Monday, July 23, 2012

Health Insurance: careful not to use it


A medical record is kept on you each time you visit a medical facility. The date, physician seen, diagnosis, what symptoms brought you in and what treatment was administered. This medical record follows you. At the time of insurance application, the questions asked of you are both historical in nature and current. If you answer yes to a knock-out question, you are denied of health insurance.

Health care discussion between the political parties is an on-going debate.  Each side believes they have the answer to our health care crisis. Each side believes their plan is better than the other. The carefully constructed health care plan is typed on the computer and printed out on clean white paper. They speak about their plan standing behind a podium patting themselves on the back for delivering a great speech hearing their own voice.  Looks good sounds good so it must be the answer. Right?
The reality is the health care rule continues to dig a hole that widens and deepens with each passing year. Take a look at individual health insurance policies. The people who hold them are self-employed or work for an employer who does not offer insurance. They begin their search for insurance carriers who write health insurance for individuals. Then chose a coverage plan that best fits their needs and finances. Incidentally, individual policies are much more costly, rated-up and health profile scrutinized. For this reason, policy premium is high and policy quality may be weak. The risk is not spread out as it is with employer issued group policies.
The ideal person for an individual policy is one without any ill-toward health conditions. The medical profile the insurance company expects a person to have is an ideal weight and height ratio, normo-tensive, non-diabetic, no spinal/muscular problems, no kidney stones, no  meds etc. In other words, a very clean internal organ system. That is fantasy. We are human and develop health issues, some conditions beyond our control.  
A person who lives a healthy lifestyle by eating right, exercising, doesn’t smoke or drink and develops a health issue, the insurance company doesn’t care. You are penalized for having a pre-existing condition. Doesn’t matter if you are asymptomatic and no treatment plan is in effect, you will be penalized. If you were in a vehicle accident and suffered minor or no injuries, you are penalized. The penalty is higher premiums, exclusions, longer waiting periods, limited coverage or no coverage on related condition, no coverage at all, lack of coverage.
When you change insurance companies, your medical record is part of the equation for determining your risk and premium cost. If a pre-existing condition requires radiological testing or phlebotomy draws, the insurance company will deny the claim. If an illness develops which can be traced back the very health condition that is excluded from the policy, the insurance company reserves the right to deny the claim.
After all, this is health insurance. The whole point of health insurance is to insure the safety, quality of health and prolong life. Insurance plans enable you to take extra care of your health. This is in part, because when you do routine physical examinations and you are responsible for a nominal sum to get check-ups rather than pay the actual fee, you would not tend to skip these tests.  Health insurance gives psychological and financial relief that medical expenses will be paid. 
Preventative care is the front line to keeping us healthy and helping us to avoid trips to the emergency room. Preventative care is much less expensive than treatment for chronic conditions that could have been avoided with routine wellness checks.  
Under individual policies the reality of the situation is that if it is used, your premium is guaranteed to increase. Although, legally you cannot be singled out for premium increase. The insurance companies provide reasons that are easily hidden and clouded by: rising cost of health care, administrative costs, a class increase and or there is something in your medical history. Aside from your annual wellness checks, be wise in your decision when paying a visit to your doctor. 
The American political system is attempting to re-structure the health care rule. However, what they are proposing is not the answer. Americans will continue to jump through hoops to have access to medical care, long term policy affordability:  not just 1 or 2 years of pocket-friendly premiums but long term affordability and the struggle with dictation from the insurance companies that tell us who, what, when and where.
Good health,
Trisha M. Pacenti RN,BSN
www.nurseinsagent.com