Toenail Fungus, Asthma, Allergies, Ear Infections, Migraine Headaches and More Put Consumers in High Risk Groups with Health Insurance Underwriting and Some Lead to Denial of Coverage

We all have to wait until the year 2014 when the “pre-existing” conditions vanishes for all of us.  In the meantime there have been some grants given to help out in a small way to states creating insurance pools to give relief to some.  Reading all of this takes me right back to “Sicko” and the scenes we saw on the big screen with one woman denied coverage on claims as she “lied” and forget to include a “yeast infection” she had many years ago on her health assessment needed to apply for coverage.  I can personally vouch for the “earl infection” item as I had that myself and openly put it on my application.   The link below here will show what happens to the human side of healthcare when “scoring” plays the ultimate role and ethics don’t get entered into the picture. 

Health Insurance Business Intelligence “Scoring” Algorithms Interfering with Human Morals

In hind sense if I had been smarter perhaps I would not have included a minor ear infection which was cleared up in a matter of days with ear drops, minor, but when running the algorithms, ear infection was a parameter to automatically bump consumers into a “high risk” assessment area and collect bigger premiums. 

Being that visit was within the last 6 months, I also had to pay a 25% higher premiums until I could show that I had NO VISITS TO THE DOCTOR FOR A YEAR.   I actually probably could have gotten away with not reporting it as I paid cash and had a $4.00 generic prescription, but the office I went to billed company insurance that I had over 6 years ago and of course it came back denied as I was no longer part of the group; however more data was added to my file in the process, so that ear ache is now all over the insurance system for all to see and compare notes on this minor issue.

So the if the underwriting didn’t get me, the antiquated billing information that someone dug up and billed at the medical office – remember I paid cash here too – got me.  There was no reason for the office to bill this – I PAID CASH.  This just goes to show how inept and complicated billing is. 

Yup you heard that right and with the focus on preventive care today, what’s up with that stipulation?  It all comes back to the algorithms that think nothing of good care, but rather risk management costing algorithms only.  Of course this makes no sense not to have a well woman visit, right?  

Underwriting via the Algorithms

When it comes to public outrage over underwriting factors, the insurers simply have the programmers in and change the parameters to let a few more in without higher premiums or denials, so perhaps those with toenail fungus infections that are over 5 years old might be salvaged the cost of being a high risks or denied.

Now when things cool down and the public is not complaining, they go back and re-adjust the algorithms to knuckle down once more so new applicants may be subject to the same or they re-write the parameters to capture a different illness group to raise premiums via high risk assessments, etc.  

Guess what – it’s all back to the risk assessment algorithms that design and make profits and this is how the business has taken advantage of a largely uneducated public with using technology, they have machine guns and we have swords, not a fair battle.

The woman in this case has a toenail fungus infection, again talking major but if we program this into the algorithms to mark this as high risk, we can collect higher premiums as the Nurse Practitioner found out, so see they even were telling a clinician that she was high risk and she knows more about fungus infections than most consumers as she is in healthcare. 

It may not be so much the denial portion of the puzzle but what are the rates offered and can you afford them.  Also, be aware of all the action that is going on with health insurance subsidiaries.  This is sometimes hidden as you may or may not be aware that a company is a subsidiary of a health insurance company.  A good example at the link below is a subsidiary buying a Chinese trading/gateway company to promote more Chinese medical devices and drugs to the US and world.  This is a wake up call if you are ready to read up. 

Consumer Watchdog Warns Sebelius on Health Insurers – Good Reason for This as Insurer Subsidiaries Are in The Game to Play Just As Private Equity Groups Diversify and Collaborate Holdings

The San Rafael resident got rid of the common infection by treating it with the prescription medication Lamisil. It was the last thing on his mind when he applied for a health insurance policy on the individual market a short time later.

He could not believe the response: Because of the toenail fungus, an insurer informed him, he would be in a higher-risk insurance pool with a 50 percent jump in premiums. Burgert was flabbergasted.

"I'm in perfect health," said the 43-year-old nurse practitioner. "Except for the toenail thing, I haven't had any illnesses. Of all the diseases you can have, it's as close to a harmless one as you can get. All it does is make your toenails white and kind of thick-looking."

Common conditions such as asthma, sleep apnea, allergies, ear infections, mild depression, migraine headaches, and joint sprains can trigger denial of insurance or higher premiums, the state learned in 2006 when it required insurers to submit information on their underwriting policies.

Applicants dismayed as minor medical conditions lead to insurance denials or big hike in premiums - San Jose Mercury News

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