Change Happens: How I read a letter from my health insurance about rate increases

by phil on Wednesday Dec 15, 2010 1:21 AM

So my health insurance provider American Republic sent me a letter announcing that my insurance premiums were going to rise by 10%. As I read their cover letter which showed how much I was paying before, and compared it to what I'd be paying now, I felt like I was taking my lumps as a liberal. I had been a supporter of Obama's health care reform initiative from the get-go, but as the tea partiers and skeptics hammered on, I started to lose faith. Even though I supported the passage of the health care bill in Congress, inside a voice cried out, "you can't get something for nothing!"

But as I flipped the page and read the rest of the letter's contents, I felt a wave of relief and pleasantness. Inside were all the automatic upgrades to my plan as mandated by Obama's reform bill. While you can call this excessive government meddling, it's probably better referred to as a Patients' Bill of Rights. I like to think of it as peace-of-mind:

Statement on Rescissions

Health insurance didn't always give me a sense of security. After watching Michael Moore's Sicko and researching about the aggressive practice of rescission in the insurance industry, I started to doubt the value of even having insurance. Here's an example of how things were back then:

In a pending case, Blue Shield searched in vain for an inconsistency in the health records of the wife of a dairy farmer after she filed a claim for emergency gallbladder surgery, according to attorneys for the family. Turning to her husband's questionnaire, the company discovered he had not mentioned his high cholesterol and dropped them both. (source)

Initially I thought the horror stories were just rare occurrences, or possibly exaggerated by journalists for human interest stories. But then I found out about secondary health insurance. Yes, that's right, there are insurance companies that specialize in back-up insurance in case your primary one rescinds your claims unfairly or provides insufficient benefits. Hopefully, this will be a thing of the past.

Against this back-drop, the following section hit me like a breath of fresh air (emphasis mine):

Our Right to Rescind or Reform provision under Section V, Certificate Provisions, has been amended as follows:
We may not void Your certificate based on a misrepresentation by You unless You have performed an act or practice that constitutes fraud; or made an intentional misrepresentation of material fact as prohibited by the terms of Your Certificate;
We reserve the right to rescind or reform your coverage under this Certificate in the event of fraud or intentional misrepresentation of a material fact by you or your representative, subject to the Incontestability provision.

In the absence of fraud, all statements made by you will be deemed representations and not warranties. No such statement will be used to deny a claim or reduce benefits unless it is stated in the Applications for coverage.

You don't need to be a lawyer to understand that that is a big difference. The bar is set really high now. In the past, your insurance application was supposed to represent any and every problem you've had, whether or not you could recall it at the time. Now, if you forget to mention something, that won't hang over you in court.

This will probably change the way insurance applications are laid out. I always remember them being ridiculously tiny, like they were begging you to leave things out.

Statement on Preventative Care

The next thing that blew my mind was the section on preventive services:

When performed by a participating provider, the following services, and any future preventive services required to be covered under federal or state law, shall be covered without regard to any cost-sharing requirement, such as deductible, copayment, or coinsurance requirement that would otherwise apply:

Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force ...

Without reading the rest, I quickly flipped to the Appendix to find six pages listing 46 different things that are now covered automatically. While most of these don't apply to me, like "screening for abdominal aortic aneurysm" or "screening for cervical cancer," there were a few that didn't occur to me, like "screening for high blood pressure." I immediately made a mental notes for doctor visits to make. This means I will be now going through a handful of screenings now, that I may not even have considered going through until years, maybe decades later.

While reading this list of services, I had a vision of a healthy America. If people don't have to wonder if they're covered for "screening for diabetes" or "screening and counseling for obesity," maybe it'll increase the likelihood that adults will get an early pep talk from their doctor about their health. If everybody's required to have health insurance, maybe Americans will get screenings in their 20s instead of their 40s. And then maybe one day we can climb up from rank 36 on the list of countries sorted by life expectancy.

There were numerous other benefits mentioned that contributed to my appreciation of all that hard work that went into health care reform. For once, I felt like something in national politics affected my life in a positive, meaningful way. And so while it's unfortunate my premiums went up 10%, I'd say it's worth it since my peace-of-mind and faith in America went up 100%.

Comments

Ned said on December 15, 2010 2:23 AM:

Is this a troll?