Insurance Brick Wall

By: Armen Keteyian
Topics: Health Care

(AP / CBS)

I've always considered myself a fortunate man. Great job, great family, great home. For the life of me I never thought I'd include "great group health plan" on that list, that is, until we started digging into the individual insurance market.

For virtually all of my working life my family and I have been covered under a large health umbrella with thousands of other company employees. During that time I've paid thousands more in premiums than were ever been paid out, and that's okay, because so-called "shared risk" is what large group plans are all about.

But not, it appears, individual insurance.

If you've been watching our reporting you'll see how companies like to "cherry pick" only the healthiest of applicants, to the point where one expert said you have to be an "android" to get selected. I laughed until I got a good look at a "Health History Questionaire," quickly realizing that despite the fact I'm in far better shape than most middle-aged males, I've got virtually no shot at ever qualifying for this kind of coverage.

Let's begin at the beginning with this "Yes or No" question:

Has any person listed on this application, in the last 10 years (their bold), had any signs, symptoms, seen a health care provider, had treatment recommended, including prescription medications, received treatment, or been hospitalized for any of the following conditions…

Let's see now, there's heart disease, impotence, infertility, arthritis, diabetes, and substance abuse, which alone disqualify tens of millions of Americans. For the more common man or woman there's allergies, infections, diarrhea, muscle pain, fractures, counseling, birthmark, acne and anxiety…

Allergies? Ah, that would be a yes. Considering I qualify for the daily double in the spring suffering and prescription medication departments given my annual trip to the doctor and pharmacy.

Infections? Yeah, as old Blue Eyes would say, I've had a few. (Do I dare reveal that dreaded finger nail debacle of 2003? Or the ear episode of '01?)

Anxiety? Have I ever had any signs or symptoms of anxiety? Are you kidding me? Yeah, every damn day about 6:15 p.m. when we're crashing a spot for the Evening News or putting the finishing touches on a major investigation. Last weekend was my 18-year-old daughter's prom at New Canaan High School. I'd say my anxiety and blood pressure (another question) levels spiked a time or two.

By the time I got to the bottom of the 20 Questions I realized I was likely on my way to the "reject" pile, especially since insurers cleverly begin each and every one of their Brain/Nervous, Lungs/Respiratory, Nervous, Mental, Emotional, Behavioral, categories with the words "such as," meaning even if you're dead honest and somehow forget or omit a complaint or condition that shows up in your medical records, the company can argue you lied or committed fraud and cancel your policy, likely just at a moment you need it the most.

So welcome, one and all, to the brave new world of individual insurance. I don't know about you but right now I'm not feeling so great.

Read the Investigative Unit's story: The "Uninsurables"

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by fb50591 May 24, 2007 10:22 PM EDT: While having worked in corporate america for over 30 years, my health unexpectedly took a turn for the worse 2/06. I suffer from Crohn's Disease; which is an incurable bowel disorder. After being placed on disability by my physician; it only took 2 months for my status to change to 'Unpaid Leave of Absence' due to the fact that the insurance carrier refused to believe my physican, as well as all of my medical results. After losing my car (unable to continue to pay notes since I no longer had an income)--but still indepted to the bank for $13k because I broke the lease--; selling my condo for $30k less than listed price in order to get it out of my name; hiring an attorney and two appeals later (1-1/2 years later); the insurance carrier finally approved my claim for long term and short term disability.
Because I have lost so much over the past year and half financially, there is no recourse to have any reimbursement for losses. The insurance carrier cannot be sued because of a clause protecting them through ERISA. The company I worked for can't be sued because they hired the insurance carrier to handle health claims. So after 1-1/2 years later, they approve my claim based on the original diagnosis they received initially. There needs to be done about procedure. I've written a book about my experience "If You Knew How Regular I Am; You Wouldn't Be So Full Of It" because thousands of IBD sufferers are going through hell dealing with insurance carriers on a daily basis.; Reply to this comment


by irish0505 May 24, 2007 6:04 PM EDT: Apparently your writer did not submit his application. Just because an applicant answers "yes" to any health question on an application does not mean that the application will be denied or that anything as minor as seasonal allergies will even require an action. In most cases (except for the most chronic and severe conditions) the greatest impact may be an additional premium is required or the condition that is listed will not be covered under the plan. Unlike your auto or homeowners insurance, most health insurance is guarantee renewable. I have worked in the health insurance industry for most of my adult life and am proud to offer a much needed service. The alternative would be a "national" plan covering everyone and means long waits for all but the most urgent care unless you are in the top income brackets and can afford to buy your way to the top of the list. PLEASE, start using responsible journalism and research before you start implying that the entire individual insurance industry is taking advantage of the public.; Reply to this comment