- Posted September 2, 2012 by
This iReport is part of an assignment:
Are you living without health insurance?
Aware of 'no options,' woman dies fighting for medical coverage
because you NEVER know if they might be declined coverage by an insurance carrier. Anything from asthma to an abnormal pap smear, even tho since the abnormal pap there has been a normal culture, could lead to a declination of coverage by an insurance carrier. Shame on all those that know about high risk pools but don't tell people about them.
Aetna hid behind the usual statement that her particular illness was not the cause of the rate increase on her small group coverage. I CALL BS!!! Of course that was at least part of the reason. Even though small groups are pooled together, the medical conditions within each small group still have a large part to do with the rate structure for each small group. Shame on insurance carriers for hiding behind legalities that allow them to say that rate increases are not due to the medical conditions of employee's of that particular small group. If that was the case, then why did I have a client that had a 20% rate increase that the carrier wouldn't re-consider because there was an employee in that group with liver cancer and a couple other people in the group with major health conditions.
I remember when PPACA came out...I agree with some of its components, but not all. Big government is NOT the answer. It starts at the source. Consumers, Healthcare facilities, Providers, Insurance Carriers, etc. And BTW, just because, in 2014, pre-ex clauses will be done away with, doesn't mean everyone will be insured, because rates are going to sky rocket, so even though you can get insurance doesn't mean you will be able to afford it. PROBLEM NOT SOLVED!
I was just denied coverage for a low dose birth control after I had a miscarriage because my doctor didn't specify that I needed it not only for birth control, but also to help control the symptoms of Polycystic Ovary Syndrome. On the Utilization Review from Anthem, it said "Our clinical reviewer concluded the following because the information provided shows that you will only be using this medication to prevent pregnancy your request can not be approved. The covered conditions for this medication are:acne, endometriosis, hypermennorhea, perimenopause, abnormal uterine bleeding, establishing normal hormonal cycles, dysmenorrhea, excessive body hair(hirsutism), polycystic ovarian disease..."
1. I have both Hirsutism and Polycystic Ovarian Disease. Both of these conditions are well documented in my medical records.
2. Insurance Carriers boast that they have doctors and nurses on staff that conduct utilization management reviews. If that is the case, why were they not able to look at my history and not only see that I have these 2 conditions, but that I also just had a miscarriage, and it would be a lot cheaper for me not to get pregnant right away.
Something is fundamentally wrong here.