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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

     

Insurance Quotes

Quality health and life insurance coverage may be hard to find if you’ve tested positive for hepatitis C.

By: Marc S. Botts

When faced with an insidious disease like hepatitis C, paying the medical bills associated with treatment is something most patients would rather not worry about. After all, that’s what insurance is for, right?

In a nutshell, yes — if insurance is in place. But, many question whether the high costs of treatment will affect their coverage; whether changing jobs will leave them without coverage; or what will happen if they lose coverage entirely.

Joseph Luchok, communications manager for the Health Insurance Association of America, said U.S. workers are protected by laws designed to help ensure coverage for those with chronic illnesses.

“In the workplace, if you work for a company that offers health insurance, and you qualify for that insurance — by qualifying, I mean under the company’s standards, sometimes they don’t cover part-time employees or something — you can’t be discriminated against,” he said. Additionally, the Insurance Portability Act protects those who change jobs while under treatment for medical conditions.

Luchok said in the eyes of insurance carriers, people with certain illnesses, such as Hepatitis C Virus or HIV/AIDS, are not pigeon-holed because of the severity of their diseases or because of the costs associated with treatment.

“Any disease that has continual, fixed-cost care is looked at the same. In the employer market, you’ve got this large volume of people, so the risk is spread across them. They know going in that out of X number of people they insure, a certain percentage will develop hepatitis, a certain percentage will develop cancer, diabetes, HIV, etc.,” he said. “You know everyone is not going to be healthy.”

 

 

Cutting Through Red Tape

Rick and Judy Hyman of Gaithers-burg, Md., said the biggest problem with their insurance is trying to keep up with what should be covered. “The amazing thing is, here we have this insurance, and we also have the prescription plan and, in order to get him the medications and what not, it has been a constant battle the entire year,” said Judy.

“We’ve had lots of fun,” added Rick. “Everything I have, pretty much, it has to be preauthorized. So, I get preauthorized and the preauthorization ends, and you have to get it re-preauthorized.”

With the myriad of medications he takes to treat the Hepatitis C Virus and to battle side effects, Rick said the authorization procedures are difficult for him to keep up with. He suspects he is not alone in that dilemma. “That makes it more difficult for the people who are more sick,” he said.

Janet Stokes Trautwein, director of federal policy analysis and state government affairs with the National Association of Health Underwriters in Arlington, Va., said scrutiny is not uncommon in cases involving chronic illnesses. The reason for it — particularly in cases involving clinical trials — is not to complicate matters for the insured party, but to protect them. Lengthy treatments, which can often be quite costly, are carefully looked at to make sure they are necessary. “Most policies have some aspect of managed care in them, whether it’s a preferred-provider network or an HMO or whatever it is,” Trautwein said. “There is some reluctance to authorize care, which they are not sure is appropriate or safe.”

Cost can become an issue when carriers pay for experimental treatment that proves to not be effective. “Premiums are based on claims paid out for a total population of people and, if you paid claims that you shouldn’t have paid, everybody’s rates go up,” Trautwein said. “They want to make sure they are paying for something that is safe and something that is recognized as being effective, for both safety and for cost reasons.” Rick said he can understand that, but it does not make it any easier for him to endure the delays and bureaucracy.

For Judy, having to scrutinize the insurance company as they scrutinize Rick’s claims simply adds another level of suffering. “The problem is, when you are as sick as he is, you shouldn’t have to be constantly monitoring your insurance company. That’s part of the problem. So, in a way it is discriminating. Thank God he can do it, and I can do it, because, otherwise, he probably would be dead,” she said. “I’m certain there are some people, when they hear ‘Oh, your coverage has been denied,’ or whatever, don’t have the gumption or intelligence to know they can fight this and get into those problems.”

Everybody into the Pool

For those who don’t have employer coverage available and have been turned down on the individual market because of a chronic illness or condition, there are still options available. The most common, high-risk pools, are typically state-created, nonprofit associations that offer comprehensive health insurance benefits to individuals with pre-existing health problems.

