What to do about health insurance rate increase?

March 14, 2008 4:40 PM

Should I appeal a rate increase or just try to find a new health insurance provider?

I was without health insurance for several months. When I applied for coverage, a representative was sent to my work place to take my height, weight, blood pressure, etc. They also gave me a urinalysis to test for HIV and also drug use. I was completely unprepared, and consequently tested positive for marijuana use. Ironically, the test was administered at my lowest/least frequent point of drug use in perhaps the past ten years. Nevertheless, pot can show up for about a month, so I got hit with a $45/month rate increase.

I can appeal the increase, but will have to submit a five year medical history. I'm fairly certain that I've admitted marijuana use to various doctors in the past five years, so I imagine that will be in my medical records. I also had a drug test conducted on myself (to 'practice' for a potential test at work) which I failed for cocaine, but not marijuana (which was also a total surprise, since the cocaine use was weeks before the test, but marijuana only two or three days). I also had some medical issues a few years back with my spine that I'd rather not have show up as a pre-existing condition. Since they were several years ago, but less than five, I'm able to honestly negatively answer any questions about pre-existing conditions, but if they see it in my medical history, I may be screwed.

I really can't afford the additional $45/month. I lead a fairly healthy lifestyle, and have abstained from all drugs since the rate increase. If I have to take a drug test at this juncture, as part of the appeal or for new coverage, I will almost certainly pass.

Should I file an appeal, or just try to find a different policy? If I apply for coverage with a new outfit, will they contact my current provider and find out about the failed drug test? Is there any way to beat this, or do I just have to suck it up and pay?

posted by anonymous to Health & Fitness (13 answers total)

I think the reason no one is touching this is that it's Friday and the question is about health insurance, not "Should I break up with my abusive boyfriend?" or "How do I program some obscure thing in flash?" Health insurance is a complete racket, so I say fuck 'em. If the insurance isn't connected to your work, then switch companies. Seek out a company that doesn't require a physical. I can only speak about California -- here, there are many insurance companies that don't need a physical, and mine, Kaiser, doesn't even check your past medical records. Obviously, lay off the blow, and less obviously, ignore the JudgeMeFi contingent who bitch at you about your drug use when that's only tangentially related to your real question, which is specifically about health insurance.
posted by incessant at 7:14 PM on March 14, 2008 [2 favorites]

I would contact a health insurance broker and ask them to get you quotes from companies that don't do a medical exam. However, if you leave something out on your self-reported health history when completing the application, and later you need to be treated for something related to whatever you left out, the insurance company might investigate your medical records and deny you coverage for the current related health issues since you didn't disclose it as a prior condition. Again, ask a broker for advice (I'm not an expert, and laws and the health insurance market varies from state to state).
posted by Jacqueline at 7:31 PM on March 14, 2008

Mod note: few comments removed - want to talk about the dangers of drug use? go to metatalk and talk all you want.
posted by jessamyn (staff) at 8:40 PM on March 14, 2008 [2 favorites]

I'm fairly certain that I've admitted marijuana use to various doctors in the past five years, so I imagine that will be in my medical records.

If you're in the US, if a doctor has disclosed or does disclose elements of your medical record to insurance company reps, or any third party, without your consent, that doctor is open to legal liabilities (see Health Insurance Portability and Accountability Act, more commonly known as HIPAA).
posted by Blazecock Pileon at 10:38 PM on March 14, 2008

If you're in the US, if a doctor has disclosed or does disclose elements of your medical record to insurance company reps, or any third party, without your consent, that doctor is open to legal liabilities

Among the many papers one signs at their doctor's office (and with their insurer) are HIPAA waivers that allow doctors to provide insurers with pertinent medical information. HIPAA is a great thing in theory. In practice, though, you really can't get anything done unless you have first signed a few HIPAA waivers. Insurers also share claims databases that they can refer to that don't fall under HIPAA mandates since they aren't, per-se, "medical" information. They are financial records from which, coincidentally, they can discern medical issues.

What does that $45 increase raise your rates to? It's hard to evaluate whether it's a punitive increase or a more "standard" annual rate increase without knowing what you're paying in total.

If you are buying your own health insurance, you should always be shopping for something better. The reason being that, no matter how good your current policy may be, it will steadily get worse/more expensive with each annual rate adjustment. Your rates will go up, regardless of your usage. You may have to take-on larger deductibles to keep your rates affordable. Or both. That's just the way it is.

