Yet Another Example of the Fucked Up Health Insurance System

Thanks to Gawker blog The Consumerist for pointing me to the latest news about why the health insurance system, especially for self-employed individuals, is broken in so many ways.

"Cancer Patient Wins $9 Million From HealthNet in Arbitration Settlement."

The LA Times has more details. Basically the woman was lied to while signing up for her policy, and then dropped as soon as HealthNet could cancel her "fairly" with their corrupt and unclear policies.

When HealthNet signed her up, this is apparently what happened...

"When asked about her weight, she told him her weight on her driver's license was 185lbs. She never told Torrez to change the weight, nor was she aware that the weight had been changed."

So... when this woman ended up getting breast cancer, they used the fact that she "gained" weight in order to bump her from the policy. Except, she hadn't gained weight at all. The person who filled out her form while signing her up changed her weight so she would be accepted.

All of this hits close to home for me. While I (luckily) do not have breast cancer or any illness like that, I do fear my health insurance policy being canceled if I ever have to use it. That seems kind of ridiculous, doesn't it?

As many of you remember, I had to lie on my health insurance application to get accepted.

My health insurance agent basically told me in so many words that my best option was to lie. He wouldn't go on record about that, but he said my odds of getting health insurance while being completely honest about my pre-existing conditions (polycystic ovary sydnrome/irregular periods and major depression) were slim to none.

And he was right. The first time I applied through Pacific Care, I was entirely honest. My health insurance agent filled out the form for me as I told him my details by phone. Later, when I reviewed the information he entered before signing the form, I noticed he had taken some creative license in describing my conditions. I tweaked the language so it was 100% accurate.

A few weeks later I was declined coverage. Not for depression, which we both thought would be what held me back, but for the "irregular periods."

As my fellow personal finance bloggers LuluGal and Escape Broklyn can attest, "irregular periods" are fairly common. And, to be fair, irregular periods often cost the insurance companies lots of money. Both those two gals are getting surgery for their problems. And, from what I understand, insurance is paying for a lot of the surgery, even though it won't be covering everything.

For me... I don't know if I'll ever need surgery for my various ovarian problems. Because I know about the problems and because I've been diagnosed with PCOS, the cheapest way to maintain my health is to take birth control pills on a regular basis. Except my catastrophic health insurance does not cover medication. So I don't take any.

Ultimately I was approved for health insurance. I had to lie to get approved. Well, I left off the depression and kept on the irregular periods bit. So now I can lose my coverage if they ever realize I lied about depression, and anything health problems I might have that relate to polycystic ovary syndrome won't be covered anyway. This leaves me wondering why I bother with health insurance at all!

I really hope that Obama or Clinton get elected and then make some major progress in getting the health insurance companies in check. While I hate paying taxes, if I'm going to pay taxes I want them to be going towards keeping people in this country healthy... not fighting some trillion dollar war we can't win.

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Applying for Healthcare, the Saga

I've been uninsured for about a month now. I don't plan on staying uninsured, so I've been doing some research into health plans (as many of you know from my previous posts). Basically, because I went to a psychiatrist for anxiety and depression, 90 percent of insurance companies out there will not accept me. (Hmm, should I be anxious and/or depressed about that?)

A few weeks ago I called a health insurance agent who I found on Yelp. People seemed to like him, so I thought seeking out help would be worth a shot... even though it would be biased help because he gets paid by the insurance companies to sell their programs. Well, after a few weeks of him calling me every other day to convince me to sign up, I finally did. I usually don't reward annoying salesman, but he's been very helpful and I need a bit of prodding to do anything. Health insurance is not something I want to fuck around with, so I've finally applied.

He told me that my best bet would be Pacific Care with a $1500 deductible and an HSA account. Oh boy, more accounts to try to organize and sort out. In any case, Pacific Care, he said, would likely be the only insurance company that would accept me due to my history of depression and anxiety. (The other major company he represents is Blue Cross, and he said they would not accept me).

So he talked me through all of the questions on the application and basically filled it out for me over the phone. It felt really awful to categorize my health history. Do I put depression or anxiety? My agent didn't think putting major depression was the best idea, but he couldn't officially encourage lying. I've been diagnosed with everything from ADD to major depression to generalized anxiety. What do I actually have? I have no freaking clue.

Anyway, we decided to put anxiety / depression and leave it at that. Later on I had to say what meds I've taken. So I took Xanax on and off for a month (in June 2005) and Lexapro for a month (in October 2007). That's all the medicine I've taken for mental illness in the past five years. But that means I'm obviously going to scam the health insurance system into spending zillions of dollars on me.

I guess I can understand why they don't like accepting people with mental illness. I know one girl who had anorexia and her health insurance company had to pay for the treatment. Then the government paid for her to be on disability so she didn't have to work while she recovered.

My other medical disorder, polycystic ovary syndrome (PCOS) didn't neatly fit into any of the check boxes. There was a separate section for menstrual disorders and another for hormonal disorders. It's both. Then we had to figure out what to say about that ovarian cyst I had last spring that likely ruptured.

In the end, I was left wondering how awful my application looked. Will Pacific Care accept me? Shouldn't I be rewarded for being honest on my application?

Nah, I'll just be "rewarded" with higher rates. He told me the base rate for this plan is $105 a month. I'm curious to see what I'll get quoted.

Oh, I had to give my credit card number and everything BEFORE I'm approved. He said I have 10 days to reverse charges once I am approved, but I think I should be able to see where I'm approved first before everyone charges me. Well, I'm only applying for this one plan right now, so I guess it doesn't matter.

Also in health insurance news... the startup company I work at is getting health insurance... but I'm not eligible because I'm part time (contract). Oh well.

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