Healthcare Gets Personal

This week, for me, healthcare got personal. Really, really personal.

As I am currently self-employed (or unemployed as the naysayers choose to call me), I am now in charge of obtaining my own individual health insurance. Let me walk you through the circus that was applying for health insurance:

June 26th: My last day at Deloitte. Thanks again to everyone who came to my party; that was a good time!

June 30th: My employer sponsored healthcare expires. I’m busy writing my book (John’s Symphony, coming soon) so I ignore it for now.

July 16th: Oh crap, I need to get on that whole healthcare thing. I spend four hours filling out an application for PacifiCare, the individual health insurance company under the United Health Group umbrella. I had been very happy with my United Healthcare insurance that I had through Deloitte, so I think this is a safe bet.

July 21st: I get a phone call from the mysterious underwriters of the insurance I am applying for. They have some questions about my application. We go through their questions, which are the exact same questions that I answered on the application (so underwriters can’t read?). At the end of the conversation, I ask when I can expect to hear back from them. They say they have to request my medical records from my doctor.

July 27th: I’ve heard nothing and have been uninsured for almost a month. I call the number on the PacifiCare website, and am shuffled around to no less than five different customer service representatives until finally, someone tells me that they’re still waiting on my medical records. I call my doctor to see what the holdup is. Turns out it takes them about two weeks to process those requests. Yikes.

August 10th: It’s been more than two weeks and I’m wondering what the heck is going on. My eligibility to apply for Cobra expires on the 29th, which is coming up soon. I check my mailbox and have a letter waiting for me from PacifiCare letting me know that I have been denied insurance for the following reasons:

Asthma, Elevated Cholesterol.

Imagine my surprise at being denied health insurance for two medical issues that I’m not even being treated for currently because my doctor doesn’t think they’re a problem. As I told the underwriters, I’ve never had an asthma attack and never been hospitalized. Ever. In fact, I ran a half-marathon not six months ago. Yet for some reason, even though I share similar conditions with 20 million Americans who are asthmatic and with 47.7% of American women who have total cholesterol levels over 200 mg/dL, I am somehow a high enough insurance risk that they won’t even cover me?! Do they cover anyone!?

See http://www.aafa.org/display.cfm?id=8&sub=42 for asthma statistics and http://www.americanheart.org/presenter.jhtml?identifier=4506 for cholesterol statistics.

Do they have the right to deny me? As a private sector company, absolutely. Ironically though, if I end up on Cobra the same umbrella company is still insuring me. Either way I am, apparently, still a risk to them. So what is going on here?!

I have a theory, and by all means, please let me know what you think.

Under the PacifiCare individual plan, my premiums would be $86 (not adjusted for premium increases for preexisting conditions). Under Cobra, my premiums would be $353 (which, as a person with $0 in income, I totally cannot afford). Either way those dollars eventually end up at the same company, United Healthcare. Which plan do you think they would prefer me to be on?

Still think our healthcare system isn't broken?