The "Uninsurables"

CBS News Investigates The Tactics Used By Insurance Companies To Deny Health Coverage

(CBS)  With 46 million Americans living without health insurance, thousands of uninsured people who can't get insurance contact call centers every month.

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.

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For more information about finding insurance as an individual, see our FYI.

[toolmangler-2009]

Posted by sclaires at 03:34 PM : May 24, 2007

Thats 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

[trixie8476]

People forget one critical thing...insurance companies are BUSINESSES. Why in the world would they want to insure anyone with an expensive health problem, or an older person who is likely to develop one?

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 $$$$!

[kaybird07]

As an health agent I deal with several companies and rarely have I had trouble getting a claim paid for someone if the coverage was truly there. I have used Assurant as my main company for individual insurance and have yet to have a complaint about a claim not getting paid. I will say however that I make it very clear up front what the plan excludes, pre-existing condition clauses etc. so there is no confusion down the road.I feel sorry for the previous mailer who apparently hooked up with a bad agent. Lets be honest though--if an agent is telling you to lie on an application or a phone interview, you know he/she is not on the up & up and he should have went elsewhere.

[rudy654-2009]

"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."

That's the U.S. health care system!! The best that money can buy. Just be sure to have a lot of it!!

[louisbee]

lets here from individuals who have been damaged by agents of the policy racket---in my case the agent falsified info on my app and now my policy has been recinded after what was catagorized by as a near heart attack and expenses of near 100,000 dollars, NOW I AM BEING ACCUSED OF FRAUD!?!?!?!?!?!?! THEY AREN'T PAYING. MY CREDIT IS TOAST AND LIFE IS NOT EASY. IN ADDITION THE CREEP TOLD ME TO LIE DURING MY TELEPHONE INTERVIEW----I THINK THE LEGAL TERM IS DETRIMENTAL RELIANCE. HIS MOTIVATION, IN HIND SIGHT, WAS TO SELL A NEW POLICY AND COLLECT THE FIRST YEAR COMISSION INSTEAD OF THE RESIDUAL OF A SECOND YEAR RENEWAL. IN ADDITION THIS INDIVIDUAL COMPLETELY ABANDONED ME WHEN I WAS IN GREATEST NEED OF HIS ASSISTANCE THE ONLY TIME HE CONTACTED ME WAS TO WHINE ABOUT WHY I HAD FILED A COMPLAINT WITH THE TEXAS INSURANCE BOARD. I COULD USE SOME LEGAL ADVICE---IS ANYBODY OUT THERE?????

[dougbob3]

As a doctor and a Canadian living in the land of the free, I see this insurance fiasco as a total underminding of the social fabric. In my humble opinion, there are at least two ways to take away both the control of the insurance companies of us patients and practitioners, and their inhumane, over-excessive profits. Either get a state controlled health insurance plan that we pay for, or just carry catastrophic insurance ,get a medical savings plan,and join a "concierge practice' to cover your primary care needs or pay as you go from your medical savings account. What this will do is reduce our costs, reduce insurance companies profits and take back control into our hands from these highway robbers. It's ridiculous for us to pay them, they use our money, take huge profits from our money, then tell us whom we can see, what we can get done, what medicine we can take, what they'll pay for, etc, using our money, and other people's expertise. It's a crazy situation!!!

[catt42701]

I laugh at the man that has paid a little over $1000 for his teeth. Mine will probably run up to $20,000 just because of having weak teeth to begin with and the fact I grind and clench, plus being exposed to radiation as a child. I am on SSI and my credit card is going to be loaded when it's done. I don't get much more than food and paying medical bills after a payment on my teeth. I also get the cheapest glasses frames they have where I go but my lenses cost ofer $250. He has it made.

[soundboy123]

I live in California... have a Domestic Partner with type 2 Diabetes.

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.

[sclaires]

I guess I am lucky in that I have group health insurance from when I retired and also Medicare. But, the problem is that it does not pay that much for dental work. Already this year I have paid out on credit cards $545 and $125 just to have two teeth pulled. Now I am going to have to pay out I don't know how much to get a partial fixed so I can wear it again. And glasses are also a problem. My vision can drop all of a sudden and then I need new glasses. And, of course, Medicare doesn't pay for glasses and neither does my insurance so that is anywhere from $200 or more out of my pocket. So that has to go on a credit card. Add all that and it comes out to a "young fortune". You either get teeth pulled or get sick from infection and get new glasses or not be able to drive. It is a "Catch 22" all the way around.

[mitch0927]

WHat about the people that do have insurance and pay and pay and pay, but when it comes to actually using it, you find that what you need done is covered and you have to pay and pay some more. Case in point..I have paid over 20 thousand dollars in premiums through out the years and needed some work done, and found I had to pay full amount because of it not being covered. The 20 grand was for nothing.

[itwasntme000]

toldyouso21

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....

[weareone2]

90,000 people die each year in the US because they don't have health insurance.
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.

[toldyouso21]

For nurses--many are on depression meds as well as numerous medications for pain (autoimmune diseases and back problems are rife in nursing--hence the huge turn over and constant need for nurses) In fact, I know of quite a few nurses who work in ICUs for either babies or adults who are on as many as 19 medications daily including morphine--many have fibromyalgia--which is a catch phrase for "we don't know what is wrong with you and why you have all of these symptoms--but we better give it a medical sounding name so we can treat you"

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

[toldyouso21]

Posted by itwasntme000 at 11:43 AM : May 24, 2007

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.

[rainyday9]

THIS should be one of the issues that helps us choose future leaders. Apparently, the ones we have now are helpless against the huge lobby force of the insurance/medical associations that run our country. It's disgraceful that they can check your credit and base an insurance policy on that. People who have no insurance, in most cases, find it difficult to have good credit. They have MEDICAL bills! Often, they have low-paying jobs that do not have insurance... that's why they NEED it. Again, we have the best medical care available in the world. We offer it to illegal aliens and third-world patients who need help... that's great. What about US???

[memerider]

And I was converted from a fte to a contract position (common for more than 10 years), so I am without any benefits at all--I am an hourly worker who must file a 1099. I know many others in this predicament. I've been avoiding going to the doctor because I just can't afford it. No mammogram, no dentist, no pap smear. Nada. I have to eat, pay for shelter and transportation, and pay for medical bills for an entire family. Just food and gas have skyrocketed until I see no hope for the future. And I haven't a prayer of getting insurance. When did someone reframe public health as an insurance problem. If even one executive in one health insurance company or pharmaceutical company is only pulling a reasonable salary, I'd be very surprised. Those of us living on the edge are slipping off.

[memerider]

Doctors have become pushers for big pharmaceuticals, in part because they've had to stop spending so much time researching and working with patients. We live in a world where we focus on one effect of each drug and ignore the others, labeling them "side effects." And we've been seduced by the magic pill idea. People believe medications will help them and trust doctors to have the answers. Neither is necessarily so, but the culture has been brainwashed by the AMA and big pharma. So now we have capitalists cherry-picking and ganging up against people instead of treating insurance as a mechanism for sharing the cost of losses. This is a disgrace.

[itwasntme000]

toldyouso21

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.

[jn122736]

Insurance came into being like marketing did, with one major difference. Insurance was a natural, community type agreement, to create a mutual fund to prevent the bankruptcy or financial destruction of any person and/or family in the event of unexpected illness/accident.

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.

[toldyouso21]

If the 90% of Americans who are NOT part of the medical system did that, this nonsence would end!

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.