« Now You Know | Main | The Boss »

Pre-Existing Condition

Ten years ago, I began seeing Howard, an experienced and accredited psychotherapist. I found myself having difficulties in my romantic relationships, and troubled by family issues from childhood, including the loss of my mother to cancer when I was five. Ten years later, I don’t see Howard, which is not his real name, as frequently as I used to, but I still go sit in the lazy boy recliner every couple of weeks to talk about how things are going. A lot has happened since we began: ends and beginnings to relationships, changes in relationships with my family, my marriage, my business, my ranch, my discovery of Zen Buddhism, this radio show, the joyful arrivals of my children, trivial things, and even some true tragedies. Several years ago, my wife and I, in trying to have children, suffered two devastating episodes; and shortly after that, my wife’s mother, a healthy woman, was diagnosed with cancer and died soon after. In the wake of these experiences, I leaned heavily on Howard, and my wife, herself a trained counselor, sought counseling with her own therapist. There’s no real pattern or framework to the discussions. Sometimes I talk about big stuff, and sometimes small stuff. Sometimes I even talk about this radio show: on some days how well it’s going, or on some days how tired I am of it; how it’s too much work, or how it’s not enough work; how it’s the right size with the right exposure, time slot, and duration, or how it’s mired in a small local market station and having difficulty reaching the larger audiences that I believe it deserves. As it is with everyone, some days you’re up, and some you’re down.

I pay for my visits with Howard out of my own pocket, and at $125 a visit it’s not cheap, but with as many things going on in life, I now view it as a nice luxury to be able to go into a quiet office and talk to someone who is bound by confidentiality and required to give objective care. Also, I should add that I am not diagnosed with any illness and am prescribed no medication for mental or emotional deficits, though if I were, I’m not sure I would tell you. As a financial advisor in private practice, I have my own health insurance policy for my family, a policy with Blue Cross that dates back to my bachelor days. And as my family has grown, I have added my dependents to the policy.

That policy has worked pretty well, but our agent recently advised me that it is an older policy and that more modern plans with more modern features are available, including so-called Health Savings Account Plans, which work a bit like IRA’s for healthcare. And so our family set about to update our health insurance. As an individual family applying for insurance, we are required to answer full medical questionnaires concerning all past and present conditions. My wife filled out the information on herself and our two small children, and she disclosed, because they asked, that she had sought the help of a therapist counselor in the wake of our personal tragedies. And I answered mine. At the end of the questionnaire is a place for my testament that I have answered truthfully. I therefore indicated, because they asked, that I have seen and continue to see a counselor, Howard.

Blue Cross decided that they needed more information, and so, in a call scheduled with a phone bank of customer service nurses, a functionary asked for more detail about my visits with Howard. I explained that the visits are related to life counseling, family matters, work-related advice, and so forth. I explained that I pay for them myself, and that I am not diagnosed with or prescribed anything. Blue Cross then sent their decision in writing, and it reads:

“Thank you for your application for coverage with Blue Cross and Blue Shield of Texas. Upon careful review, we determined that Leo is not eligible for coverage, and we are only able to offer Leo’s wife coverage at an increased premium rate. Our decision was based on our current underwriting guidelines and Leo’s medical history, which includes outpatient counseling received every two weeks, as communicated during the telephone interview. We are only able to offer Leo’s wife coverage at a premium rate due to her medical history, which includes outpatient counseling received as communicated during the telephone interview.”

So there it was. My ongoing visits with a counselor for non-medical purposes resulted in denial of coverage. And my wife’s visits with a grief counselor in the wake of devastating tragedies, resulted in her acceptance but only at premium prices. The letter goes on to say that

“All insurance companies have underwriting guidelines to determine if a policy may or many not be issued to an applicant. These guidelines are then applied uniformly to all applicants, in full compliance with federal and state regulation.”

In other words, Blue Cross believes that it applies a standard set of criteria to make its decisions, that it applies those criteria objectively and without discrimination, and one of those criteria is that if you currently have a therapist they will not insure you, and if you had a therapist they will only insure you at a premium; and furthermore, Blue Cross believes that its decision is legal and permissible under the current laws of the United States of America and the State of Texas. And for all I know, they’re right about every single one of those assumptions. Still, Blue Cross left an opening, indicating that I could submit additional information that might better shed light on the matter, when they wrote that:

Additional medical information may be submitted in writing for possible reconsideration from the physician treating the condition.

So Howard wrote a letter to Blue Cross:

Mr. Gold makes use of our meetings at his own discretion, and would be free to give these up at any time with no untoward consequences. Mr. Gold pays for these consultations out of his own pocket. In our meetings we have discussed family history and ways to optimize vocational choices and personal communication in the face of the challenges of multiple responsibilities. Our regular conversations make Mr. Gold a much more insurable individual than your average individual who has not benefited from the insights of professional interpersonal consultation. Mr. Gold is not diagnosed with a mental health problem.

We waited to see if that would do the trick. I was neither hopeful nor skeptical. Blue Cross responded:

We have reviewed the additional information from Howard, and regret we must maintain our original decision.

Well, at least the nice woman who signed the letter said they regret it. And so that was that. Blue Cross had no intention of granting me coverage under my application. As a consolation they informed me:

"Enclosed is a Notice of Availability of Coverage under the Texas Health Insurance Risk Pool. This health insurance plan may be available to you due to medical history.”

In other words, because I visit with a therapist every two weeks, Blue Cross is not willing to insure me, but is willing to refer me to a state-run insurance program.

