Big Brother Health Care?

May 17, 2011 4:35 PM

What kind of recourse do I have when my company's new health insurance will be charging me if I don't take a biometric screening and health assessment?

Just got a letter in the mail from my (US) company's new health insurance provider that "encourages" us to participate in two programs:

1. Biometric screening
2. Health assessment

"We are asking you to participate in order to establish a baseline from which we can measure how well the programs are assisting our employees and their families."

This letter gives me the heebie jeebies about the medical and health information that will be collected and (presumably) used to compare against in the future. A previous question makes me worried that my insurance rates may increase if I don't show some kind of "progress" with regards to BMI, LDL, non-fasting blood sugar and blood pressure.

To top it all off, if I don't participate, they will charge me over $200 a year extra in insurance premiums.

Ack!

I am a healthy, non-smoking 30yr old woman with no kids and no prescriptions who exercises and eats well - can I just drop the insurance plan and pay my health costs when I incur them? If I do this and decide to get on health insurance again in the future, how would this lapse in coverage affect me?

This is a very large company, so I doubt that me arguing with HR will make much of a difference.

Am I overreacting? Please help give me some perspective and advice!

posted by jillithd to health & fitness (28 answers total)

Don't lapse your coverage. That's the worst thing you can do.

Is your privacy worth $200 a year? I'd look at it that way.
posted by St. Alia of the Bunnies at 4:42 PM on May 17, 2011 [3 favorites]

Is the insurance company actually charging you a fee for non-participation, or are they offering those who participate some sort of discount. This could make a big difference regarding how sound this practice is.

In regards to your insurance, I would say that $20 a month extra is well worth having health insurance. Being diagnosed with some serious and common (like cancer) is not something that you will be able for out of pocket. Even modest treatment for a serious illness can easily lead to bankruptcy.
posted by Nightman at 4:43 PM on May 17, 2011 [1 favorite]

They are actually charging a "Non-Participation premium" of $208/year.
posted by jillithd at 4:45 PM on May 17, 2011

Upon review, I'm mortified by the typos. However, my main point is that the extra cost to you is likely worth the benefit of having coverage in the event of a major illness.
posted by Nightman at 4:47 PM on May 17, 2011

Keep the insurance, but ask for a $208 raise.
posted by ifandonlyif at 4:50 PM on May 17, 2011 [7 favorites]

I really sympathize but if it turns out to be the difference between having insurance or not, always have insurance. The other posters are right, your health is worth $200. Be outraged, but be insured. I'm Australian and am continually astounded by what Americans have to go through to get decent healthcare. Google around and make sure that what they're doing is even legal. If they're a big company, you won't be the only disgruntled customer.
posted by Jubey at 4:55 PM on May 17, 2011 [2 favorites]

I'm a big privacy freak but doesn't the insurance company already have access to all your medical records? You don't seem to be in any big risk group like being overweight or smokers so I don't think that the tests will have much effect on you. I'd be tempted to go ahead and do the tests but if you're still gun shy, stall and see what happens when someone else does it. If it's not much, take the plunge. If it's all big brother, pay the extra money. Don't go uninsured. You're still in the healthy age group more or less but I noticed people starting to have health problems when they hit 35-40 and it's a nightmare to get insurance then.
posted by stray thoughts at 5:05 PM on May 17, 2011 [2 favorites]

What they're doing is legal. We just went through a big fight about this with my husband's company.
posted by anastasiav at 5:06 PM on May 17, 2011

What recourse do you have?

None. Zero. Zilch. Your choices are to either participate or pay. Or find a new job. Employers have unilateral discretion to add, remove, or modify benefits packages unless there is a specific contract specifying otherwise, and there usually isn't.
posted by valkyryn at 5:08 PM on May 17, 2011 [2 favorites]

Wow anistasiav. That really sucks. I guess the OP has a few choices then. Pay extra, have the test, get different insurance or quit insurance altogether. I would pay extra.
posted by Jubey at 5:10 PM on May 17, 2011

Pay the $208 with righteous moral indignation, be privately grateful you have the financial wherewithall to make that choice, and never, ever let insurance lapse if you have any other options, ever.
posted by DarlingBri at 5:14 PM on May 17, 2011 [10 favorites]

Just as a data point, I'm a healthy individual who came down with pneumonia a few years ago. Totally unpredictable. I ended up in the hospital for 36 hours, all covered by my insurance, except for a small deductible. Had I not had insurance, it would have cost me $18,000. I would be very skittish about not having insurance given the possibility of large expenses like that. Plus if you have a lapse in insurance and do come down with something nasty, it may be hard do get covered for it ever, as it will now be a pre-existing condition.
posted by pombe at 5:21 PM on May 17, 2011

can I just drop the insurance plan and pay my health costs when I incur them?

