More Evidence US Health Insurance is Broken

Updated: Apparently I’m living in the past, and hadn’t yet educated myself on the implications of the Affordable Care Act. While I knew that the ACA protected people from being denied coverage based on pre-existing conditions, I didn’t know that this was universal across all providers (not just the ones available on HealthCare.gov), and that it also prevents insurers from hiking rates based on them. Of course this is all true only as long as the ACA isn’t repealed or whittled away, so if you care about this issue make sure to vote!

Regence LogoIn case you needed it, here’s some more evidence of just how broken Health Insurance really is in the United States.

On Friday, I received a letter in the mail from Regency’s “Condition Manager Program” with enclosed materials that “may be helpful to you.”

Dear Participant:

Enclosed are materials from the Regency Condition Manager Program that may be helpful to you. Please look them over and we encourage you to discuss them with your doctor. You can call us toll free at 1 (800) 267-6729 with any questions.

The Regency Condition Manager Program is a free health management program sponsored by Regency BlueShield.

The program provides information, education and support to help you learn more about your condition. You should still see your doctor. If you have any concerns about your health, you should contact your doctor. In an emergency, call 911 or your local emergency services number.

Thank you for allowing us to be a part of your healthcare management team. We look forward to speaking to you again soon.

Sincerely,

Your Regency Condition Manager Team

Enclosure(s)

And the condition that the letter refers to? Diabetes.

Here’s the thing: I have never had diabetes. I’ve never been diagnosed with diabetes. I’ve never been treated for diabetes. I was on a medication a couple of years ago that could cause an increase in blood sugar levels, but I’m no longer on the medication, and never needed any intervention.

So my health insurance provider decided unilaterally that I have a pre-existing condition that I don’t actually have.

Presumably they did this based on a badly designed and poorly tested matching algorithm running against their customer database, (I refuse to use the word “patient” since I am not one, and even if I were, I’m not theirs.)

I can’t tell you how messed up this is

For those of you who live outside the United States, or if you’re young enough or fortunate enough to have never had to contend with the pre-existing condition rules we have here, here’s the skinny:

If you have been diagnosed with a condition, and your health insurance ever lapses for more than 30 days (90 in some states including Washington), you are now in a situation where no insurance provider will pay for care related to that condition. Ever. Period. End of story. You’re screwed.

Even worse, some insurance companies are even in the habit of denying coverage as a matter of course if you have a pre-existing condition, and hoping that you won’t contest the decision—which can often be prohibitively costly for the patient. You’re screwed again.

This practice should be illegal

There should be no way for an insurer to attribute someone with a medical condition without an explicit diagnosis and provision of covered care for the specific condition.

Just because you have some mediocre DBA on your cost-control team who had the bright idea that they could mine your customer database to find people who need help managing chronic conditions, doesn’t mean that you now get to decide they have some health issue that they don’t have.

Diagnosis is done by doctors, not database analysts. And certainly not computer systems.

Hey Regence: Stick to what you know

Health insurance companies should stick to the business they understand: Forcing sick people to sell their homes and declare bankruptcy in order to pay for unjustifiable profits for their shareholders and investors.

Oh wait. Did I just say that?

We fixed the problem

I did call them, and the customer service representative was “happy to fix this for you.”

When I told him why I was so concerned, and suggested that they really need to look into fixing the bug in their computer system, he said, “Oh, I know—we’ve been getting complaints, and they’re working on a fix.”

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