Causecast

by JESSICA WOLF, Contributing Writer

Swine flu is dominating the news this week, but America’s convoluted health insurance industry is a pandemic that will last long after the current rush on Tamiflu is over.

Is there a panacea in sight, especially for the most health-afflicted in our country?

Insurance company executives testified to Congress last month that they might just be willing to excise the often uber-stringent restrictions they place on insuring people with pre-existing medical conditions (cunningly enough, these companies get to individually determine what constitutes a pre-existing condition, even if actual medical professionals disagree).

There’s a sticky caveat to potentially shedding this long-established and highly lucrative non-coverage tactic, however. It would only come about if federally mandated healthcare comes to fruition as well. (Breath-holding not recommended.)

In the meantime, a recent New York Times article offered tips for getting or keeping health coverage even with a pre-existing condition.

LOCATION, LOCATION, LOCATION

Every state is required to offer an individual health coverage plan that cannot exclude anyone. Of course, individual plans are the diciest and often carry the most restrictions, highest premiums and co-pays. Check with your state insurance department to find out what the coverage laws in your state are.

If you do find yourself in the market for an individual policy, do some quick comparison shopping and read the fine print before signing on. Lower monthly premiums often equal higher co-pays and deductibles.

THERE’S STRENGTH IN NUMBERS

Experts quoted in the Times article suggest sticking with a group plan whenever possible. As long as you have not gone without insurance for more than two months, a new employer cannot exclude you from general coverage.

That also means if you lose your job you should likely hang on to COBRA coverage as long as possible.

CALL IN THE CAVALRY

If your insurance company drops you for what seems like a nonsensical pre-existing conclusion, fight back. Enlist your doctor’s help to prove that one condition is unrelated to another. Sometimes it works, according to examples cited in the NY Times article.

The new administration is holding automakers and bankers under a high-powered microscope of accounting. But where’s the scrutiny for the health care industry?

One could argue the health of our health care system is intricately tied to the health of our overall economy. We’ve all heard about American families that go bankrupt and lose their homes thanks to mounting medical debts that rack up more quickly than they ever anticipated thanks to job loss, being dropped from insurance, etc.

The very fact the New York Times is advising readers how to work the system, coupled with how other media entities frequently watchdog the insurance companies by diving into insurance-disaster stories that tug at the heartstrings of the American public and create potential PR disasters for the insurance industry should be symptom enough that the time has come for real change.

Image by bartificial, flickr