By Jan Greene
This may be a foolish thing to do, but I'm going to publicly discuss my lower back problems. This is dangerous because I buy my health insurance on the individual market, which means that anything that places me in a category of undesirable risk could make me uninsurable in the future. But what's happening to me is not uncommon and raises interesting questions for consumers.
I've been buying my own health insurance for the past five years or so. My premiums have doubled in that time; to some extent it's because of my age — I'm 47, a time of life when medical expenses tend to creep up. But premiums for everyone have also been rising at the same time.
Like an increasing number of Americans, I have a high-deductible health insurance plan. I pay $2,500 before the 70 percent coverage for most things kicks in. There are exceptions for many prescription drugs and a certain number of doctor appointments. But for both of the past two years I've spent that deductible and more because of what seemed like relatively routine medical tests that turned out to be really expensive even after the insurance paid its part.
So I sought out help from an insurance broker to see if I could get a better deal. I'm healthy, except for some chronic low-back pain that I deal with on my own with exercise and stretching. The broker, though, said I could not qualify for a lower deductible/higher premium plan because I've had a diagnosis of degenerative disk disease. This sounds rather dire until you realize that the medical world views this dwindling of the pads between the vertebrae as "a natural process of aging" that affects the majority of people over age 50.
But to insurance companies, the chance that a person with low back pain will seek out expensive surgery or long-term physical therapy appears to be such a terrible risk that they don't want to give insurance to people with that diagnosis, or at least not without a big spike in premiums. A friend of mine went through a similar process, seeking to buy better coverage from her existing insurer, and was turned down because she once sought very short-term treatment for insomnia.
So the message seems to be that if you want to stay insured you should never use your insurance. I've certainly avoided asking my insurer to help me pay for physical therapy appointments for my back, which I use every so often, or consultations with mental health professionals when my emotions need a tweak, such as after my mom died a couple of years ago. Why put red flags on my record for a measly $30 payment, which covers barely a third of the cost of the appointment?
Theoretically, though, even if I pay for those kinds of things myself, my insurer expects to know about it and take it into account if I ever apply for a better plan or ask a different company to insure me. It would be nice if they could take into account the fact that I'm only going to make claims for the bigger things I can't afford and that they can negotiate good rates for, given their clout in the marketplace. But these are large corporate entities that don't flex well to account for individuals and their problems.
I'm interested in hearing from other people about whether you carry out stealth healthcare, paying out of pocket even though you're insured, so you don't make waves with the insurer. In California this has become a big issue because several of the big insurers have been accused by state officials of finding flimsy excuses to cancel the coverage of people who make substantial claims (because they're particularly sick). It's scary out here, and getting more so. As a journalist I don't like to advocate one way or another, but I do get chills when I hear free-market supporters talk about how the marketplace is the best way to provide health security. I have my doubts.