The "Uninsurables"
CBS News Investigates The Tactics Used By Insurance Companies To Deny Health Coverage
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The Uninsured In America
Insurers have become very picky in selecting which individuals they are willing to cover. Some companies have gone so far as to interview friends and neighbors of applicants. Armen Keteyian reports.
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First Look: Insurance Expose
Only On The Web: Armen Keteyian previews his investigative report for "The Evening News." It focuses on the many Americans who are healthy but cannot get individual health care benefits.
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Denying Health Insurance
Only On The Web: Jeffrey Miles, the former president of the California Association of Health Underwriters, talks about what insurance companies do to deny people health coverage.
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Scott Svonkin, 41, calls himself the "new poster child for Americans living without health insuance." He's healthy, fit, and has been repeatedly denied coverage by insurance companies. (CBS)
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Scott Svonkin, an active 41-year-old, never thought he'd be one of them.
"Pacificare rejected me because I'm an expectant father. Blue Shield rejected me because I got a spider bite. And then this one rejected me because of asthma," Svonkin said.
Svonkin has managed his asthma for more than 20 years with $150 a month in medication, making him one of the new "Uninsurables" — people who've been denied individual health insurance, but not for a serious illness, CBS News chief investigative correspondent Armen Keteyian reports.
"I'm the new poster child, or the poster man, for the uninsured in America," he said.
A two-month CBS News investigation exposes a system stacked against the individual. Unlike group plans provided by employers, individual insurers can pick and chose their customers, creating guidelines designed to deny coverage for the most common of health problems.
Acne, asthma, athlete's foot, allergies — and that's just the A's. How do you explain that?
"Our members very much want to get and keep customers," Susan Pisano, vice president of communications at the Association of Health Insurance Plans told Keteyian.
The argument from the other side is that they're cherry-picking the healthiest people, and people even with the most minor problems are being excluded?
"Conditions that seem minor to me and you entail a level of expense that is fairly substantial," Pisano said.
Last year one nationwide survey, the Commonwealth Fund, found that 89 percent, or 52 million, of those looking for individual health insurance didn't get it because it was too expensive or they were turned down.
"Insurers are getting double the profit that they make in the group market. Why is it so lucrative? Because they exclude anybody and everybody who has even a remote sense of risk associated with their health care," says Dr. Bryan Liang, who has studied the insurance industry for more than a decade.
One individual application asks: Have you ever had a headache? Have you ever had an infection? Have you ever had muscle pain?
"They want to know everything about you. Your credit history," for example, Liang said. "Your credit history is something that is very interesting to them, and they to know about it."
It's not just your credit history, but your driving record and the sports you play.
Insurers find all that information — and much more — in a massive, little-known data base called the MIB, or Medical Information Bureau. Insurers have even been known to question "friends and neighbors" about "morality and lifestyle" — using all of this information to decide who they will cover and who they won't.
"They can check your morals and your lifestyle?" asks Keteyian.
"Exactly," says Liang. "And they are going to judge you on this."
If you have any problem whatsoever, you are on the outside looking in — in the individual market.
"One of the things that you are saying essentially is the perception," said Pisano.
But it's a reality for millions of Americans as well.
"Maybe the perception and the reality are a little different," Pisano conceded.
Not for Svonkin. Ironically, he's a member of Los Angeles County's Insurance Commission.
"I never imagined it would be so hard to get health care," Svonkin said. "It's not a matter (that) I can't afford it. It's a matter that they won't give it to me at any price."
All of which has left the new face of the "Uninsurables" with nowhere to turn but a state-run program for high-risk people offering minimal coverage — for $528 a month.
For more information about finding insurance as an individual, see our FYI.
© MMVII, CBS Interactive, Inc. All Rights Reserved.
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Posted by babsmax at 07:46 PM : May 23, 2007
+ report abuse
Yes but with the trashing of Unions Corporations have consistently dumped their Group Medical, pointing to Third World Labor as an excuse. The whole mess goes right back to "Free" Trade and the Rape of American by Multi-National's.
I have come to the conclusion that there are only two realistic solutions:
1. Take a low-end job for long enough to get health coverage; then quit and go on COBRA for 18 months.
2. Do what I did and join a union, trade group, or organization that offers group insurance. I keep my real estate license current, not to sell property, but to buy group health insurance. I got a high-deductible HMO for $271/month, no questions asked. For a 52-year-old guy in marginal health, this is a steal.
I have come to the conclusion that there are only two realistic solutions:
1. Take a low-end job for long enough to get health coverage; then quit and go on COBRA for 18 months.
2. Do what I did and join a union, trade group, or organization that offers group insurance. I keep my real estate license current, not to sell property, but to buy group health insurance. I got a high-deductible HMO for $271/month, no questions asked. For a 52-year-old guy in marginal health, this is a steal.
a serious shortage of doctors is another,
having to wait many long months to have surgery and numerous other things,there is one advantage that I wish my American friends had too,You are never stuck with a huge hospital bill to pay.
