Magazine article Clinical Psychiatry News

Coverage Varies Widely across Insurance Market

Magazine article Clinical Psychiatry News

Coverage Varies Widely across Insurance Market

Article excerpt

The decisions of who qualifies for health insurance and how much they should pay for it are as individual as the people who review the applications.

Despite reforms in several states, the individual insurance market is highly variable and difficult to navigate, even for people in relatively good health, according to a study by the Henry J. Kaiser Family Foundation.

The study's authors--Richard Sorian and Karen Pollitz, both of Georgetown University's Institute for Health Care Research and Policy, and Kathryn Thomas, an insurance industry consultant--based their conclusions on the decisions of 19 insurers who were asked to assess seven hypothetical insurance applicants: "Alice," a 24-year-old waitress with hay fever; "Bob," a 36-year-old consultant with a college knee injury; "Carl," a 36-year-old married father of a healthy daughter and a son with asthma; "Denise," a 48-year-old actress and 7-year breast cancer survivor; "Emily," a 56-year-old widow with "situational" depression; "Frank," a 62-year-old retired salesman who has hypertension, is overweight, and smokes; and "Greg," a 36-year-old freelance writer who is HIV-positive.

The researchers looked at the individual market in eight different geographic areas ranging from large urban centers such as Miami to small towns like Corning, Iowa. They submitted 60 applications for each applicant for a total of 420 submissions. The study was structured so that none of the applicants was in a category that would have guaranteed them coverage under current federal law.

With the exception of "Greg," "these patients' houses were not on fire," Mr. Sorian said at a Washington, D.C., press briefing. "They were not in active treatment for [diseases engendering] high medical expenses. Yet we saw denials at both ends of the spectrum."

Six of the seven applicants were rejected for coverage at least once, and the rates of denial varied widely "Alice," the 24-year-old waitress who had hay fever but was otherwise in excellent health, was denied coverage 8% of the time. …

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