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Health Insurance's Fight Club Rules

by Anonymous Guest Contributor 09-16-2009 | 1:30pm
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"The first rule of Fight Club is you do not talk about Fight Club." I said this the first time I came to work with bruises on my face.

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"The second rule of Fight Club," I joked about a week later, when I came to work with new bruises on my arm, "is you DON'T talk about Fight Club."

The third week, I had no jokes. I just had new bruises, a history of epilepsy, no health insurance due to a pre-existing condition, no anti-seizure medications, and a willingness to accept often-violent episodes of falling and losing consciousness on a weekly basis in locations that often left me bruised.

Ironically, when I got a job at a hospital, I was denied coverage by their health-care provider after I told them about my "pre-existing" history. When they turned me down, I turned to the hospital's other insurance company. I didn't tell them about my history, and I was accepted. When I had my "first" seizure, they put me on medication and the seizures stopped for the first time in months.

So what's the message here? The first rule of Health Insurance Club is you do not talk about your actual health.

G.C.F. is job-searching and currently without health insurance.

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by: Ngchen

09-16-2009 @ 5:32pm

This is a sad story. I certainly cannot condone lying and fraud, but I do sense the desperation. Does the state the anonymous poster lives in have some sort of "high-risk pool" that he can sign up for? Are there generic meds that can control the seizures?

This deception described by the anonymous poster would raise rates for the rest of us, and yes, in some sense unfairly punish those who are actually honest. As I've noted repeatedly, something needs to be done to reign in the high cost of health-care, or more and more people will fall through the cracks.

by: aspokane

09-16-2009 @ 6:51pm

Yes, this is a sad story. Doesn't the health insurance industry exist to help maintain health and share the costs? Why are we talking about unfairly punishing the honest? Many diseases are inherited, a gift from God...aren't we obliged to share that "gift"? It all comes down to "Do unto others..." What would you do if you were born with this disease?

Epilepsy is not an expensive disease to treat. In fact, the care and medications are much cheaper than trips to the emergency room for minor illnesses by people who can't afford insurance. And guess who pays for those ER trips? It's the public, who already pay for indigent care in their taxes. It is we who pay because insurance companies are out for profit and will not accept those who are not profitable. Profit at the expense of others is not something Jesus would condone.

by: Ngchen

09-16-2009 @ 7:31pm

When I noted that the OP would raise rates and punish those that are honest, what I meant is that the rates for those without epilepsy would rise to account for those who do have it and actually knew about that fact. Perhaps it's fair and good that we should share that cost, but it should be done in an open, transparent way. Otherwise, it's the honest epileptic, who honestly discloses the existence of the condition, that gets left out and gets the proverbial shaft.

I ask whether the OP could sign up for some sort of high-risk pool, and for the possibility of getting treatment with generic drugs. Insurance is supposed to spread the pain so that it's bearable for all, and insurance regulations are supposed to determine what are fair ways to do it. IMHO, it's fair to make smokers pay more than nonsmokers because they chose to smoke. OTOH, discrimination due to age or sex is more iffy, even though we know that the very young and elderly cost more.

by: weiwentg

09-21-2009 @ 3:58pm

Many, but not all states, operate high risk pools. However, coverage in the pools is often expensive (because the enrollees are unhealthy). Even with state subsidies, the high risk pools are too expensive to attract very many enrollees, and often have a lot of limits on coverage (like high deductibles, caps on certain services, etc). Again, though, not all states operate them. Additionally, you have to pay the full cost of your plan without any subsidy by your employer, and I don't think most employers would increase your compensation in that instance.

If the OP had no less than a 30 day (or 60) gap in enrollment in health insurance, the employer-sponsored plan should have enrolled her or him without excluding the condition. Unfortunately, this apparently wasn't the case. It is a little odd that the insurance company didn't offer to exclude the epilepsy for a certain amount of time (I think 6 or 12 months), although that's hardly ideal either.