That depends. Do you have several hundred grand to pay for cancer care? While I was going through treatment this past year, I met (either in person or online) more healthy, nonsmoking 30-somethings who exercised and ate well who were diagnosed with cancer than I could keep track of. Looking at all my insurance statements, the cost of a year of treatment came to nearly half a million dollars. Being insured, my out-of-pocket costs came to a tiny, tiny fraction of that.

And heck, forget cancer; do you have several hundred grand to pay if you're in an accident while exercising? A friend of mine broke his back while cycling; another friend broke his neck while playing hockey. The hospital and rehab costs were astronomical. One of them was fully insured, while the other one only had emergency coverage (which is more than you'd have). Guess which one of them is still paying his medical bills more than 15 years later?

If I do this and decide to get on health insurance again in the future, how would this lapse in coverage affect me?

If anything -- ANYTHING -- happens to you during your lapse of coverage for which you seek medical care and you try to roll onto a future employer's group plan (or even on to your current employer's group plan), you can be blackballed in a shocking variety of ways. Respiratory infection requiring a short course of antibiotics? Broken ankle? Getting diagnosed with a common, easily treatable thyroid condition? All of these, as minor as they seem, can result in coverage denial (either in part or entirely) in the future.

The health care system in this country is staggeringly fucked in a truly countless array of ways. It sucks that they have you over a $208 barrel, but better than barrel than many, many of the other barrels you can be put over for a single medical emergency.
posted by scody at 5:26 PM on May 17, 2011 [13 favorites]

There is a legal theory that these schemes violate the ADA's ban on unnecessary medical inquiries and examinations. See 42 U.S.C. section 12112(b)(2) (prohibiting covered employers from participating in contractual relationships that subject employees to prohibited discrimination), (d)(4)(A) (prohibiting employers from requiring medical inquiries and exams unless they are job-related and consistent with business necessity), (d)(4)(B) (permitting "voluntary medical examinations, including voluntary medical histories, which are part of an employee health program available to employees at that work site"). The argument would be that the assessments are not voluntary (and not at the work site), and are not required by business necessity, so they fall within the prohibition.

A person could submit to the screening or pay the money to access health insurance, but still protest the action as violating the ADA. A person aggrieved by a violation of the ADA can file a charge of discrimination with the EEOC.
posted by ClaudiaCenter at 5:37 PM on May 17, 2011 [6 favorites]

Reddit has sorta covered this problem before. (okay okay its not exactly the same. dont cancel your coverage, find a different provider.)
posted by tmthyrss at 5:40 PM on May 17, 2011

I am a healthy, non-smoking 30yr old woman with no kids and no prescriptions who exercises and eats well - can I just drop the insurance plan and pay my health costs when I incur them?

I'll be the lone dissent that says: yes, of course you can. I have gone without, for years at a time. You get significant "discounts" from most doctors and dentists when you're uninsured. (You likely still pay "more" but I haven't done the math.) And hospitals and emergency rooms will negotiate with you for reductions in cost... sometimes... depending on your income....

That being said, I am getting catastrophic insurance ASAP because Jesus, it's unnerving. What people are saying above is correct about being insured, but that doesn't mean it can't be done. I'm just glad I never [had x or y bad thing happen, knock on wood knock on wood].
posted by RJ Reynolds at 5:42 PM on May 17, 2011

I'm on Team "Sure You Can, But Don't."

This is mostly because of the potential for catastrophe, but also because I've found that on balance, my insurance company knowing more about me has actually helped me a little bit. They send me letters explaining additional benefits that might come in handy for me based on specific diagnostic codes my doctors bill under, and send suggestions on ways of keeping myself healthier. Which is a little creepy, but given how little ongoing attention I get from actual doctors, on balance I find it beneficial. I suspect strongly that UHC knows more about me than my primary care physician, for instance, and has spent more time thinking about my medical conditions (albeit in a automated way.)

And, my employer and I have saved money over the long run thanks in part to these kinds of programs. Insurance is a tricky business: your "30 year old super healthy no meds" data will probably save the entire group on premiums, in addition to your $208 personal savings. We got a discount (plus $25 gift cards) last year when people filled out health assessments, and I suspect that the data provided by those who cooperated also contributed to the difference in changes amongst our half dozen or so premium groups.
posted by SMPA at 6:02 PM on May 17, 2011

Pay the extra money, don't let the coverage lapse.
posted by winna at 6:02 PM on May 17, 2011

If you don't have any pre-existing conditions, you may want to look at private catastrophic coverage rather than a group plan. It will likely still cost more.

