Sally and Dave have been married for 11 years and have two wonderful children. Dave works the executive shift of 11-hour days while Sally takes care of the house, kids, and everything else that keeps the family in one piece. They have the cars paid for and have made a very large dent in the mortgage. All is looking great for this all American family. Health insurance has never been a concern because Dave has always had a job with great benefits, mainly paid by his employer.
After 10 years of hard work and following in the footsteps of his father, Dave was quite proud of his achievements until the day he found a note on his desk from his boss. After a brief meeting, Dave is now offered a short severance package and sent out the door with a form for a COBRA extension of his health insurance benefits.
For those like Dave not familiar with a COBRA extension, now Dave gets to pay the total amount billed for his health insurance with no premium being paid by his former employer. This extension of health insurance benefits will last for 18 months unless Dave and Sally can secure a cheaper health insurance premium. With the monthly family health insurance premium now costing close to one thousand dollars for his family, Dave decides to look for an individual health insurance policy.
Dave calls several health insurance agents and also checks the internet for an online health insurance quote for his family. Eureka, Dave is all excited because an agent has offered him a policy that has similar benefits to his current policy for half the cost. Dave no longer needed maternity coverage in his new health insurance policy. Removing this benefit is another way to create a premium savings on any health insurance policy.
An appointment is scheduled and Dave and Sally sit down with the health insurance agent and complete the application for what would be their new coverage. Once completed, the agent takes the application and submits it to the insurance company just as he has done for the other 425 insurance clients he has. Dave and Sally were told that the information they entered into their health insurance application all looked great. The agent told them that he saw no reason that they would have any kind of a problem securing this new affordable coverage.
Two weeks have gone by since the friendly health insurance agent has taken their application away in his unstylish sub compact car. Dave decides to call for a status report. The phone rings three, four, five times, then the voice of the agent answers by stating the name of his agency. Dave asks for an update. The agent seems taken back for a bit then begins to speak between two coughs and an eternal clearing of the throat. The agent tells Dave that he and the two kids will be eligible for coverage but Sally has been declined. Dave in disbelief asks what the mistake could be. The agent stated that there was no mistake. The insurance company had requested medical records from Sally’s doctor and found something in the records that has prompted them to decline Sally’s application. The agent tells Dave that they could appeal the decision but this would be a very long process and the chances of getting the decision reversed were very slim.
How did this happen? To answer this we will have to go back eighteen months to an appointment that seemed perfectly innocent at the time.
The kids had been dropped off at school and now Sally was off to her friendly family doctor that she has only had for one year. After reading two magazines from front to back, the nurse finally calls her name to come back to the exam room. Hello, the doctor says in his usual, I really do not care tone. From time to time she may actually see the doctors eyes. The rest of the time, the friendly doctor is ready with pen in hand anxiously awaiting the next opportunity to mark some new findings in Sally’s records to be filed. The doctor begins by asking if Sally has been feeling well. Sally replies that she has been having some pretty intense chest pains and she suspects it must be from the busy schedule she leads. The doctor asked if there is a history of heart or coronary problems in Sally’s family. She said almost her entire family has suffered from some type of coronary problem at some time in their lives. The doctor with pen still sizzling on the paper, calls for a bio-imaging scan. After the scan shows minimal plaque build up in Sally’s arteries, she is relieved and forgets the visit all together. The good doctor made elaborate notes detailing the severe chest pain Sally experienced and the prevalence of coronary problems in her family. He also noted some slight abnormalities in her heart rate.
Eighteen months to the day from this seemingly routine checkup, Sally is now refused health insurance. This is a problem that many Americans face every day. We are taught to share every thing with our doctors. The doctors are taught to document everything. Health insurance underwriters are trained to look for any reason to decline a policy before they will accept the risk. No wonder America has so many uninsured individuals trying to find a health insurance solution.