If health reform is passed, insurance companies should be unable to exclude pre-existing conditions, so GCF should be able to get individual insurance at least (although he/she might not be able to afford the rates).

It's true that GCF's behavior would, if replicated en masse, drive up costs for the rest of us. It's true that this behavior is technically illegal; it would be a valid reason for the insurance company to conduct a recission (retroactively canceling a policy due to actual fraud, or fishing for a reason to disenroll an expensive enrollee). However, I would hardly complain.

by: ukusmed

09-16-2009 @ 8:36pm

This story is extremely common, and health care providers are aware of it. A friend of mine has Crohn's disease, but not officially of course. I'm a med student and my friend is a nursing student, everyone knows he's got classic Crohn's disease.....the thing is though, the free clinic doctor knows he doesn't have insurance, so hasn't given him an official diagnosis.....this is so that when he does get insurance he can honestly say he doesn't have any official medical history......I think this is all getting a little legalistic about it all.

by: myfanwy

09-16-2009 @ 11:26pm

I think you mean "rein in."

by: Ngchen

09-16-2009 @ 5:32pm

This is a sad story. I certainly cannot condone lying and fraud, but I do sense the desperation. Does the state the anonymous poster lives in have some sort of "high-risk pool" that he can sign up for? Are there generic meds that can control the seizures?

This deception described by the anonymous poster would raise rates for the rest of us, and yes, in some sense unfairly punish those who are actually honest. As I've noted repeatedly, something needs to be done to reign in the high cost of health-care, or more and more people will fall through the cracks.

by: aspokane

09-16-2009 @ 6:51pm

Yes, this is a sad story. Doesn't the health insurance industry exist to help maintain health and share the costs? Why are we talking about unfairly punishing the honest? Many diseases are inherited, a gift from God...aren't we obliged to share that "gift"? It all comes down to "Do unto others..." What would you do if you were born with this disease?

Epilepsy is not an expensive disease to treat. In fact, the care and medications are much cheaper than trips to the emergency room for minor illnesses by people who can't afford insurance. And guess who pays for those ER trips? It's the public, who already pay for indigent care in their taxes. It is we who pay because insurance companies are out for profit and will not accept those who are not profitable. Profit at the expense of others is not something Jesus would condone.

by: Ngchen

09-16-2009 @ 7:31pm

When I noted that the OP would raise rates and punish those that are honest, what I meant is that the rates for those without epilepsy would rise to account for those who do have it and actually knew about that fact. Perhaps it's fair and good that we should share that cost, but it should be done in an open, transparent way. Otherwise, it's the honest epileptic, who honestly discloses the existence of the condition, that gets left out and gets the proverbial shaft.

I ask whether the OP could sign up for some sort of high-risk pool, and for the possibility of getting treatment with generic drugs. Insurance is supposed to spread the pain so that it's bearable for all, and insurance regulations are supposed to determine what are fair ways to do it. IMHO, it's fair to make smokers pay more than nonsmokers because they chose to smoke. OTOH, discrimination due to age or sex is more iffy, even though we know that the very young and elderly cost more.

by: Bungarra

09-17-2009 @ 12:32am

Citizens of most social democratic first world nations would not be subject to such discrimination and the failure of society to provide an effective safety net. Nor would they put up with it. Time to carefully question the basic philosophy driving this situation. In who's interest is the nation run? Who is the nation?

by: ukusmed

09-16-2009 @ 8:36pm

This story is extremely common, and health care providers are aware of it. A friend of mine has Crohn's disease, but not officially of course. I'm a med student and my friend is a nursing student, everyone knows he's got classic Crohn's disease.....the thing is though, the free clinic doctor knows he doesn't have insurance, so hasn't given him an official diagnosis.....this is so that when he does get insurance he can honestly say he doesn't have any official medical history......I think this is all getting a little legalistic about it all.

by: Ngchen

09-17-2009 @ 1:54am

Corrected. Thank you.

by: dlowen

09-17-2009 @ 10:08am

Even for those of us who have insurance, it is almost impossible to get coverage for prevention. When I turned 50, there were a number of diagnostic tests that studies had determined were cost effective, my doctor felt were necessary, but for which my insurance would not pay unless I had symptoms of a disease. (Of course, if I had symptoms, a disease would be much more difficult to treat than catching on routine screening.) The doctor didn't really ask me a thing. He told me, "I'm sure you have to get up some times in the night to go to the bathroom." etc.