But remember that you are in a privileged position. Do not give it up.
posted by freshwater at 6:17 PM on May 17, 2011

My employer offered a $200 incentive for doing this, and participating in healthy activities. The signup website sucked, so I called the health promotion company. I found their security less than adequate, so I forfeit the 200 clams. I do not trust them, but I am paranoid and cranky.

Do not give up insurance. Either pay the 208, or suck it up and submit. Health insurance is worth a lot.
posted by theora55 at 6:36 PM on May 17, 2011

Nthing the importance of insurance. I was 30, healthy and uninsured when I was hit by a car on my bike and tore my ACL clean through, rendering me unable to walk or work. My parents literally wrote a check for $15,000 to pay for my surgery. I was living in the UK at the time and was unable to fly so that was the massive UK bargain compared to the costs of doing it at NYU Medical Center where my mother wanted me to go.
posted by DarlingBri at 6:49 PM on May 17, 2011

If you want the privacy pay the extra 208 dollars but, do not let your insurance lapse, you never know what could happen. I was 33 when I was diagnosed with kidney cancer, and thank goodness we had good insurance.

Hell, discounting cancer, I had a hospital stay for an infection that started as a scratch on my leg. We did not have insurance at that time. We will be paying that bill off for the rest of our lives.
posted by SuzySmith at 1:54 AM on May 18, 2011

In essence you (and your employer) are paying the health insurance company to make sure you stay healthy and to pay for expenses, yeah? The health insurance company is basically saying, 'You know what, it would be a lot easier and cheaper to keep you healthy if problems are caught early.'
posted by Caravantea at 2:58 AM on May 18, 2011

The argument would be that the assessments are not voluntary (and not at the work site), and are not required by business necessity, so they fall within the prohibition.

There may be a theory that argues that, but I have to say, it looks like a bad one from where this lawyer is sitting.

First of all, the examination here is not being made a condition of employment, nor will one's employment be affected adversely by the results of the test, so there's no real damages there. None that a court is going to recognize anyway.

Second, it isn't discrimination if it's being applied to anyone. To have a cause of action under the ADA, one needs to be able to argue that one is being discriminated against on the basis of something protected by the ADA, i.e. a physical disability of some sort. A uniform screening required of all employees which will not result in anyone being fired or have otherwise adverse action taken against them hardly counts.

If anyone wants to put this theory to the test, heck, lawyer up and see what they say. But if I were a plaintiff's attorney... I'd want the money up front.
posted by valkyryn at 3:15 AM on May 18, 2011

I think you're overreacting.
My employer just had its employees do the same thing for an $800 discount on insurance premium.
This is not about you, based on your youth and healthiness.
A new trend in health insurance is employee wellness programs. These are intended to improve the health of the 20% of individuals that drive 80% of health costs. (this is a widely held belief in my workplace. I work in healthcare)
If an employer provides wellness resources to employees to improve the health of employees at risk for "preventable" health issues like type 2 diabetes, heart disease, smoking, obesity, premiums will go down for your employer as the cost to insure a healthy pool of employees is lower. Wellness resources are things like an employee gym, weight watchers groups on site, smoking cessation classes. All voluntary.
To get the same level of benefit that you have now (group plan) in an individual plan would cost you much more than $208 (on top of you current premiums).
This is about the insurance market, not your employer.
posted by natasha_k at 4:32 AM on May 18, 2011 [1 favorite]

Thank you all for your help in giving me some perspective! I appreciate all of the answers. :)
posted by jillithd at 6:47 AM on May 18, 2011

Update re legal claims against these programs -- Seff v. Broward County, --- F.Supp.2d ----, 2011 WL 1522558 (S.D. Fla. 2011) was decided on April 11, 2011. Summary judgment was in favor of the employer, and granted against the employees.
posted by ClaudiaCenter at 9:51 AM on May 18, 2011

jillithd, I just wanted to post to commiserate. Our big national insurance provider just did the same thing to us, and our "incentive" to participate was a $1300 non-participation fee. Yes, I just typed two zeroes. Thirteen HUNDRED dollars extra per year if we didn't agree to the health questionnaire and blood panel.

Now, our provider is pretty awesome, and I do a little "thank god for my awesome insurance" dance any time I need a procedure or test or prescription. So the privacy part bothers me but I was prepared to suck it up.

I was mostly mad because Insurer originally presented the assessments as totally optional—and it was only after a company HR person alerted everyone that we only had three days to get the bloodwork done in order to meet the deadline, that we learned about the $1300 fee.
posted by pineapple at 12:31 PM on May 18, 2011