Guaranteed Healthcare

As the former Senior Program Officer of a health care philanthropy, I knew about the health insurance crisis from a policy perspective. However, I didn't realize just how bad things were for consumers until I moved from New England to the Midwest, started a consulting business, and became self-insured.

As a fifty-year-old man with no significant current or historical health concerns, I thought I would have little trouble finding a high-deductible plan that would provide me with adequate coverage. I attempted to find good comparative information on coverage that I might purchase. I didn't find a truly useful website. I applied to Blue Cross Blue Shield of Illinois, and was declined because of herpes. This is, as you know, a common virus which infects a significant percentage of the population, and is not generally associated with any significant health problems.

Next, I turned to an insurance agent. She secured a high-deductible plan for me with Assurant Health, informing me that it was a quality company. Frankly, I was too busy with other aspects of my life, and didn't ask as many questions as I should have. I provided a great deal of information to Assurant Health in order to obtain coverage, including an extensive medical history. I filed a claim against my deductible about three months after starting the coverage. I received a letter from Assurant demanding my complete medical history for the last five years. I phoned them, and asked why they needed this information, since they already had it? Their response was that these were their requirements.

In the absence of a convincing explanation as to why they required me to resubmit current information that they already had, I assumed that this was an administrative impediment designed to avoid paying claims. I concluded that should I ever become ill, they would likely be a nightmare to deal with, and decided to find another insurance carrier. I phoned my insurance agent to inquire what level of scruity they had put into Assurant before selling their policies. Their answer was "none." They also told me that I shouldn't be concerned about what had happened -- all health insurance companies were similarly obstructionist.

I did another web search, and found another insurance agent who came highly recommended by several consumers on a local website. He was, in fact, much more knowledgable, and proposed coverage with a company called Humana. I applied. Humana declined me because of a diagnosis of chronic fatigure syndrome. This struck me as odd since I have never been diagnosed with chronic fatigue syndrome. I pursued this with Humana, and discovered there was an error in my medical records from New England. After a month process with my New England physician, which included amending my medical records, getting an explanatory mea culpa letter from her, and sending the records twice (they were lost in the mail the first time), I appealed the declination of coverage with Humana.

I am still awaiting an outcome. As irritating as my experience has been, I can only imagine how much worse it would be if I were unhealthy, indigent, or not conversant with navigating Kafkaesque systems. Would someone please give me a rational reason why this system which appears to benefit no one but insurance companies is still in place? Oh, right -- greed!