I dont pay one cent after a visit to see my family doctor.However you do still need to have private insurance bought at your own expense or through your job,in order to see a dentist or to
visit an eye doctor.The downside of course is that taxes are much much more higer here than in the US,however most people here are willing to pay the extra taxes to have health coverage.
America is going to h*e*l*l in a hand basket because of greed, corruption and indifference to others.
We are experiencing the modern day "fall of Rome"--American style.
LORD hep me forgive em!!
The real problem with the costs is not the insurance companies tho(well maybe i don't know if the pharmicutical own them to) The problem is the BIG Pharmacutical companies. They charge extremely prices. A government control over them to try to make them non-profit would be awsome. or something i dont know what would work to lower prices.
There's more than "cherry picking". I've gotten annual physicals - a mistake! - and any trivial finding the doctor notes has become a major illness on my record. One example of several is a 1995 creatnine test that went wrong at the lab and became "acute renal disease" forever. He redid the test, and it came back in the normal range as it always was and is, but that doesn't matter. My doctor is outraged and says he'll write letters, but we never bothered. There's clearly both cherry picking and gross exagerration going on in the qualification process.
Posted by itwasntme000 at 10:25 AM : May 24, 2007
I normally do not call names but you are an ignorant person and do not have a clue of what you are talking about--the classic example of --"if it isn't happening directly to you--then it must not be true" Grow up. Of course what is said about the health insurance industry is true and it is unfair.
I happen to be in the unique position of having worked for a few insurance companies (Golden Rule, Conseco, etc) as well as worked for pharm co. The fact is, most of the high cost of drugs or equipment is NOT from the drug co but from the mark ups by the distributor and then the hospitals. A drug company may produce a drug for about 300K for a batch of 100K vials at a wholesale cost of 20.00 but by the time the customer gets it in the hospital that 20.00 batch of 20 pills (at an individual cost of 1.00 a pill will have become 6 to 20.00 PER PILL. Because everyone wants to make a profit. Insurance companies are complicit in this.
Be an informed consumer--before you say a situation is a lie or even go against it--LEARN about it--Americans are easily manipulated because most don't learn anything--they wait to be fed--so if they are fed bs--then that is all they spout and believe. Ask yourself why Ins companies charge more for an outpatient emerg. room visit in metro areas than they do if you stay overnight.
The insurance and pharmaceutical industry lobbyists have our elected representatives in their pockets. That's the main reason for this mess. No name brand drugs are covered under my policy, but I can buy name brand drugs or generic equivalents of some drugs that are not available as generics here from Canada for **half** the US price, but the government wants to outlaw this on the ridiculous grounds that imported drugs may not be safe. We are talking about Canada, not a third world country, and name brand drugs come from the same manufacturer as the drugs sold here.
People have neen complaining for years about not being able to get health care. Why not really start reporting on WHY they can't get help from Congress or the Insurance Companies. That is the real story. We already know we cannot afford private insurance. We already know the Insurance Companies are *** us. We do not need to read the same story day after day just because it holds a different spin on the story line.
Do some real reporting.
You don't understand--America is very, very capitalistic--to the point of it being a religion. High insurance, high pharmaceutical prices--high hospital bills all mean more money--the government could not care less about the citizens, they are owned by big business and are in it for the profit also. As long as we allow businesses to run and influence government via lobbies, special interests and donations and PACs--we will have our current system and it will get worse and worse and worse. Social systems are for countries that actually put their people not personal profits first--we are not a social minded country and most Americans have been trained to reject any idea of shared cost or taking care of anyone in addition to themselves.
Posted by rsh_rsh at 10:49 AM : May 24, 2007
If 90% of Americans were not part of the medical system they would either be dead or destitute. Just what do you imagine happens in this country if people cannot pay their hospital bills? They can lose everything and end up in bankruptcy. When hospitals learn they do not have insurance, they get the worst hospitals, bad service/care, horrible rooms. Accidents happen (though they also happen to people with insurance). They may wait hours and hours to be fed, medicated, SEEN---or worse yet, they may be sent back home uncared for --if the situation is not deemed acute and the hospital thinks it can get away with it. Often, people are transferred to the welfare hospitals, where the staff is overworked, the halls crowded and triage of gunwound victims, drug overdoses and preemie babies by children take precedence.
Telling Americans to stop paying for health insurance is like telling them to not pay taxes--they know they do those things to their own detriment--and since most will NOT join them--then only they would suffer for their actions.
