A Letter from Anthem Blue Cross

I’ve been without major medical insurance for about a year now, though I’m on the waiting list for California’s Major Risk Medical Insurance Plan, which is a pool of people who are denied coverage by insurance companies. Periodically I apply for individual insurance anyway, on the offchance that I might be accepted, which means that every couple of months I get a thick packet of paper in the mail listing all of the reasons I’ve been denied.

I would be willing to bet that just about everyone who is speaking out against Health Care Reform has spent the majority of their lives insured through their jobs or healthy enough to get individual insurance. That’s certainly true of our senators and congresspeople, and I have a hard time imagining someone who has had to manage chronic or serious medical conditions without insurance, or who has had to fight against insurance companies to get desperately needed services or procedures covered, spewing the kind of vitriol I’ve heard from the anti-HCR camp.

I’m one of the millions of Americans who doesn’t get benefits from my job — I work full time, but I’m technically a consultant — and who can’t get individual health insurance because I need it so badly. It sounds ridiculous when you say it that way, but it’s true. I’ve been denied health insurance because I have too many pre-existing conditions. In fact, any one of the conditions they list in the following letter would be enough to deny me. My sister-in-law has been denied coverage because she has slightly elevated blood pressure — not high enough to need medication or even close followup, but apparently high enough to make her a poor risk in the eyes of the insurance companies.

Today I got one of these denial letters, which because I applied for a “hip” new plan offered by Anthem to attract young (and healthy) people, is worded a bit more casually than the usual, but under the slight glaze of conversational language is the same old same old — we don’t want you, you need health care too badly.

Dear Ms. [my last name],

Thank you for applying for a Tonik plan from Anthem Blue Cross Life and Health Insurance Company. We wanted to follow up and let you know what’s happening.

Bear with us while we get a bit technical.

Sometimes medical conditions present uncertain medical underwriting risks. We carefully reviewed the health information and medical history that you gave us when you applied, and you are not eligible for any of our medically underwritten plans at this time. Specifically, our decision was based on the following health information:

Source: Health Statement, 03/05/2010

Medical History:

  • Complex regional pain syndrome requiring ongoing treatment (since 2003) with [list of four medications].
  • Migraine headaches.
  • Epilepsy/seizure disorder
  • Melanoma or squamous cell carcinoma (our records reflect a history of stage III melanoma).

This medical history precludes coverage under any of our medically underwritten plans.

Although we cannot offer enrollment under any of our medically underwritten health insurance plans, enrollment in the California Major Risk Medical Insurance Plan (MRMIP) may be an option for you.

[Followed by several paragraphs of information on who to call or talk to about different options and how to appeal.]

This is what’s wrong with our current health care system today. We have the best health care in the world here in the U.S., yet our infant mortality rate, our lifespan, and other statistics that measure how accessible that health care is are far below the top of the list. We have handed over control of access to healthcare to the insurance companies, who make decisions based on profit. They routinely jack up premiums by 40% even though they are making record profits. They deny lifesaving coverage or force families to go through lengthly appeals and legal challenges because some treatment that is generally accepted is still “experimental” in the eyes of the insurance companies. And as a matter of policy, unless you are covered as part of a group policy (through your job), they deny anyone who might actually need the health coverage they offer, so that they can profit as much as possible from people who are healthy and pay monthly premiums in case they need the coverage someday. (And even when these people who have paid years of premiums get sick, the insurance companies will do anything they can to get them kicked off the rolls — including finding the tiniest infraction that could be considered “lying on your application”, no matter how ridiculous it is. We’ve all seen the stories in the news, and they are the rule, not the exception.)

Yet every day now I see people blogging and talking about how HCR is handing over our health to the government (it isn’t — public option and single payer were off the table long ago, and the current plan keeps the control under insurance companies), how the government is going to be killing the elderly with “death panels” (it isn’t — what was painted as “death panels” is actually coverage for conversations with your doctor about living wills and end of life care, something everyone should be doing no matter how young or healthy), how HCR will spend federal funds on abortion (it doesnt, because federal funding of abortion is already prohibited except in extremely limited situations — in cases of rape or incest, and when an abortion is life-saving). These rumors/myths/scare tactics are designed to pull people away from the cause of HCR, to draw support from reform our country desperately needs because the Republicans are on a mission to stop any of Obama’s plans from becoming law.

The thing I really don’t get is when people go on and on to me about being pro-life, yet will tell me how much they are against HCR. Sometimes it’s because of the abortion funding they thing is in the bill, or they say they’ll only support it if the Stupak language is added (which is impossible at this point, and which is unnecessary because the bill already prohibits abortion funding except in the very limited circumstances listed above), and sometimes it’s because “why should I have to pay for your health insurance? you should go and get a job and pay for your own insurance! why should my money pay for your medical care?”

I read just today that universal health care reduces the abortion rate — and I’ve been saying for weeks that if we already had universal health care, Angie Jackson would probably have already had a tubal ligation, her IUD would not have failed, and she would never have needed an abortion in the first place. There would have been no #livetweetingabortion. Yet most people who call themselves “pro-life” continue to be bitterly against HCR. It’s a contradiction I don’t understand at all.

Right now, people die every day because they don’t have access to health care. People wait months to have conditions checked by a doctor because they can’t afford it, and end up in the ER only when their condition becomes deadly. Even people on Medicare don’t have coverage of preventative care or physicals, which means that conditions like cancer that can be found early through routine exams go unchecked until it’s far too late as well as much more expensive to treat them. Women who don’t have health insurance have abortions because they can’t afford the out of pocket costs of pregnancy — prenatal care, labor and delivery, postnatal care, medical care for their children. Women have more unwanted pregnancies because they don’t have access to birth control, because they can’t afford the birth control pills or other methods that would protect them from getting pregnant. More unwanted pregnancies equals more abortions.

We desperately need universal health care and coverage in this country. It would save lives, it would reduce the number of abortions, it would reduce our overall health care costs, lower infant mortality rates, raise life expectancy, reduce the number of bankruptcies due to medical costs.

No one should ever get a letter like the one I got today. If HCR passes, which by all appearances it will, that may become a reality. We’ve let this system become so dysfunctional, and it’s time for real change, real coverage for every single American.

1 Comment »

  1. Not Guilty Said:

    Sitting here in Canada, I know exactly how dysfunctional the US system is, and while not perfect, how functional ours up here is. It is true that some people die here waiting for treatment, but it is the exception rather than the rule. But it is better then dying because you couldn’t get a physical.

    The lies that have been spread by the anti-HCRs are almost humourous because that is not how it works. It is so sad to read your story, and that of other Americans. I can’t even fathom what it is like to have to make a financial decision to get healthcare. I go to my doctor for very random and mundane reasons all the time. I flash my ‘OHIP’ card and bitch about the address form I have to fill out every time. The only advice I have for you is to become Canadian. Our insurance also pays for abortion, and except for one province (where we are fighting for change), it is on demand, no questions asked. We haven’t had laws relating to abortion in this country since our Supreme Court struck down the Criminal Code section 20-odd years ago. No government will touch the issue, and I am happy about that. Good luck.


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