Friday, June 29, 2012

The Healthy Uninsurable Patient

On the heels of the Supreme Court ruling regarding the Healthcare bill my oldest daughter turned 26. (If you aren't aware, this is the age after which your child can no longer be listed on their parent's health insurance plan). After this, a saga began. She applied for a high deductible personal insurance with Anthem right before her birthday. At that time the extent of her medical problems included a twisted ankle about a week before she applied, for which she took a couple of days of naprosyn. Other than that she's been perfectly healthy. They declined her. Unbelievable! Exactly who do these people give insurance to?

She contacted an independent insurance agent, who was equally mystified, to try to help her. Anthem has yet to provide her with the promised explanation of their denial.

So here is the amazing thing--immediately after her denial, she developed epigastric and chest pain. She had recently been on an airplane and her chest pain was worrisome for a pulmonary embolis. So of course she got a CT scan which she will have to pay for out of the money she has saved for medical school. My question is--are the insurance companies now omnipotent, able to see into the future? If so, how do I, as a Family Physician, obtain the same powers. It would really come in handy in my line of work!

(Of course now she'll NEVER be able to get personal health insurance.)


  1. I don't understand why you say she'll "NEVER be able to get personal health insurance." The statistics I've seen say close to 50% of denials are reversed on appeal, and when Affordable Care Act is fully implemented, that number will probably go to 80 or 90%. Back when we had Humana, they denied almost every claim out of hand and when you called, they invariably said "Oh, OK." It seems there is something built-in to the operation of Insurance companies by profit by hoping people are too lazy, too fearful, too under-educated to put up a fight.

    1. The "never" was meant facetiously. I agree regarding dealing with insurance claims and appeals, it does make a difference. The other issue, of course, is will she be able to get AFFORDABLE insurance. We'll see.