Monday, May 08, 2017

Pre-Existing Conditions

Okay, disclaimer first.  I am not your HR or benefits administrator.  Everything I am saying is as me, a person on the internet.  But. But.  We have to talk about pre-existing conditions. So let's define the term and the reason behind it. 
I'm going to start with the basic premise behind insurance.  Insurance is essentially you making a deal to give a company money on a regular basis, so that if you experience a large and/or unexpected expense, the company will then cover this expense.  Kind of a more boring version of you saying I'll pay for dinner this time, next time you can pick up the check.  Insurance companies are, you may have heard, for profit businesses, so they put various rules in place to try and mitigate their financial risk.  And part of this is pre-existing conditions.  You see this in things like vision coverage too, where they sometimes require you agree to pay for vision coverage for at least two years, because they figure two years of premiums offsets your pair of glasses. Obviously, when we get to health insurance, we are talking about more than a pair of glasses.  So, pre-existing conditions are there to make it so you don't just pick up health insurance two seconds after you discover you had cancer and possibly are not a premium paying person long enough for the insurance company to recoup their expenses. Prior to the ACA it was not uncommon to see it on employer sponsored plans, particularly in companies that had a lot of turnover.  
I understand that this thing that may become was passed with a lack of clarity, but I feel fairly certain that the legislation as it existed when it passed the House, did not have a specific list of pre-existing conditions.  It basically removed the requirement put in place by the ACA that people be charged the same premium regardless of their medical history and turned it back into hair salon rules, wherein you can be charged different amounts based on your gender, your medical history, and your expectation that you might need so-called premium services like pregnancy coverage, and also meant that they can put into place a restriction that anything that is a pre-existing condition does not have to be covered by them for a period of time. HIPAA - unless they did something else we haven't heard about - still applies to group coverage and maxes that at a 12-18 months, and waives that if you had continuous coverage.  
So, what does this mean.  Let me tell a story.  I once started getting terrible headaches.  I took sick days off work (and I had a job where I did not get paid leave) and lay in bed.  Sometimes I tried to power through.  And because I had health insurance at the time, I called regularly to document this in case this turned into something else.  I had gotten as far as noticing they happened a lot Sunday nights and Monday mornings when a friend pointed out to me that I hated my job and maybe that was it.  (Hate is a strong word, but I knew it was time to go.) So, I figured out my next plan, and ultimately didn't give notice for another month because reasons, but my headaches went away.  I currently have health insurance. I have a number of known conditions. Allergies, asthma, things like that.  If I quit my job now, and couldn't afford the COBRA or reached the end of COBRA without getting another plan, and had a break in coverage before being able to work out a new plan, then yes - things that I had already been treated for count as pre-existing conditions. So my asthma inhalers (without which I need even more expensive nebulizer treatments), any cold that might really just be allergies, yes, those they could choose not to cover.  If it was group coverage, then after the waiting period I could get coverage, you know, assuming I made it that far.  But it would also apply to things I had not been diagnosed with but could be attributed to something I had previously been treated for, that coverage could be denied too.  So, if I ended up with migraines, they could pull those medical records and say, gee you had this period of headaches that you reported, so maybe that was really that, and now we don't have to cover this until the end of the waiting period.  
So, my point here is not to make you terribly depressed about the state of health insurance in this country. I don't think insurance companies are evil and no one is paying me to say that.  I think we have a system that is designed to make insurance companies money.  But there isn't a magic list of pre-existing conditions.  You aren't safe if your particular afflictions weren't on the list you saw. Everything is a pre-existing condition. 


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