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Monday, September 21, 2009

Just because "coverage" is guaranteed doesn't mean claims will be paid
Posted by Jill | 6:24 AM
One thing I am not hearing anything about in the so-called "health care reform" debate is the actual payment of claims. We are hearing a lot about "coverage" but nothing about claims. As anyone who has ever fought with an insurance company knows, you can be covered for any number of things, but getting the claim actually paid is another story. Somehow I think that when all is said and done, what we will end up with is a mandate to buy insurance that professes to "cover" pre-existing conditions, but that still won't pay related claims. And in case you think that pre-existing conditions only cover major illnesses like heart disease and cancer, guess again.

We've already seen that being a victim of domestic violence or wanting to have a child constitute pre-existing conditions. (So much for "family values", eh?) But as Consumer Watchdog points out, there are any number of ailments small and large that the insurance industry deems to be pre-existing conditions, including:

  • being an air traffic controller, professional athlete, police officer, or war correspondent

  • taking prescription allergy medications

  • having ever had a toenail fungus

  • having ever had acne

  • being an expectant FATHER

  • having ever sought therapy or counseling

  • any symptoms for which you did not consult a doctor

  • taking Lipitor or similar statins for high cholesterol

In other words, simply not being dead constitutes an uninsurable pre-existing condition.

Remember, "coverage" is not an agreement to actually pay claims. So when politicians, even Barack Obama, talk about "coverage", don't be fooled. Until you start hearing a requirement to actually pay out, it's all a big wet kiss on the buttocks of insurers.

(via ThinkProgress and Cookie Jill, who notes that "the insurance companies are creating 15 - 9/11's each year in the number of american deaths due to lack of coverage, under coverage and denial of coverage.")


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Anonymous Anonymous said...
Misleading. For instance, having toenail fungus is covered, but you can be denied coverage if you have ever taken medication for toenail fungus. And taking medication for toenail fungus is a waste of money -- it doesn't work, and the fungus is not a threat to your health anyways. That said, I am on our side about health care in general.

Blogger Steve said...
Wait'll the teabaggers discover that stupidity is a pre-existing condition.

Blogger Deborah said...
I've just started reading Maggie Mahar's book, Money-Driven Medicine, and I highly recommend it.

One thing she claims is that competition in the health care field doesn't work. 1) do you really want every clinic in your community spending millions of dollars for an MRI machine? They won't be lowering the prices for them because they still have to pay the bills; 2) surgeons become good at what they do by doing surgeries. Having more surgeons competing against each other actually lowers the quality of care, etc.

Mahar also claims that pharmaceutical companies are currently spending more on advertising than on R&D. Do any of these POS bills have the FCC repealing their decision allowing such advertising? I would not be one bit disappointed if I never had to see another dick hardening drug commercial ever again!

Blogger Interrobang said...
Taking medication for toenail fungus is not a waste of time, and it does work in the majority of cases (80% with the most common oral antifungal), and I'd say it's arguable whether it affects your health or not. I know since I did the course of oral antifungal, my toenail fungus has gone away, and I've gotten a lot fewer fungal infections elsewhere (even dandruff!).

I'm only commenting about this because I'm sick to death of healthy, able-bodied people who don't need drugs insinuating that every single drug out there is some kind of money-making conspiracy by a cabal of pharmaceutical companies. Ya basta. I'm currently taking something like seven different medications, and I'm a lot happier and healthier this way. Better living through chemistry.