I give flu shots in my pharmacy, but the largest insurer in the state will not pay for them. (They'll pay big bucks for drugs to treat the flu and hospitalization if needed though.) I read a book a few years back (sorry I can't recall the title or the author) that stated that the United States does not have a health care system. It isn't health, it doesn't care, and it isn't a system. What we have is a disease state management industry.

by: myfanwy

09-16-2009 @ 11:26pm

I think you mean "rein in."

by: Bungarra

09-17-2009 @ 12:32am

Citizens of most social democratic first world nations would not be subject to such discrimination and the failure of society to provide an effective safety net. Nor would they put up with it. Time to carefully question the basic philosophy driving this situation. In who's interest is the nation run? Who is the nation?

by: Ngchen

09-17-2009 @ 1:54am

Corrected. Thank you.

by: dlowen

09-17-2009 @ 10:08am

Even for those of us who have insurance, it is almost impossible to get coverage for prevention. When I turned 50, there were a number of diagnostic tests that studies had determined were cost effective, my doctor felt were necessary, but for which my insurance would not pay unless I had symptoms of a disease. (Of course, if I had symptoms, a disease would be much more difficult to treat than catching on routine screening.) The doctor didn't really ask me a thing. He told me, "I'm sure you have to get up some times in the night to go to the bathroom." etc.

I give flu shots in my pharmacy, but the largest insurer in the state will not pay for them. (They'll pay big bucks for drugs to treat the flu and hospitalization if needed though.) I read a book a few years back (sorry I can't recall the title or the author) that stated that the United States does not have a health care system. It isn't health, it doesn't care, and it isn't a system. What we have is a disease state management industry.

by: insurancepolicyonline

10-26-2009 @ 10:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.

by: SFR

09-19-2009 @ 1:08pm

National Health Care.

by: Miami Health Insurance

09-20-2009 @ 6:04am

This is a huge issue with the current system, and really a sad thing for everyone involved. I feel your pain and sympathize with your situation. I hope things work out.

by: insurancepolicyonline

10-26-2009 @ 8:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.

by: SFR

09-19-2009 @ 1:08pm

National Health Care.

by: insurancepolicyonline

10-26-2009 @ 8:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.

by: Miami Health Insurance

09-20-2009 @ 6:04am

This is a huge issue with the current system, and really a sad thing for everyone involved. I feel your pain and sympathize with your situation. I hope things work out.

by: insurancepolicyonline

10-26-2009 @ 10:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.

by: weiwentg

09-21-2009 @ 3:58pm

Many, but not all states, operate high risk pools. However, coverage in the pools is often expensive (because the enrollees are unhealthy). Even with state subsidies, the high risk pools are too expensive to attract very many enrollees, and often have a lot of limits on coverage (like high deductibles, caps on certain services, etc). Again, though, not all states operate them. Additionally, you have to pay the full cost of your plan without any subsidy by your employer, and I don't think most employers would increase your compensation in that instance.

If the OP had no less than a 30 day (or 60) gap in enrollment in health insurance, the employer-sponsored plan should have enrolled her or him without excluding the condition. Unfortunately, this apparently wasn't the case. It is a little odd that the insurance company didn't offer to exclude the epilepsy for a certain amount of time (I think 6 or 12 months), although that's hardly ideal either.