You are actually lucky your insurer didn't outright cancel your policy. Aside from the downside of not having coverage, being denied coverage (or having coverage cancelled) is a big red flag for other insurers. You may have seen the question on most insurance applications..."Have you ever been denied insurance coverage?". Answering "Yes" can open a huge box o' problems in terms of getting affordable coverage. It's akin to having a lapse in coverage. It opens you to minute scrutiny of your life's medical history.
posted by Thorzdad at 6:46 AM on March 15, 2008

There's a couple of things that are pretty confusing about what you've laid out here. I assume that you're buying individual coverage, not getting it through your employer--because if you were offered health insurance through your employer (they pick the plan, they withhold the premiums from your paycheck) then it's against federal law for them to do any sort of individual medical underwriting or test you for health status. So if the situation is that you're taking up coverage that your employer offered, and they sent someone to your office to take some medical measurements, then increased your premiums by $45 (but not the premiums of everyone in the company), then this is the sort of thing that should have you calling up your state Department of Insurance to give your company a very, very stern talking-to. In that situation, you should be able to find resolution where you don't have to pay the extra $45 unless everyone does.

If you're buying individual coverage, you have very few protections. However, this varies significantly from state to state, and it's almost impossible to answer what your best course of action might be without knowing where you are. (Perhaps you could email one of the mods?) Some states have laws known as "guaranteed issue" in the individual market, which means that they have to sell insurance to anyone who applies. I have a sneaking suspicion that might be the situation where you are, because otherwise I can't imagine an insurance company being willing to take anyone on as a customer who tested positive for drugs. (Nothing about drugs in particular; insurers are just loath to insure anyone in the individual market unless they're the picture of health, and sometimes not even then.)

Also, I'm a bit concerned about your statement about your spinal problems:

Since they were several years ago, but less than five, I'm able to honestly negatively answer any questions about pre-existing conditions, but if they see it in my medical history, I may be screwed.

I urge you to be VERY, VERY cautious with deciding that you can "honestly negatively" fail to disclose those to your insurance company if you're applying for individual coverage. Does the form asking about pre-existing conditions specifically say that you don't have to disclose anything that far back? You should be aware that insurance companies in the individual market can retroactively cancel your policy if they find out you lied. It's pretty much in their best interest not to dig too deep when people initially report, and only follow up with serious investigations once you get, oh, cancer or something. If they find out you lied about anything, even something unrelated to the huge medical problem you have at some point in the future, they'll say, "Too bad! You lied, our contract is void, and we're not covering anything," and you'll be seriously screwed. (They don't refund your back premiums, when this happens. It's one of the worst things that can happen when you get insurance, and you *really* don't want to be on the receiving end.)

Given everything you've said, I really urge you to: (1) email one of the mods to let them know what state you're in, so we can give you some state-specific resources about your protections and maybe point you to people who can help; or (2) talk to an insurance broker. This is complicated stuff, and an insurance broker can give you some good advice about whether failing to disclose your spinal problems might be putting you in for a world of hurt later, and what your other options for switching insurance coverages are.
posted by iminurmefi at 8:12 AM on March 15, 2008

Anonymous, my take:

This isn't meant to be sarcastic or rude (check my profile) If you can't afford $45 a month for health insurance, then how do you pay for the drugs you're buying?

You're not going to bet a better deal on personal health insurance: You and your company probably pay a discounted premium because you're effectively buying in bulk.

My advice: Eat the cost of the health insurance hike (explanation follows below) and find a professional psychologist, counselor, social worker, etc. to help you figure out why you're taking the drugs in the first place. Then when you get off the drugs and work for a new company, you won't be back here asking this question again.

Hey, iminurmefi,

A couple things worth addressing:

if you were offered health insurance through your employer (they pick the plan, they withhold the premiums from your paycheck) then it's against federal law for them to do any sort of individual medical underwriting or test you for health status.

I don't think that's necessarily accurate. If I'm understanding correctly, this is an employee who was previously uninsured. When he was eligible for coverage through his new employer, the company had him complete a standard medical profile/risk assessment (standard procedure with managed care, no matter how you get it). Because he had been without insurance for more than, say, 1-2 months, the insurance company asked him to submit to a medical examination by a physician (another standard procedure given the circumstances).

The insurance company has a pretty big stake in insuring him because he uses marijuana and narcotics, which means he is considered at a greater risk for health complications. Also, if Anonymous decided he was an addict and needed to go to treatment, Somebody (ahem, insurance company) is going to pay out a HUGE cost for his care. The $45/month is probably a pretty modest hike compared to the risk they are taking on agreeing to cover him. He's lucky that they're not just denying him straight away.

