The High Stakes of Childbirth | New America Blogs | medical underwriting
This Blog at New American Foundation misrepresents key issues about medical underwriting. While medical underwriting practices face increasing scrutiny, it is important that an evaluation be based on a real understanding of the practice and its effects.
Insurance companies that use medical underwriting are required to consistently apply eligibility standards for all applicants. I can confirm that exclusion due to prior cesarean section is not part of Golden Rule Insurance's underwriting policy filed with the Colorado Insurance Department and that the company does in fact insure many women in Colorado with prior cesarean deliveries. Normally an insurance policy whose rates are based on a medical preferred risk would simply exclude the cost of cesarean delivery from the coverage. Golden Rule Insurance uses independent agents in Colorado whose livelihood depends on assuring their customers that insurance companies follow published underwriting standards. It is not reasonable to believe that an insurance company would risk the penalties for failure to follow published medical underwriting guidelines. If this woman was denied coverage, the denial was based on other medical factors not presented in the article.
Second, medical underwriting is becoming less common in new individual insurance policies. Most states, including Colorado where this woman was located, have at least a few low cost limited benefit policies that are available to all applicants and do not use medical underwriting. More of these types of policies are likely as Americans embrace the concept of universal health insurance policies like those listed at http://medsave.com/universal-health-insurance.htm.
Third, federal HIPAA law assures that everyone is eligible for some type of health insurance where the rates are fairly based on the collective medical costs of the applicants. Some health insurance can be ridiculously expensive. But the price of insurance, by law, is only a mirror of the medical expenses of the members. It does not make sense to criticize some insurance plans that are meant to keep claims for its members lower through exclusionary eligibility or limits on benefits paid. It is crucial that we recognize that “affordable insurance” is synonymous with “limited benefits” regardless of the political approach we adapt to tackle America’s health care crisis. Not every medical condition will be covered by insurance. In order to ensure that all of us can afford health insurance, we will face substantial out-of-pocket risks for medical procedures not covered by our health insurance.