How can I get health insurance even though I have ulcerative colitis?

August 1, 2007 2:25 PM

How can I get health insurance even though I have ulcerative colitis?

I was diagnosed with ulcerative colitis the summer following my freshman year of college. Flash forward four years. I still have it and require daily medications to keep it under control but recent colonoscopies have shown things have not changed for the negative or positive.

I have run my own business for years but upon graduating college and coming off of my parents' insurance plan, I was unable to obtain any health insurance when seeking it directly as an individual due to my condition (I tried all of the big companies). Approx. 1 year ago I took a full time job just to gain health insurance (pay was good too).

Well, the job is a mess and the company lacks direction, so I want to part ways with this company fairly soon. I am torn as to what to do, as my business still does well on the side and I would be able to support myself if I returned 100% of my "work" time to it.

With UC, not having insurance is not an option. It gets expensive really fast.

So, if I did insurance through my business (with only me as the employee, but it is a fully formed LLC) could I bypass the normal underwriting BS that gets me denied on a personal level? Or is there an insurer out there that will accept me with my UC? Or do I just need to find a less stressful position at another company to keep me insured?

Please help me as the job stress doesn't make the condition any better and I really don't want to feel so exhausted and down anymore. I want to run my business but I must have insurance.

And yes, I know nothing says the next job won't suck too if I have to go that route, but almost anything would be better than this mess.

posted by anonymous to Health & Fitness (19 answers total)

At worst, check into your state's high-risk health insurance fund. The premiums may be prohibitively high, though - I certainly can't afford them here.
posted by dilettante at 2:35 PM on August 1, 2007 [1 favorite]

I second checking the high-risk insurance fund. My wife is on it - the premiums are expensive but it would be far worse to go without insurance.

As far as I know, the cost of insurance for businesses revolves around the overall health of its employees. If you have a single employee(you) with health issues, your business may be expected to pay a higher premium. I'm not 100% sure; I last researched this a few years ago.

Here is a similar ask thread of mine.
posted by neilkod at 2:41 PM on August 1, 2007

Oh yeah, when I posted the above thread, my premium was $360/month - it shot up to $490/month in this short little while; its worth every penny.
posted by neilkod at 2:42 PM on August 1, 2007

My suggestion is to do what far too many of your fellow citizens do. Namely, stick with a crappy job for the health coverage. Really, unless you can jump to a job with a different employer, you're pretty much hosed. I don't think the trick with your own company will work. I'm pretty sure the insurers have that loophole closed, somehow.

Dilettante is right about checking with your state's high-risk pool (though, I think the hurdles for qualifying are quite high. In some states, you have to be denied coverage by insurers first. Possibly multiple times. YMMV)

I'm really sorry about your situation. I know it can make a person crazy.
posted by Thorzdad at 2:44 PM on August 1, 2007 [1 favorite]

I truly feel for you. I was diagnosed with UC just after college and spent a week in the hospital as a result. Fortunately, I've not had a flare up since then and don't require medication (I am, however, continually on the lookout for symptoms).

Because it's a chronic condition that can requires ongoing (and expensive) medications and the definite possibility of surgery insurance companies won't touch you (I realize you've figured this out already).

While freelancing and dabbling in a small business with a friend of mine, I was only able to get catastrophic coverage that did not include anything that might result from my UC.

So I left my pal and the potential business behind and took a full time job. It's the only way I could get the benefits I might need. Sadly, I suspect it's the only solution that will work for you.

But if you do find a better option I'd love to hear about it. I'll definitely be the first in line.

My email is in my profile should you wish to commiserate about UC, lousy insurance coverage or anything similar.
posted by aladfar at 2:47 PM on August 1, 2007 [1 favorite]

You can also move to Massachusetts or another state where insurance companies aren't allowed to deny plans to people because of preexisting conditions.
posted by alms at 2:57 PM on August 1, 2007

A lot of professional organizations also cover members, which makes being a consultant or small business possible for those people in the US that aren't healthy enough to be profitable for the insurance companies to underwrite.
posted by kcm at 3:00 PM on August 1, 2007

As a one-person (or two, or five) company, you'll generally be underwritten individually -- meaning questions and health exams. The larger your group, the less likely insurance companies are to mess with all of that, trusting on the large size to average out their risks. In some states, Texas for one, you can form a coalition with other small employers that will then be considered a large employer. That organization will be underwritten as a whole, meaning you get to have the benefits of a group policy while still being self-employed.
Even if you can't/dont want to go that route, you should look into COBRA eligibility on your current group plan. It is probably cheaper and/or better than your state's high risk pool, although HRP is better than nothing.
posted by katemonster at 3:03 PM on August 1, 2007

I may be missing something, but why not extend your current employer-sponsored group coverage through COBRA? It will be expensive, but you can do it for up to 18 months, which ought to be adequate time to find another job with group coverage, at which point you should be eligible (under HIPAA rules) to join their plan without regards to your pre-existing condition.

