Denied Healthcare Coverage

The flaws in our healthcare system are hitting home. More of us will see it personally in these times of job losses and economic strain. Some will lose coverage; others will be denied.

I recently applied for a family health insurance plan in the individual market. Despite excellent health, I was denied. The reason? Too many prescriptions, plus chiropractic follow-up from an automobile accident.

Okay, I'll confess. For many years, I've been taking two prescriptions to correct minor, long-term conditions. Both prescriptions are generics and not expensive. Never before has it affected my insurability.

The third prescription was Lipitor®. Without it, my cholesterol level was 210 and wouldn't decrease despite a careful diet and frequent exercise. My doctor put me on Lipitor as a preventive measure against heart disease—after trying another medication that caused side-effects. It worked well for years.

The chiropractic care was to loosen my neck muscles after an automobile accident. (I was a passenger and the driver was not at fault.) No emergency treatment was required. I simply wanted to restore my natural balance. None of the billing went through my health insurer and treatment was ending.

The remainder of my family was accepted. What's wrong with this picture?

- Two family members spend much more annually on healthcare than I do.

- Now accepted, my family members can be covered under three separate individual plans for a lot less money. So, the insurer gets to triple the administrative costs and receive lower premiums.

- I'll have to find coverage elsewhere, so the insurer loses my business. And, by the way, I've been insured by this company since birth.

- My efforts to prevent future problems actually worked against my insurability.

Obviously, the health insurance company would have done much better by simply accepting my entire family under one plan in the individual market. It's a wonderful company. Why couldn't it do better?

- Lack of complete medical data for decision-making

- Bureaucratic complexity of the healthcare system

- Lack of regulation that would preserve an optimal risk pool

- Ineffective methodologies for reimbursement

The flaws of our healthcare system are moving from being someone else's problem to becoming our own. And that's the best impetus for sweeping change.

— Tom DeSanto

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