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Denials up amid large health insurers-US lawmakers

Source: Thomson Reuters Foundation - Tue, 12 Oct 2010 08:57 GMT
Author: Reuters
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* Investigation shows denials for individuals on the rise

* Denials for preexisting illness up nearly 50 pct

* Probe targeted Aetna, Humana, UnitedHealth, WellPoint

* Insurers use pregnancy to deny coverage

* Law does not ban such denials until 2014 (Adds industry comment, consumer group reaction, background, shares)

By Susan Heavey

WASHINGTON, Oct 12 (Reuters) - Coverage denials of individuals based on their medical histories by the nation's top for-profit health insurance companies rose by nearly half in recent years, U.S. lawmakers said on Tuesday.

The findings raise questions about industry practices before a law to prevent such discrimination kicks in in 2014.

In a report released on Tuesday, the House Energy and Commerce Committee's top Democrats said the number of people refused health insurance plans by big insurers Aetna Inc<AET.N>, Humana Inc <HUM.N>, UnitedHealth Group Inc <UNH.N> and WellPoint Inc <WLP.N> due to pre-existing conditions rose 49 percent in the last three years.

The denials affected tens of thousands of individuals seeking to buy their own insurance. In 2009, 257,100 could not get a plan compared with 172,400 in 2007, the committee said.

Overall, the insurers refused to sell plans to more than 651,000 individuals -- or one out of every seven applicants -- because of their medical history, Committee Chairman Henry Waxman and fellow Democrat Representative Bart Stupak said.

Health care reforms passed earlier this year would make it illegal to deny insurance based on such so-called "preexisting conditions," but so far it only protects children. Insurers do not have to change their practices for adults until 2014.

Additionally, the committee said the four insurers all considered pregnancy a preexisting condition to trigger automatic denial for a plan. Most also do not cover maternity care under policies issued to those not already pregnant, although some sell additional "rider" policies to cover pregnancy.

As a result, "women who are pregnant, expectant fathers, and families attempting to adopt children are generally unable to obtain health insurance in the individual market," the report found.

Changes to maternity coverage under the health care reform law also do not kick in until 2014.

In the meantime, consumers can try to buy coverage through a nationwide, temporary program that aims to help those with preexisting conditions find insurance until 2014.

Democrats used the findings to tout the new health law just weeks ahead of the midterm U.S. congressional elections. But some consumer advocates said there is little relief for the next three years for people who do not get insurance through an employer or government programs.

"We will continue to see an insurance market that does not allow people to get in," said Steven Findlay, a senior health policy analyst at Consumers Union. "Some companies may try to clean up their act a little bit," he said, but for the most part such denials are likely to continue unabated.

The America's Health Insurance Plans, which represents U.S. health insurers and largely fought the health care reform law passed in March, has said that companies must determine a potential customer's health beforehand to prevent individuals from seeking coverage only after they get sick.

"Health plans recognize that individuals with pre-existing medical conditions have difficulty obtaining coverage," AHIP spokesman Robert Zirkelbach said. (Reporting by Susan Heavey; Editing by Gerald E. McCormick; Carol Bishopric)

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