If health reform is passed, insurance companies should be unable to exclude pre-existing conditions, so GCF should be able to get individual insurance at least (although he/she might not be able to afford the rates).

It's true that GCF's behavior would, if replicated en masse, drive up costs for the rest of us. It's true that this behavior is technically illegal; it would be a valid reason for the insurance company to conduct a recission (retroactively canceling a policy due to actual fraud, or fishing for a reason to disenroll an expensive enrollee). However, I would hardly complain.

Comments sorted by highest rated. After voting you must refresh your page to see the sort order change.

by: Ngchen

09-16-2009 @ 5:32pm

This is a sad story. I certainly cannot condone lying and fraud, but I do sense the desperation. Does the state the anonymous poster lives in have some sort of "high-risk pool" that he can sign up for? Are there generic meds that can control the seizures?

This deception described by the anonymous poster would raise rates for the rest of us, and yes, in some sense unfairly punish those who are actually honest. As I've noted repeatedly, something needs to be done to reign in the high cost of health-care, or more and more people will fall through the cracks.

by: Ngchen

09-16-2009 @ 5:32pm

This is a sad story. I certainly cannot condone lying and fraud, but I do sense the desperation. Does the state the anonymous poster lives in have some sort of "high-risk pool" that he can sign up for? Are there generic meds that can control the seizures?

This deception described by the anonymous poster would raise rates for the rest of us, and yes, in some sense unfairly punish those who are actually honest. As I've noted repeatedly, something needs to be done to reign in the high cost of health-care, or more and more people will fall through the cracks.

by: aspokane

09-16-2009 @ 6:51pm

Yes, this is a sad story. Doesn't the health insurance industry exist to help maintain health and share the costs? Why are we talking about unfairly punishing the honest? Many diseases are inherited, a gift from God...aren't we obliged to share that "gift"? It all comes down to "Do unto others..." What would you do if you were born with this disease?

Epilepsy is not an expensive disease to treat. In fact, the care and medications are much cheaper than trips to the emergency room for minor illnesses by people who can't afford insurance. And guess who pays for those ER trips? It's the public, who already pay for indigent care in their taxes. It is we who pay because insurance companies are out for profit and will not accept those who are not profitable. Profit at the expense of others is not something Jesus would condone.

by: aspokane

09-16-2009 @ 6:51pm

Yes, this is a sad story. Doesn't the health insurance industry exist to help maintain health and share the costs? Why are we talking about unfairly punishing the honest? Many diseases are inherited, a gift from God...aren't we obliged to share that "gift"? It all comes down to "Do unto others..." What would you do if you were born with this disease?

Epilepsy is not an expensive disease to treat. In fact, the care and medications are much cheaper than trips to the emergency room for minor illnesses by people who can't afford insurance. And guess who pays for those ER trips? It's the public, who already pay for indigent care in their taxes. It is we who pay because insurance companies are out for profit and will not accept those who are not profitable. Profit at the expense of others is not something Jesus would condone.

by: Ngchen

09-16-2009 @ 7:31pm

When I noted that the OP would raise rates and punish those that are honest, what I meant is that the rates for those without epilepsy would rise to account for those who do have it and actually knew about that fact. Perhaps it's fair and good that we should share that cost, but it should be done in an open, transparent way. Otherwise, it's the honest epileptic, who honestly discloses the existence of the condition, that gets left out and gets the proverbial shaft.

I ask whether the OP could sign up for some sort of high-risk pool, and for the possibility of getting treatment with generic drugs. Insurance is supposed to spread the pain so that it's bearable for all, and insurance regulations are supposed to determine what are fair ways to do it. IMHO, it's fair to make smokers pay more than nonsmokers because they chose to smoke. OTOH, discrimination due to age or sex is more iffy, even though we know that the very young and elderly cost more.

by: Ngchen

09-16-2009 @ 7:31pm

When I noted that the OP would raise rates and punish those that are honest, what I meant is that the rates for those without epilepsy would rise to account for those who do have it and actually knew about that fact. Perhaps it's fair and good that we should share that cost, but it should be done in an open, transparent way. Otherwise, it's the honest epileptic, who honestly discloses the existence of the condition, that gets left out and gets the proverbial shaft.

