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Major Insurers Deny Healthcare Coverage, Seek Higher Rates

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A new government report finds that WellPoint Inc., Aetna Inc., Humana Inc. and UnitedHealth Group Inc. denied health coverage to 49 percent more people over the past two years, citing pregnancy or plans for adoption among the reasons for denial.

The insurers rejected 651,000 applicants from 2007 to 2009 for illnesses or conditions they had before applying for coverage, according to the report by the House Energy and Commerce Committee, led by Representative Henry Waxman, a California Democrat. Each company had a business plan to exclude pre-existing conditions, according to the report. The report cited internal insurer documents the panel obtained.

The report highlights why the provisions of the new health care law are so needed, among them a ban on insurers denying coverage due to medical conditions. The report forces Republicans to tell voters why insurers should be able to deny coverage to those who need it the most.

The companies turned down 257,100 people last year who sought to buy benefits on their own and not through employers, the House report said. They denied 172,400 applicants in 2007, the report said. Enrollment increased by 16 percent in that time, according to the committee.

Insurers agreed to end denials for pre-existing conditions early in the health-care debate last year, but the insurance industry argues that until all consumers are required to buy health insurance, the coverage restrictions are needed to keep people from gaming the system, he said.

One insurance company cited “improved pre-existing exclusion process” as a way to increase business, said the report. One of the companies had a list of 425 conditions that could be used to deny people insurance coverage, including pregnancy, diabetes and heart disease.

Other documents in the report showed that people who were surgical candidates, pregnant, female and “treated for infertility within the past five years,” and “any applicant with a (body mass index) 39.0 or greater” were denied health insurance without any internal review by the company. The committee obtained the documents in response to letters Waxman sent in March. The report didn’t specify the insurers that carried out the actions.

Because of the economy, healthy customers have been more likely to drop coverage over the past few years, leaving insurers with sicker customers more likely to drive up medical costs. The four insurers treat pregnancy as a pre-existing condition and generally don’t offer coverage to expectant mothers, the House committee said in a second memo that cited company documents.

Expectant fathers and those about to adopt are often denied as well, and documents show the companies have moved to limit the availability of riders that can be bought to add maternity coverage, the report said. One rider limited a woman to $6,000 in maternity benefits after she paid extra premiums for four years, the report said.

In company documents, executives said maternity coverage resulted in “higher prices, lower margins and loss of market share,” the report said. Another document said one insurer typically spent 90 percent of the premiums it collects on medical care for policies with optional maternity benefits, “a money-losing ratio.”

At least six major companies — including Anthem, Aetna, Cigna and Humana — have said they will stop writing new policies in Colorado for individual children not covered by their parents’ or other plans, insurance officials said. They blamed the new health reform mandates requiring companies that write such policies to also cover sick children up to age 19.

Some of the same insurers, meanwhile, have filed proposed rate increases with Colorado for individual policies, hiking premiums by up to 27 percent, regulators said. UnitedHealthcare has asked for an 8.3 percent increase in large-group plans, affecting 71,400 people; it also asked for 20.5 percent increases for 241 individuals. Aetna, in one plan covering 22,500 people in Colorado, wants a 12.5 percent average boost. Other group plans from Aetna ask for 26.4 percent hikes covering 6,600 people.

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  1. JILL PAUL RN says:
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    SO MUCH FOR OBAMACARE!!!! We all knew in the medical field that this would happen.