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Wednesday, August 31, 2005

Why a private health insurance system doesn't work
Posted by Jill | 9:38 AM

The health insurance system in this country like the automotive insurance industry in New Jersey was before they instituted the point system: One strike and you're out:

In July 2004, my husband and I applied for personal health insurance from Anthem Blue Cross and Blue Shield of Virginia. He had left his job to start his own company, and I was self-employed, so we began looking for family coverage while the COBRA clock ticked. Because I was blessed with lifelong health, the "medical information" page of my application was relatively brief. I listed a prescription for Clomid, a fertility drug I'd taken while trying to conceive my daughter, and a single appointment I'd had with a psychiatrist after she was born, regarding the possibility of postpartum depression.

Shortly after we submitted our paperwork to Anthem's headquarters in Roanoke, the letters started arriving in our mailbox. My application was under review. More information was needed. Then another letter arrived. My husband and 9-month-old daughter had been approved for coverage at Level 1, the company's best rating. I had been rejected. The reason: the psychiatrist appointment.

I contacted Anthem. The company could not deny me coverage because, as stated on my application, I met all the criteria of the federal statute that protects health-insurance coverage for workers and their families when they change or lose their jobs. A week later Anthem approved me at Level 4, its worst rating. My husband and daughter's combined monthly premium was $237. Mine was $730.

During numerous calls to Anthem in the ensuing weeks, I learned that an indication of depression—including temporary postpartum depression—within a year of application sends a candidate down the Level 4 chute if legally she can't be rejected outright. "You were on medication for your condition," a representative noted during one of the calls. "It was a physician's sample," I explained, "and I discarded it after I learned the medication could pass into breast milk." The representative was not swayed. "I can only go on what the doctor's form says, and the form says Zoloft."

Over the next three months I appealed Anthem's decision. I argued that a single visit to a specialist should not be cause for charging an applicant the highest possible premium. Nor should taking a single pill of a medication that takes weeks to become effective be considered tantamount to receiving drug treatment. Trying to understand my low rating, I got a copy of the original form submitted to Anthem by the psychiatrist I'd seen. On the "diagnosis" line, she'd written "depression." I asked her to send a follow-up letter. In it she explained that during our one appointment, I'd had "depressive symptoms" that had subsequently been resolved.

Nonetheless, Anthem twice denied my appeal. The identical rejection letters assured me of the "thorough review" of my case. But it was hard to have faith in that when the underwriters failed even to get my name right on the letters, addressing me by my husband's last name after I'd told them in writing of the error. In the end, I had to opt for an inferior and yet more costly insurance policy, at $450 a month, than the one granted to my husband and daughter. After more calls to Anthem, I learned that the psychiatrist's appointment would bar me from a Level 1 rating for five years. I later filed a complaint with the Virginia Bureau of Insurance, but the state found no wrongdoing on Anthem's part. Insurers are free to establish their "own guidelines without regulatory interference," as long as those guidelines apply to everyone.


That insurers in a country that is trying so mightily to make women captives of their reproductive systems are writing off tens of thousands of women with postpartum depression is truly reprehensible. That any illness or complaint is grounds for refusal is a sign that the existing system doesn't work...no matter HOW much politicians in the pockets of the insurance industry want to pretend it does.
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1 Comments:
Anonymous Anonymous said...
My name is Helen Page and i would like to show you my personal experience with Clomid.

I am 30 years old. I have taken for 3 months. My progesterone level after my first dose of Clomid was 65 so I knew that I had ovulated. Couldn't try the second cycle on it because my husband went out-of-town while I was O'ing, go figure. Hoping it worked this month!!

I have experienced some of these side effects-
Mood swings, increased appetite, hot flashes, increased pain during ovulation, abdominal pain, mild but infrequent headaches. Also, I used to be on a consistent 28 day cycle, but I think Clomid might have lengthened it as I'm now on a 31-32 day cycle.

I hope this information will be useful to others,
Helen Page
10/22/08, 8:16 AM  
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