I ask whether the OP could sign up for some sort of high-risk pool, and for the possibility of getting treatment with generic drugs. Insurance is supposed to spread the pain so that it's bearable for all, and insurance regulations are supposed to determine what are fair ways to do it. IMHO, it's fair to make smokers pay more than nonsmokers because they chose to smoke. OTOH, discrimination due to age or sex is more iffy, even though we know that the very young and elderly cost more.

by: ukusmed

09-16-2009 @ 8:36pm

This story is extremely common, and health care providers are aware of it. A friend of mine has Crohn's disease, but not officially of course. I'm a med student and my friend is a nursing student, everyone knows he's got classic Crohn's disease.....the thing is though, the free clinic doctor knows he doesn't have insurance, so hasn't given him an official diagnosis.....this is so that when he does get insurance he can honestly say he doesn't have any official medical history......I think this is all getting a little legalistic about it all.

by: ukusmed

09-16-2009 @ 8:36pm

This story is extremely common, and health care providers are aware of it. A friend of mine has Crohn's disease, but not officially of course. I'm a med student and my friend is a nursing student, everyone knows he's got classic Crohn's disease.....the thing is though, the free clinic doctor knows he doesn't have insurance, so hasn't given him an official diagnosis.....this is so that when he does get insurance he can honestly say he doesn't have any official medical history......I think this is all getting a little legalistic about it all.

by: myfanwy

09-16-2009 @ 11:26pm

I think you mean "rein in."

by: myfanwy

09-16-2009 @ 11:26pm

I think you mean "rein in."

by: Bungarra

09-17-2009 @ 12:32am

Citizens of most social democratic first world nations would not be subject to such discrimination and the failure of society to provide an effective safety net. Nor would they put up with it. Time to carefully question the basic philosophy driving this situation. In who's interest is the nation run? Who is the nation?

by: Bungarra

09-17-2009 @ 12:32am

Citizens of most social democratic first world nations would not be subject to such discrimination and the failure of society to provide an effective safety net. Nor would they put up with it. Time to carefully question the basic philosophy driving this situation. In who's interest is the nation run? Who is the nation?

by: Ngchen

09-17-2009 @ 1:54am

Corrected. Thank you.

by: Ngchen

09-17-2009 @ 1:54am

Corrected. Thank you.

by: dlowen

09-17-2009 @ 10:08am

Even for those of us who have insurance, it is almost impossible to get coverage for prevention. When I turned 50, there were a number of diagnostic tests that studies had determined were cost effective, my doctor felt were necessary, but for which my insurance would not pay unless I had symptoms of a disease. (Of course, if I had symptoms, a disease would be much more difficult to treat than catching on routine screening.) The doctor didn't really ask me a thing. He told me, "I'm sure you have to get up some times in the night to go to the bathroom." etc.

I give flu shots in my pharmacy, but the largest insurer in the state will not pay for them. (They'll pay big bucks for drugs to treat the flu and hospitalization if needed though.) I read a book a few years back (sorry I can't recall the title or the author) that stated that the United States does not have a health care system. It isn't health, it doesn't care, and it isn't a system. What we have is a disease state management industry.

by: dlowen

09-17-2009 @ 10:08am

Even for those of us who have insurance, it is almost impossible to get coverage for prevention. When I turned 50, there were a number of diagnostic tests that studies had determined were cost effective, my doctor felt were necessary, but for which my insurance would not pay unless I had symptoms of a disease. (Of course, if I had symptoms, a disease would be much more difficult to treat than catching on routine screening.) The doctor didn't really ask me a thing. He told me, "I'm sure you have to get up some times in the night to go to the bathroom." etc.

