in costs. But, according to Zack, the company said the policy allowed it to cut Jan off because she suffered from a “chronic condition.” It stopped paying her bills in January, Zack says.

I reached Sophie Walker, the group head of claims for InterGlobal. She said she couldn’t talk about an individual case. But she explained in an e-mail message that with a “chronic condition” the policies can have a much lower limit, $85,000, on lifetime claims. That’s the limit that Jan ran into in January, Zack says.

Then Ms. Walker gave me the company’s definition of “chronic” (you couldn’t make this up):

“Chronic means a medical condition which has at least one of the following characteristics: has no known cure; is likely to recur; requires palliative treatment; needs prolonged monitoring/ treatment; is permanent; requires specialist training/rehabilitation; is caused by changes to the body that cannot be reversed.”

That sounds like a spoof from “The Daily Show.” To translate: We’ll pay for care unless you get sick with just about anything that might be expensive. Then we’ll cut you off at the knees.

more...

http://www.nytimes.com//2010/03/21/opinion/21kristof.html

[muriel_volestrangler]

1. Wow. Health insurance that refuses to pay for anything you really need it for

Is such a ceiling on payments outlawed in the bill going through Congress?

[rosesaylavee]

2. No limits on lifetime care in this bill...

That is one thing I remember from it. That is huge as the OP indicates for countless thousands who have been cut off.