Best of luck, Anon, from the bottom of my heart.
posted by mynameismandab at 9:49 AM on March 15, 2008

When he was eligible for coverage through his new employer, the company had him complete a standard medical profile

That should say, the Insurance Company had him complete a standard medical profile...
posted by mynameismandab at 9:55 AM on March 15, 2008

mynameismandab--The relevant federal regulation for group plans offered through an employer is HIPAA. The nondiscrimination requirements contained in HIPAA are one of the key protections for consumers that make it almost always a better bet for people to get a group health insurance plan rather than an individual plan (that is, one bought in the open market rather than through an employer)--in general, they require that employers treat similarly-situated employees exactly the same with respect to their health insurance coverage, and in particular prohibit companies from doing things like charging employees different premiums based on health status (although they could charge all part-time employees a different premium than all full-time employees).

The Department of Labor has an overview of the nondiscrimination requirements for group health insurance through employers here. Based on the way that the OP describes their problem, I think it's likely that this isn't group health insurance being offered by the employer--I was just throwing it out there because I thought it sounded weird for an insurance company to send someone to the OP's office without the OP knowing they were coming, and that almost makes it sound like the insurance might have been arranged through the company.

I'm not a health insurance lawyer, and it's possible that there's some reason (if this is a group health insurance plan) that the OP's workplace isn't subject to HIPAA. But if the insurance is a group health insurance policy, I think the best thing for the poster to do is to contact their state department of insurance to follow up and make sure that the company isn't trying to do something illegal--the people in that department will generally be able to make a determination about legality, and in my experience many state insurance departments have hotlines or people specifically hired to help citizens in situations like this.
posted by iminurmefi at 10:53 AM on March 15, 2008

From the above-referenced website:

Can plans exclude or limit benefits for certain conditions or treatments?
Group health plans may exclude coverage for a specific disease, limit or exclude benefits ...if the benefit restriction applies uniformly to all similarly situated individuals and is not directed at individual participants or beneficiaries.


Anon, if you are questioning the legality of the premium increase, you need to start by asking the insurance company whether they charge all users of illicit substances with the same plan a $45 monthly (or comparable) fee. If they say no (which is unlikely), then you may make a case against them to under HIPAA. Otherwise, they are compliant with the law.
posted by mynameismandab at 1:30 PM on March 15, 2008

Well, the case against anybody would be against the employer, not the insurance plan, as it's the employer who would be violating the law. And under HIPAA, a plan may exclude a certain benefit for all similarly-situated employees, but "drug-using employees" is not a similarly-situated group, as it's based on health status and not "bona fide employment-based classification consistent with the employer’s usual business practice."

Anon, if this whole exchange shows you anything, it should be that the laws regarding what plans are allowed to do with regard to premiums is complicated and very dependent upon many things you haven't included in your post. If this is a plan offered through your employer, you typically have many, many protections about what premium increases are allowed and you should definitely contact your state Department of Insurance. You don't have to say that your company is charging you more because of drug use, but you could inquire about whether your company is allowed to charge you a different amount in premiums compared to other workers based on medical tests you had to undergo before obtaining insurance. They should be able to tell you whether your employer is subject to HIPAA.

If your company is not the one offering you this insurance--if you went directly to the health insurance company and applied for coverage--the sort of protections you have are dependent on the state in which you live. This set of guides might be a good place to start looking what sort of protections you have in the individual market and how likely it is that you can get insurance easily through other companies. A health insurance broker would be another good person to talk to about how likely it is that you would find comparable insurance for the same price or cheaper than your plan now.
posted by iminurmefi at 2:01 PM on March 15, 2008

If you can't afford $45 a month for health insurance, then how do you pay for the drugs you're buying?

It's not $45 a month -- it's a $45 a month increase from what he's currently paying. Big difference.
posted by incessant at 3:33 PM on March 15, 2008

"You should be aware that insurance companies in the individual market can retroactively cancel your policy if they find out you lied. It's pretty much in their best interest not to dig too deep when people initially report, and only follow up with serious investigations once you get, oh, cancer or something. If they find out you lied about anything, even something unrelated to the huge medical problem you have at some point in the future, they'll say, "Too bad! You lied, our contract is void, and we're not covering anything," and you'll be seriously screwed."

In fact, there's been a big case here in California of insurers doing exactly that, including having low-income folks fill out reams of forms quickly, to try to increase the number of errors.

Which is tangential to the OQ's problem, but it is something to keep in mind when discussing health-insurance disclosure.
posted by klangklangston at 9:57 AM on March 18, 2008