Joe Smuck ends up paying 3 times more for health care than someone with the right insurance card. Then when he files his tax return he/she gets screwed over by Uncle Sam. Employer provided health insurance escapes all taxes. Joe Smuck on the other hand has a high exclusion before he gets a tax break.
By failing to clamp down on unfair pricing and subsidizing employer paid insurance the government is forcing the public into zero deductible insurance. This is the most idiotic policy possible.
Imagine if you had to first buy food insurance to get reasonable access to food. And your food insurance company would thenm make deals favorable to them and decide what foods you could buy that would be covered by your food insurance. oh, and the only way that you could get reasonably priced food insurance is through your employer.
Marketing/bartering, in the beginning, was one person, having more of one thing than they need, trading some of it for something they haven%u2019t enough of.
Today, that is called %u201Csocialism%u201D. But then so are our police and fire departments, armed forces, county, state, and federal governments (not to mention the Supreme Court).
Social security is one of the most successful, government run programs in history. As a matter of fact, Bush and Reagan, between them, have %u201Cborrowed%u201D $2 trillion dollars from the social security surplus.
The only protection we ever HAD against over-pricing and control of commodities, or anything NECESSARY for survival, was/is anti-trust and anti-monopoly laws, which have been either gutted or ignored.
The favored way of defeating any person or thing is to label it/them. I.e.
Tie the word socialism to Russian communism and beat the hate drums until the word and reference become one in the minds of the people.
Other words have been debased to the point that they no longer have they original meaning in the minds of most.
Like, for instance, the word Gay once meant carefree/happy, and the word liberal once meant, preferring freedom.
did i say i was an expert??? no... my point was the huge insurance costs are directly related to huge prescription drug costs. how many elderly people do you know that take over 5 pills every day??? and isn't that baby boomer gen hitting old age??? Ok yea doc's need to actually be a real doc and know what and when a person needs for pills but still.
an even scarier question: how many nurses and care givers do I know taking over 5 pills a day? To your question I know of about 2500 to 3500 Seniors who take over 10 pills a day. This is because I also worked in the adverse reaction and complaint arenas in the Pharm business and have many friends and family working in the health care industry (incl nursing homes) Anyone with heart disease (most in their 40's and 50s) is easily on 4 meds.--1 or 2 for blood thinning, 1 for hbp, 1 or 2 diuretics---usually with this disease comes potential renal failure or complications and often type II diabetes--which means--insulin , testing strips, sharps, etc. If the diabetes is progressive and it usually is--then also pain meds, antibiotics, special socks, shoes, etc.
I did not take issue with your remarks about pharm comp. but with your attitude that this stuff is not true--if anything, it is downplayed. The sad fact is, when it is bad enough for you to realize--you will be personally affected and then--those left will disbelieve you also. A terrible catch 22
People who work harder than most, in low pay jobs, such as waitresses, may not be able to afford $25 or $30 for a visit to a low cost clinic.
While you are on the nurses topic... Why is it that they passed a law awhile back (or whatever it was) to make it so a truck driver can't drive for more then 8 hours straight without a 4 hour nap i think it is, yet a nurse after her lets say 8 hour day can be mandated to stay for another 4-8 hours if noone else will come in?? and nurses are the ones giving the meds to patients, taking care of them. When you are in your 15th hour at work I hardly think they are completely their....
I know EXACTLY how this goes. Because he's self-employed, he was paying $650/month for health insurance.
the insurance company had a co-pay for his medication... they payed $.25 of the cost of the drugs he uses every month ($168).
twenty-five cents.
Recently, I changed jobs and my new employer offers Domestic Partner benefits... I now pay about $544/month for BOTH of us.
they tell us group insurance has a pool of HUGE amounts of money (paid in by people that hardly need to see a doctor) that allows them to cover people with existing conditions.
okay, so... how big a pool of money is the 'uninsurable'? If they're paying huge amounts every month for insurance, and there are thousands of people paying in... shouldn't the costs paid out be offset by the amount being paid in? why are they paying so much?
greed. Health insurance (in my view anyway) is just another form of Mob protection... especially to someone turned down because of Acne, Athlete's foot, etc.
That's the U.S. health care system!! The best that money can buy. Just be sure to have a lot of it!!
This is exactly why government needs to be in charge of health insurance...insurance companies are not a charity...they are not there to HELP you...they are there to make $$$$!
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by toolmangler-2009
May 26, 2007 9:54 PM PDT
- Posted by sclaires at 03:34 PM : May 24, 2007
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See all 45 CommentsThats not fair!!! No way can I let you be sicker than me. I have had two heart attacks and Cirrhosis. I've got one eye, six teef,th thorry, an a veritable plethora of other ills, so there!!!! :p