Health Insurance - A Cautionary Tale

[APKhaos]

Background for the recent members here: I was diagnosed in 2005, treated for 24 weeks in the Vertex Prove 1 trial, SVR 48 weeks post treatment. Now read on.....

I got some good advice that involved switching health insurance plans with my current carrier. The family has been covered by this carrier for years, with no major claims. The plan switch required an application, and a repeat of all the history stuff as usual. Yes, its a pain filling out endless pages of questions that the carrier has better records to answer than I do, but that's the way it goes.

I checked YES to HCV, and included a detailed summary including when diagnosed, the trial details and references, the results, and contact information for the investigator and the clinic to verify all this.
You know what's coming, right?
We got the call from the happy chaps in Underwriting, "You have been refused coverage because you have [yes HAVE] HCV."

I'm calmly documenting the fact that I do NOT have HCV, and fully expect that this will be accepted at some point in time. I also fully expect that it won't be easy, that it will require endless back and forth, that the clinic and the investigator [the hepatologist running the clinic] and others will be required to provide document, attest to facts that are established in documents already provided to the carrier, and testify, amplify, quantify, qualify, and perform unnatural acts until the carrier finally accepts what I laid out in the application.

The short story is that SVR means a lot to us who have lived with HCV and slogged through tx, but all the insurance carriers see is an opportunity to say, "You have been refused coverage because you have [yes HAVE] HCV."

[Facta_non_verba]

I know what you mean. My wife had breast cancer at age 33 and is now 15 years out and healthy. There's no way she could ever get insured under a private plan. I have my own business and was able to get a group plan because I have at least two employees -- yours truly and my wife. As a group we can't be denied insurance. We do have to pay 10% extra because of medical history, though.

The insurance company is just that: a company. As such, their business is to make money, and they do that by passing on patients who are unhealthy or at risk for disease. You would be assessed as being a risky patient given your history. SVR or not, they're not going to take a chance that you'll cost them a million dollars down the road. You may not have active hepatitis, but you probably do carry the virus, if just in minute quantities.

So when you see the Blue Cross billboards with a nurse holding a newborn baby, remember that the insurance company doesn't care about your health unless it's to decrease their financial risk. Sad but true.

Jeff

[alagirl]

I'm on BCBS with so many pre-existing issues (like chronic procrit dependent anemia (long before I had HCV), but I'm always on through these group plans and go directly from being covered under one to being covered under the next, so I don't have to fill out my pre-existing.

The one I'm on now has been particularly good.  They haven't denied me anything yet (crossing fingers) and I've had to have an awful lot of interventions on treatment in order to even get this far through.  

[amirtracy1]

Hi. I was just denied private insurance last week due to the fact that i HAVE hpv also but i treated for 48 weeks and am SVR too. My doctor wrote a detailed letter for the rebuttal but i was denied again in spite of providing complete records and his testimony etc. The only explanation is that i am high risk.
I, like Jeff, am self employed and was told by an insurance advocate to apply in August (in fla) during the open enrollment for group insurance since they can't deny me in spite of medical history. Is this a great country or what.

[jmjm530]

Insurance statues vary state by state. As to the self employed, in some states you will be refused coverage for pre-existing conditions. However, in other states, the laws of that state stipulate that you cannot be denied coverage for pre-existing conditions with certain qualfications which again vary state by state. For example, if you've had continuous insurance coverage (or a lapse under "x" months) then some states will allow pre-existing conditions but if your coverage wasn't continuous (or a long lapse) then there might be a waiting period - say six months - before your pre-existing condition wuld be covered.

Always good to research all the state statues, because in let's say the latter case, you might get a letter stating you are not covered for HCV, but in reality if you wait "x" number of months you might be.

Prior to treatment, I researched out all the insurance issues involved and switched plans to one which I felt would give me the best coverage for my year or so in treatment.

You really don't want any surprises, so check the insurance situation out before you treat and if possible switch to the best possible plan which often isn't the least expensive, but in reality it will turn out to be the least expensive by the time you get through treatment.

APK -- that's a tough one and hope it gets resolved. If the question said "do you have HCV", I'd answer "no" because I'm cured. If the question asked "have you ever had HCV" -- that's a tougher one, because not answering truthfully could conceivably come back and haunt you in terms of insurance coverage. I'm assuming they asked the latter question in your case.

-- Jim