WSJ: Having Insurance Doesn't Guarantee Coverage

[question everything]

The Wall Street Journal

Having Insurance Doesn't Guarantee Coverage
May 31, 2005; Page A8

(snip)

When Jean Green, a 36-year-old Braille translator from Cave Creek, Ariz., had a baby girl named Alex last May, she knew she had to move quickly to get the infant insurance. Mrs. Green's group plan at work covered the baby for just 31 days, and she couldn't afford to add her to her policy. So she applied at the same company where her two older children had policies. The application was rejected because Alex had a closed tear duct, a fairly common condition among newborns. Mrs. Green tried again, with Blue Cross and Blue Shield of Arizona, the company that provides her group plan at work. It took time to get Alex's medical records to the company. When Blue Cross issued coverage on July 15 last year, Alex had been uninsured for about two weeks.

At Alex's two-month check-up in late July, her pediatrician said that her misshapen skull, attributed at first to normal birth trauma, hadn't gone away. In September, a specialist diagnosed Alex with a rare birth defect that was causing her skull to grow abnormally. Blue Cross denied coverage for the specialist's visit, saying that the bone disorder was a "pre-existing condition" -- a health problem that predated Alex's insurance policy. Mrs. Green filed an appeal with the company, but officials denied it. Meantime, doctors said Alex needed a $90,000 operation to relieve pressure to avoid damage to her brain and eyes. Alex's eyes and ears were lopsided, and doctors wanted to correct the problems before they got worse. Mrs. Green scheduled the surgery, even though Blue Cross was signaling that it wouldn't pay. The policy excluded coverage of a pre-existing condition for 11 months -- far too long for Alex to wait.

(snip)

If not for the gap in Alex's coverage, Blue Cross officials say they wouldn't have viewed her birth defect as pre-existing. She would have moved seamlessly from one Blue Cross policy, in the group market, to another, in the individual market. If Mrs. Green had kept Alex on her own policy for another month, for example, there wouldn't have been a problem... Alex would have had more protections in an employer-sponsored plan or in individual plans in many other states, where there are stronger consumer protections. But in Arizona "it's the most wide-open it can be," says Karen Pollitz, project director at Georgetown University's Institute for Health Care Research and Policy.

Eventually, Catholic Healthcare West, the parent company of the Phoenix-based hospital where the surgery was scheduled, helped get Alex into a state program for children with costly health problems. The surgery went ahead in December, with the state picking up most of the tab. Now a year old, Alex's scars have healed and she seems to be growing normally, Mrs. Green says.

---- Sarah Lueck

URL for this article:
http://online.wsj.com/article/0,,SB111750175890146701,00.html

[FloridaPat]

1. There are tons of stories like that. It's a shame that this is happening

in the richest country in the world and the only industrialized country that doesn't have universal health insurance. But we have $300 billion for an illegal invasion and $1 trillion for a useless Star Wars defense system.

[Benhurst]

2. As Bette Davis once said,

"What a dump!"

[aquart]

3. Note that the STATES are picking up the costs.

You'd think they would have noticed this problem by now.

[FloridaPat]

6. The only problem the gov't seems to notice is lack of democracy

in the Middle East and lack of total extravagant profits for the banks.

[xray s]

4. Did ya hear Paris Hilton is marrying a guy named Paris?

What are the odds of that happening!

Now that's a story America can pay attention to!

[pfitz59]

5. don't forget Mikey J.!

verdict any day now...

[lovuian]

7. People are finally waking up they are paying for No Insurance

its called Deny Deny Deny!!! and Don't Pay!!! thats why people are going unisnured and its going to get worse!!!

[Old_Fart]

8. Insurance is a card that you carry in your wallet

When you need to use your insurance the card becomes void.

[question everything]

10. Welcome to DU

:toast:

[Old_Fart]

11. Thanks

:toast:

[Cleita]

9. I paid for no coverage for five years.

After my HMO tripled my premium within a year to $450 a month, and after my primary care physician refused to carry them anyway, I got a bare bones policy with Blue Cross. It still cost me just under two hundred a month. With a $3,000 deductible, you can bet that I paid for my own medical care while handing them the money for the monthly premium.

I wonder too, that if I had something happen to be that would require a $50,000 operation, like Andy's, if they wouldn't have found a reason not to pay for it. Also, I would have had to co-pay 20% besides the $3,000 if they did.

So I essentially I considered myself uninsured and screwed at the same time. Now that I turned sixty-five I have Medicare and all I can say is that it is a god send. I hope Bush doesn't fuck it up like he does everything else he touches.

[progressivebydesign]

12. Don't the idiot republicans realize THEY are paying for this?

I mean.. has any of the Rush Limbots realized that by continually supporting politicians that will not support health care for all they are hurting themselves? If the insurance companies won't pay, or people are uninsured, WHO do these republicans think is paying for the medical care (albeit scant)??? The taxypayers. A simple lesson in economics would really help those folks out. We all pay for the un and underinsured, even the republicans. Oh, they can say that they have all these loopholes on their taxes, but they pay in sales tax, property taxes, increased fees, higher insurance premiums. They don't get it, do they?

[Not_Giving_Up]

13. I recently spent four days in the hospital

Three of those days were in IMCU. United Healthcare is refusing to pay the $11,000 bill for the stay due to a pre-existing condition. My coverage was effective in January, and "pre-existing condition" was defined as anything that had been treated in the last six months. I had not been treated for anything, mainly because I had no insurance and couldn't afford to be treated. I did have a prescription for an inhaler, just to keep me breathing. My hospitalization was due to an upper repsiratory infection compunded with my adult onset asthma. Since I got my inhaler filled in the six months prior to coverage, they have decided that they don't have to pay for anything asthma related.

I'm now out of a job and uninsured again. I guess my next carrier will screw me over the same way.