In most states, health screening is a prerequisite on an individual-market policy. High-risk pools are for people who don’t make it through that process. They provide regular insurance with benefits equal or similar to other plans. The premiums, which are slightly higher, cover part of the cost of the pool. The cost of the health care expenses paid by the pool in excess of the premiums they collect are generally covered in a variety of different funding mechanisms across the states. The most typical source is assessments made on the insurance industry on a real broad basis to take care of any overage in costs. Linda Good, a Huntsville, Texas, attorney who has represented numerous hepatitis C patients, said that even with high-risk pools there are a significant number of people who are left out in the cold when it comes to insurance. “They are either going bare, they’re going without, or they have to go to Medicare and Medicaid,” Good said, adding that Medicare and Medicaid come with stringent eligibility requirements.

Medicare has very limited coverage and is typically for the elderly. However, it is also available to individuals who are not elderly but are found to be disabled and individuals who have sufficient work history to receive disability benefits based on their work record. There is a two-year waiting period from the onset of the disability before Medicare kicks in. Good says, however, it typically takes that long to prove disability. Medicaid actually has a number of programs available to people with fairly low income levels. “There’s Medicaid that comes attached to receipt of welfare benefits. Then there’s medical assistance-only Medicaid,” Good said. “There’s medically needy Medicaid. There’s spend-down Medicaid. There are lots of different types.” For people who have some income but don’t have access to employer-based health insurance, and who can’t afford a private-pay policy, one frequently used avenue is spend-down Medicaid.

 



Spend-down Medicaid is a month-to-month insurance policy. Every month, the individual has to provide proof of their income to Medicaid and proof of that month’s medical expenses. Medicaid uses a formula to determine what percentage the individual has to pay and then Medi-caid pays everything above and beyond that. “The problem is finding a doctor, hospital or clinic that will treat such an individual without making them pay 100 percent of the cost up front,” Good said. “If they could afford to pay 100 percent of the cost up front, they wouldn’t need Medicaid. They would be self insured.”

Other Insurance Needs

Patti Johnson of Richmond, Va., who is retired from the Department of Defense because of disabilities related to Hepatitis C Virus, said she has not had any problems with her health insurance, but she did run into a brick wall when trying to get insured on a car loan. “It wasn’t that big a deal, and I could understand why they would object because, really, I wouldn’t be a good risk. It would drive everybody’s rates up if a whole bunch of people who were really, really sick got insurance and then died, and they had to pay. I can kind of understand it from their point,” she said. “If it was health insurance and I was trying to get it, I probably would have raised hell. When you are sick, you have to have health insurance. There is no way I would be able to pay for any of my health care right now if I didn’t have health insurance.”

Cindy Harrington of Ashville, N.C., said she counts her blessings every time she thinks about the life insurance policies she and her husband took out right before she was diagnosed with Hepatitis C Virus. “Three or four years ago we took out a life insurance policy for $100,000 each for my husband and me. When we were talking to our agent a few months ago he said there was a clause that if you transferred over to a whole-life policy during the first five years they couldn’t hold any pre-existing stuff against you,” she said. After her agent double checked on the clause, she was able to convert the 10-year term-life policy over to a whole-life policy with her preferred rates. Now, because of her disease, she is extremely careful that she makes the premium payments, for fear that the policy should lapse.

“No matter what, that’s got to be a first priority out of everything because I just know I won’t ever be able to get it again,” she said. “We have seven children between the two of us and it’s important to have.”

Making the premium a priority is precisely the advice Craig Casey would give. Casey, whose company caters to people who are turned down for coverage, said keeping a policy in force is paramount for people who later learn they have a chronic disease like Hepatitis C Virus. “That would be a horrible mistake,” said Casey of letting a policy lapse. “There are several things you can do to try and keep your policy in force, whether it is whole life or a burial policy. If you have some cash value, you can have them take money out of the cash value to pay the premium. You want to keep that policy going if you have hepatitis, because virtually everywhere else you go it is going to cost you more. If you have insurance through your employer, try to convert it if you ever leave your employer.” For those who did not have a policy in place before they were diagnosed, all is not lost, Casey said. Workplace plans are frequently available and professional associations often have some life insurance options available to members. These are typically group life plans that have a limit of $50,000 in death benefits and are not usually transferable if the job or association membership ends.

Other options on the individual market include easy-issue and no-questions-asked policies, which have death benefits of $25,000 or less and may include waiting periods before a benefit will be paid. “Anybody still living can get life insurance,” Casey said, adding the price, the term and the amount of benefit are greatly affected by chronic disease.