I give flu shots in my pharmacy, but the largest insurer in the state will not pay for them. (They'll pay big bucks for drugs to treat the flu and hospitalization if needed though.) I read a book a few years back (sorry I can't recall the title or the author) that stated that the United States does not have a health care system. It isn't health, it doesn't care, and it isn't a system. What we have is a disease state management industry.

by: SFR

09-19-2009 @ 1:08pm

National Health Care.

by: SFR

09-19-2009 @ 1:08pm

National Health Care.

by: Miami Health Insurance

09-20-2009 @ 6:04am

This is a huge issue with the current system, and really a sad thing for everyone involved. I feel your pain and sympathize with your situation. I hope things work out.

by: Miami Health Insurance

09-20-2009 @ 6:04am

This is a huge issue with the current system, and really a sad thing for everyone involved. I feel your pain and sympathize with your situation. I hope things work out.

by: weiwentg

09-21-2009 @ 3:58pm

Many, but not all states, operate high risk pools. However, coverage in the pools is often expensive (because the enrollees are unhealthy). Even with state subsidies, the high risk pools are too expensive to attract very many enrollees, and often have a lot of limits on coverage (like high deductibles, caps on certain services, etc). Again, though, not all states operate them. Additionally, you have to pay the full cost of your plan without any subsidy by your employer, and I don't think most employers would increase your compensation in that instance.

If the OP had no less than a 30 day (or 60) gap in enrollment in health insurance, the employer-sponsored plan should have enrolled her or him without excluding the condition. Unfortunately, this apparently wasn't the case. It is a little odd that the insurance company didn't offer to exclude the epilepsy for a certain amount of time (I think 6 or 12 months), although that's hardly ideal either.

If health reform is passed, insurance companies should be unable to exclude pre-existing conditions, so GCF should be able to get individual insurance at least (although he/she might not be able to afford the rates).

It's true that GCF's behavior would, if replicated en masse, drive up costs for the rest of us. It's true that this behavior is technically illegal; it would be a valid reason for the insurance company to conduct a recission (retroactively canceling a policy due to actual fraud, or fishing for a reason to disenroll an expensive enrollee). However, I would hardly complain.

by: weiwentg

09-21-2009 @ 3:58pm

Many, but not all states, operate high risk pools. However, coverage in the pools is often expensive (because the enrollees are unhealthy). Even with state subsidies, the high risk pools are too expensive to attract very many enrollees, and often have a lot of limits on coverage (like high deductibles, caps on certain services, etc). Again, though, not all states operate them. Additionally, you have to pay the full cost of your plan without any subsidy by your employer, and I don't think most employers would increase your compensation in that instance.

If the OP had no less than a 30 day (or 60) gap in enrollment in health insurance, the employer-sponsored plan should have enrolled her or him without excluding the condition. Unfortunately, this apparently wasn't the case. It is a little odd that the insurance company didn't offer to exclude the epilepsy for a certain amount of time (I think 6 or 12 months), although that's hardly ideal either.

If health reform is passed, insurance companies should be unable to exclude pre-existing conditions, so GCF should be able to get individual insurance at least (although he/she might not be able to afford the rates).

It's true that GCF's behavior would, if replicated en masse, drive up costs for the rest of us. It's true that this behavior is technically illegal; it would be a valid reason for the insurance company to conduct a recission (retroactively canceling a policy due to actual fraud, or fishing for a reason to disenroll an expensive enrollee). However, I would hardly complain.

by: insurancepolicyonline

10-26-2009 @ 8:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.

by: insurancepolicyonline

10-26-2009 @ 8:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.

by: insurancepolicyonline

10-26-2009 @ 10:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.

by: insurancepolicyonline

10-26-2009 @ 10:54am

Your blog is very much good. I am very much impressed by your blog content, i also come across number of sites for the health insurance for the travel insurance and medical insurance, you can also check these are also very much useful for everyone.