by Paul Fiarkoski
The Affordable Care Act – aka Obamacare – has become a hot political topic as of late. Oddly, this issue has divided even voters registered within the political parties.
From my perspective, much of the talk before the Obama healthcare plan went into effect was rhetoric based on fear. As a result of my insurance training, the notion of having everyone in the U.S. insured would spread risk across a huge pool of people and greatly reduce costs across the board.
Now that Obamacare has been in place for about a year, I’d like to share my family’s recent experience with the health insurance buying process.
Want the conclusion? Here’s mine: Obamacare is sorely needed in today’s economy.
Due to a new career path I decided to take, my wife and I recently (July 2012) found ourselves in the market for health insurance for our family of four. I gave up the group insurance I had for the last twelve years and decided to pay out of pocket for a high-deductible individual policy. We have two tween-aged daughters. The company we dealt with is Aetna. That’s who I had the group policy with and who I applied for the individual policy with.
I thought it would make things simpler to stick with them since every one of our health insurance claims went through Aetna for more than a decade. I couldn’t have been more wrong. We still had to document for them every doctor visit, illness, etc. over the past ten years. When I suggested that they look up our claims and base their decision of whether or not to insure us based on their records, the representative said they couldn’t do that due to privacy laws. Right from the script!
Playing by the insurance company’s rules
Really? Privacy laws prevent me from giving my own insurance company access to their own files containing information about my health. I didn’t like that answer but played along since I really didn’t want my family to be uninsured.
As it turned out, my wife was denied coverage completely. And not just for me misstating her height and weight. It was that, combined with something that was not discovered in the physical but that my wife mentioned to the doctor, who logged it in her notes to the insurance company. We paid out of pocket to have the doctor treat the other matter, then appealed Aetna’s decision knowing in our minds that my wife would likely not be able to get coverage with another company now since one of the key questions on a new application is “Have you ever been denied coverage by any insurance company?”
I was issued a policy but with a 40% higher premium than I was originally quoted. Even though the bloodwork that I paid out of pocket for revealed that I’m in better health than I was five years ago, they rated me for “pre-diabetes,” likely because I mentioned on the application that a family member has diabetes. Great, now I’m paying more for revealing information that is none of Aetna’s business and they would have otherwise had no access to. Both of my kiddos were issued policies but one of them was rated higher due to an injury she sustained at gymnastics practice six months earlier.
At that point I couldn’t help but wondering if I had not mentioned the gymnastics injury, or my family member’s diabetes, or if I had been accurate with my wife’s height and weight, would we be having any of this trouble. Would Aetna have detected omissions on the application by checking our claim history? Call me a cynic, but my hunch is that yes they would.
Light at the end of the tunnel
Currently I and my two kids are insured. My wife is still uninsured as we await the outcome of the appeal. In the meantime, thanks to a tidbit I found in small print on Aetna’s denial letter, my wife will be eligible to apply for a “no pre-existing conditions” policy in early 2013. Prior to Obamacare this option would not have existed. I have already checked the premiums and the cost is about 30% higher than what Aetna originally quoted us. Chances are that even if Aetna does decide to cover her, it will be at an increased rate.
Regardless of the outcome, it is good to know that thanks to Obamacare we have the ability to get insurance for my wife. We just need to pray that she remains healthy until her insurance kicks in.
Option for people who have been denied health insurance
Apply for insurance under the Pre-existing Condition Insurance Plan made possible by the Affordable Care Act. Get details at www.pcip.gov
As for the runaround and rated policies we received from Aetna, I don’t attribute that to Obamacare. Having dealt with them for the last twelve years for my group policy, I have become wise to their archaic infrastructure and tendency to stonewall when it comes to paying out benefits.
Here are some tips I would offer to anyone thinking about applying for an individual (not group) health insurance policy:
- Don’t guess when completing the application. I guessed my wife is 5’8′ and 120. Although I scored big points with her for that one, Aetna said she was too thin to be considered for coverage.
- Don’t overshare. Since insurance companies are allgedly prevented from obtaining health information about your relatives, don’t reveal anything. Make them insure you based on your health.
- Apply to more than one company about three months before you need the coverage. That’s about how long it can take to get insurance from the time you apply. This way you can go with the company that offers you the best overall package (price, service, efficiency) and tell the other(s) you won’t be needing them.
- Keep detailed records of medical treatments you and your family members receive. It will save you a lot of grief if you ever have to apply for individual health insurance.