It's awful, but having a serious pre-existing condition under the U.S.'s hellish health insurance situation can and does place limits on millions of people in terms of the options they can exercise in terms of making a living. It's one of the major reasons I will probably never go freelance full-time -- getting individual coverage would be either impossible or prohibitively expensive.
posted by scody at 3:06 PM on August 1, 2007 [1 favorite]

Re: professional organizations:
I looked into this as well and discovered that most of these arrangements amounted to no more than a special group-pricing deal with one particular insurer.
And, while the "come-on" prices were okay (more or less), I still had to go through the normal underwriting and disclosure as if I were buying the insurance as an individual, subject to the usual dis-allowances and upward rate-adjustments.
posted by Thorzdad at 3:08 PM on August 1, 2007

alms: is that really true in Mass? They cannot deny you coverage based on preexisting conditions? Can they effectively do it by charging you a prohibitive assload?

good luck poster - you're in the same conundrum millions of us are! woe.
posted by xmutex at 3:11 PM on August 1, 2007

I've encountered some people who took part time jobs while running a business of their own specifically to get health coverage. In particular, I hear Home Depot is good for this although I know nothing about their benefits myself.
posted by yohko at 3:53 PM on August 1, 2007

Starbucks has health care benefits for part time workers as well.
posted by availablelight at 4:39 PM on August 1, 2007

I have UC and the high-risk pool saved my sorry ass while I was in law school. It is a must and is worth every penny, as someone said.
posted by Saucy Intruder at 5:10 PM on August 1, 2007

I believe you misunderstand what "insurance" is. It's a risk pool where everyone pays in a small amount, and an occasional low-probability but high-impact event causes a lot of money to be paid out to the unlucky one. The essential characteristic of insurance is that the majority of people who have it pay more than they get, and the amount paid out approximately equals the amount paid in. (It isn't exact. The insurance company takes some of the money to pay for its expenses, and it also invests the pool money which yields profits. Whether the payout is greater or less than the premiums paid depends on the company.)

Based on that definition, you're not really looking for insurance. What you're looking for is a subsidy. When you say you want "affordable insurance", what you're really saying is that you want the insurance company to charge you less than your medical treatment costs. You want them to take a guaranteed loss on you.

But that's not insurance -- and it isn't good business for the insurance companies. They're not charities.

A "high risk" pool means that the likelihood of a big payout per participant is higher. That means that everyone who's in it must pay more. Payouts still approximately equal premiums paid in, but since there's more common and larger payouts, then premiums are higher.

But for someone like you, for which payouts are certain, even in a high risk pool you're going to pay in premiums more than your treatments cost.

...at least, if you're trying to get individual insurance.

That's why the advice given to you above is right, sadly: suck it up and continue working for a corporation. You'll never get what you're looking for (insurance a subsidy) in individual coverage.
posted by Steven C. Den Beste at 5:57 PM on August 1, 2007

SCDB: state high-risk pools are subsidized.
posted by dilettante at 6:34 PM on August 1, 2007

But that's not insurance -- and it isn't good business for the insurance companies. They're not charities.

And that is the essential problem with insurance companies. The missions of providing the best healthcare possible and making the most money possible are completely incompatible.

COBRA or the high-risk fund may help, but your best bet is to stay with the company until you get something else lined up.
posted by chrisamiller at 7:02 PM on August 1, 2007

One other option would be to get married and obtain insurance through your spouse. I'm sure people have wed for worse reasons.
posted by Violet Hour at 12:31 AM on August 2, 2007

Anonymous, it would really help to know what state you're in, if you'll email one of the mods. Massachusetts is not the only state that prohibits companies from looking at health status when underwriting insurance. There are a number of other states with similar laws, like New York and New Jersey. The words you're looking for on your state insurance department website are "guaranteed issue"--meaning companies are not legally allowed to turn down anyone who applies for insurance--and "community rating"--which means insurers are only allowed to take a limited number of characteristics into account when deciding what they'll charge you, such as age and gender (but generally not health history).

Another thing to look into on your state insurance department website is the laws regulating small group insurance. Some states require insurers in the small group market to offer guaranteed issue or community rated insurance; some of these states also allow a small group of one person for self-employed people, although you generally have to show tax records to prove you're a business.

A better sense of what state you live in (and whether you'd be willing to perhaps move a state or two over to get health insurance) would help people find you resources.
posted by iminurmefi at 6:26 AM on August 2, 2007