- Posted September 25, 2013 by
West Palm Beach, Alabama
Getting a Physical Upped my Insurance Premium
I've never been without health insurance. My father always provided it to me until I got my own health insurance through working. Last year I had to quit my job to move to Alabama with my new husband. Luckily he had fantastic health insurance which was good considering I couldn't find any full time jobs as a speech pathologist. This past summer we moved back to Florida for my husband's new job. His new employer provides his insurance for free but for me the price was expensive and not as good of coverage. I'm 29 and in good health so I decided to go get my own health insurance.
Since I didn't have any health issues we went for a simple plan that provided coverage for basic preventative care and would make sure I wouldn't go broke for an sort of major medical emergency. The sales rep at Florida Blue asked me a series of questions about my medical history. Consistently I responded "no" to every health concern until he asked me if I had ever had any of the following tests. When he named EKG I had to say yes. Last fall I was having a weird random inconsistent sort of heart flutter. I went to my PCP and she did an EKG. She didn't find anything and as it turned out it was nothing - it was just a side effect of the allergy medicine I had been taking for seasonal allergies. While I was there she mentioned I hadn't had a physical in awhile and had some labs drawn but other than my yearly visit to my women's health doctor I have had no doctor visits since. I was quoted a $121/month premium.
I wasn't surprised when I got a call from Florida Blue wanting to ask some questions about that EKG. It felt like a complete interrogation. I got 20 questions about the EKG and then about my seasonal allergies. Then the woman remarked she could see I had labs drawn last fall - what were they for? Oh, just a standard physical. She asked what the results found. I told her everything was normal, just my B12 was low normal. Red flag. This led to a lot of questions about my B12. Yes, I did have an issue with my B12 about 5 years ago requiring B12 shots. Nothing since. I even got asked if I had taken a B12 vitamin that day. I got off the phone feeling exhausted. This is what it feels like to get health insurance when you don't really have anything wrong with you? What does it feel like if you have a true pre existing condition?
Florida Blue called back again. This time they said they needed a copy of my blood work from that last physical that was 9 months ago. Here's exactly what my blood work said - my B12 was 314 pg/ML with a note from my doctor that it's a "little low," normal values are between 200-1100, and that 5-10% of patients have symptoms between 200-400 pg/ML. So, technically my B12 was within normal limits and I was not complaining of any symptoms. The other note from my PCP was that my LDL (or bad cholesterol) was "slightly elevated." It was 147mg/DL with normal being below 130 mg/DL. Okay I'll give you that but it should also be mentioned I have FANTASTIC HDL (good) cholesterol of 91 mg/DL (you want to have 45 mg/DL or higher) and because of this had great cholesterol and triglyceride ratios. Because I also have higher good cholesterol it actually made my total cholesterol (260) look out of range (normal is less than 200). But If you look at the whole picture I'm doing fine.
Florida Blue didn't agree. They sent me a letter that my monthly premium would be going from $121/month to $211/month. Yep. A $90/month increase. $1080 more a year. Why? Because my B12 was "low" though technically within normal limits and my bad cholesterol was "slightly elevated" though my ratios to my good cholesterol and triglycerides were fine.
This situation has me obviously frustrated. I am in good health and they worked extremely hard to find ways to raise premiums on me. We are days away from the Obamacare marketplace and I look forward to pricing it out and being able to get insurance without being made to feel like I don't deserve it. This whole experience has confirmed my support of Obamacare and providing better care to those with pre existing conditions. But here's my biggest issue. I'm not proud of the fact it had been a few years since I had a physical. I believe in preventative health. I think it's very important for someone to see their PCP regularly so that something small can be taken care of it before it becomes something bigger (and more expensive). Not once was I asked if I regularly get physicals. I didn't get any credit for eating a healthy diet or exercising regularly. No one stepped back and looked at the whole picture of me. Something I did for my health - getting a yearly physical - got used against me. And now I have to pay the price. If I could go back last year I would have declined that doctor's request to run labs and that is just wrong. In essence that is like awarding people who avoid the doctor. Those are the people who wait until something small becomes a much bigger deal costing all of us more.
I am going to be working on an appeal to Florida Blue in the coming weeks. Before I even knew my insurance premium had been increased I went to a new PCP here in Florida to get established. She drew my B12 levels to check they were okay. My lab results are in the mail but she called today to tell me they were in the 'high end of normal." As far as my cholesterol goes I already found a Harvard medical journal article stating that the triglyceride to HDL ratio is the biggest predictor of a heart attack. A ratio of 2 or under is excellent. My ratio is 1.2. I feel fortunate that my background and education have equipped me to fight this appeal with evidence. I wonder how often they unfairly raise premiums and people don't appeal because they just don't know how to argue their case.
Those of you that comment that Obamacare isn't the answer that will fix everything you're right. But the current system sure isn't working either. I took a course last spring in health care delivery models and we were asked if we could design the health care bill what we would have done. I had a few minor things I would have changed but I didn't change much. It's not because I think it's perfect. I just think it's the best we can do on top of an extremely broken system. We can't start from scratch but I applaud those who don't throw their hands up and say its hopeless. We can do better.