I was recently talking to a woman who is 62 years old and “uninsurable”.  You’d never know it to look at her, but she cannot get health individual insurance, no matter how much she is willing to pay.  Paula M wanted to leave her job after her husband retired and she figured she’d quit her job and buy individual health insurance until she turns 65 and gets Medicare.  Before leaving her job, Paula figured she’d get the most out of her employer health insurance by getting a full physical and tests she might have to pay for once she retired.  As part of her physical, Paula got a chest x-ray, and here is where her troubles started.

The chest x-ray showed a small spot on Paula’s lung and her doctor said this is probably nothing. A month or so later, when Paula applied for individual health insurance through Blue Cross Blue Shield, this x-ray was in her record and the insurance company thought the spot was something.  BCBS told Paula they would not insure her because of the spot on her lung x-ray. Paula’s doctor sent her analysis to BCBS, which was that the spot could have been left over from Valley Fever, but was probably not cancer.  BCBS said the spot could be cancer and, therefore, Paula was a bad risk.

Paula told me her story and I contacted UnitedHealth to see if they might consider her case.  I was quickly told that, if a person is turned down by one insurance company it is in her record, and no insurance company will touch her.  Paula was……uninsurable.

Because Paula has had employer coverage (without a gap of 63 days) she can get expensive insurance because she can use COBRA for 18 months. This means she can continue to use her company health insurance, but she pays the full cost that is normally shared between the employer and the employee.  When the 18 months is up, she will be able to get even more expensive insurance, but she will pay twice as much as anyone would pay for the policy.  There is a federal law that requires insurance companies to offer at least two plans (usually the lousiest ones they have) to someone like Paula. The policy will have a big deductible and a big price tag – but at least she will be able to get insurance.

Eighteen months from now, when Paula’s COBRA insurance runs out, she is hoping the spot on her lung will not have changed and an insurance company will determine it is no risk – and will agree that Paula is no risk for insurance coverage.  Otherwise, Paula’s only choice will be to let an  insurance company rob her with their overpriced, high-eductible ”guaranteed issue” coverage.

Paula is also hoping there will be some healthcare reform this year or next.  If (and that’s a big if) legislation is passed, it looks like insurance companies will not be able to deny coverage to people like Paula.  And insurance companies will not be able to charge people like Paula a higher premium.

There has been so much negative talk about healthcare reform legislation – which is actually “health insurance reform”, that people seem to have overlooked some important changes that will affect millions of people like Paula.

This entry was posted on Friday, November 27th, 2009 at 4:26 pm and is filed under Health. Tags for this post: health insurance, Healthcare reform, Medicare Advantage, medicare arizona, medicare tucson. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.