Here is what the Pool’s website says about itself:

The Texas Health Insurance Risk Pool was created by the Texas Legislature to provide health insurance to eligible Texas residents who, due to medical conditions are unable to obtain coverage from commercial insurers. The Pool also serves as the Texas alternative mechanism for individual health insurance coverage, guaranteeing portability of coverage to qualified individuals who lose coverage under an employer group plan, church plan or state plan, as mandated by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The Program continues to serve the State of Texas as an important "safety net" for individuals who have been denied health insurance coverage because of pre-existing conditions, can afford the Pool's premiums, and do not have other coverage options. The stated mission of the Pool's Board of Directors is to foster public awareness of the Pool and provide eligible Texans with cost-effective health coverage that is consistent with major medical policies available in the commercial market.

I looked a little deeper at the Pool’s information, and to my surprise I discovered that the fulfillment arm of the Pool – the physician network, treatment management functions, and so forth - was contracted to an outside company, and lo and behold, that company is Blue Cross. The relationship between the Pool and Blue Cross is so intertwined that Blue Cross representatives regularly attend and participate in the Pool’s Board of Directors meetings. I’m not saying there’s anything illegal about this, but let’s consider the ironies: a Republican legislature, inveterately and philosophically opposed to government health care, writes legislation that allows insurance companies to exclude applicants who simply have a therapist, thereby ensuring that there will be a need for a government health insurance pool; and that government health insurance pool, because it does not have the resources to offer all elements of a health plan to its participants must contract with the very entity whose refusal of coverage resulted in the need for the pool in the first place. It’s no wonder that we Americans spend 15% of our GDP on health care, with all the inefficient bureaucracies, public and private, designed to pass people from entity to entity like hot potatoes. There are approximately 27,000 participants currently enrolled in the Texas Pool.

This past Sunday I watched John McCain, who is running for President of the United States, answer questions on one of the morning political talk shows about health care. McCain, when asked why he opposed a national health plan, laughed defensively: “Go to Canada! Go to the UK!” as if they were threats. Well, last week Frontline, the great PBS documentary series, did exactly that: they sent TR Reid of The Washington Post, to the UK, Japan, Germany, Taiwan, and Switzerland to look at their health care systems. I encourage everyone to watch “Sick Around the World" online and to encourage others to watch it. Links are available on today’s show. Frontline’s piece shows that McCain’s taunts are empty lies, blustery shows of bravado covering for an absolute absence of facts, which are: national health plans in other modern countries work; there are a variety of models to choose from, with a wide spectrum of government and market-based options; most people in those countries like their health care systems; and those countries – every single one of them - pay less for health care – sometimes significantly less - as a percentage of GDP than does the United States. Elizabeth Edwards, the cancer-stricken wife of former Presidential candidate John Edwards, points out that three generations of McCains have enjoyed US government-sponsored health care, since McCain, his father, and grandfather have all been career government employees. McCain, asked about this, responded weakly that this was a “cheap shot,” but really it’s a demonstration of how hypocritical is the position of this man who professes to have the integrity necessary to lead this country. When pressed on his plans for people with pre-existing conditions (like himself, since he has had bouts with melanoma), McCain advocated that he would create an expanded Medicare risk pool for people – like me – who are turned down by private insurers for pre-existing conditions. That is to say, John McCain envisions the Medicare system taking over the work that the Texas Pool is currently doing. McCain finished off his comments about his opposition to a national plan by passionately decrying that “Families should have the choice!”

We are a young family, self-employed with a successful business, honest, hard-working, and quite healthy by the standards of most Americans – and you listen up John McCain – the choices we were given by Blue Cross were:

  1. Shut down a successful business and take some new job solely to obtain group health care coverage
  2. Stop visiting with Howard, even if I find it to be valuable and pay for it myself
  3. Remain on an outdated, disadvantaged health plan, or
  4. Apply for the state run health pool

Our family applied for health insurance in the State of Texas in the United States of America in the year 2008. At the time that we applied, we already had insurance with the same company; we were simply trying to update our coverage. Still, our application served as a clear assessment of how a major private insurer views us. In a long questionnaire, the insurance company asked us about every single health condition, and we answered honestly. The insurance company rejected me for coverage and offered expensive coverage to my wife and small children, effectively offering us a situation that would have separated us as an insured family, with my wife and small children covered by one plan, and me forced to go elsewhere. It’s certainly not as bad as being separated as a family on the rail platform at Auschwitz, but it’s a far cry from the way self-employed families should be treated.

In the end, we told Blue Cross they could keep their coverage - we would simply remain on our old outdated plan with them - and that is exactly what we have done. I get no pleasure from publicly discussing on the radio my own and my family’s medical insurance or health matters. But if it will help raise awareness about the real choices we face – not the false choices from John McCain’s feverish imagination – then it’s worth it. Our family’s case is a demonstration of the degree to which health insurance companies, sanctioned to operate in our state by our legislature, cherry-pick the absolutely pristine applications for their “risk” pools. Far from supporting entrepreneurs, sole practitioners, and other small businesses, these entities – public and private - have instead institutionalized discrimination against them. If you are an employee of a corporation, company, government, or organization, your employer generally provides insurance and you answer few or no health questions when you enroll. But if you are an individual or family, you are subjected to thorough scrutiny, and you may be rejected or experience price discrimination even if your malady is simply that you value talking with a therapist for grief or life counseling.

At the same time that Blue Cross was rejecting and discriminating against our family for our belief in mental health services, a new HBO drama, In Treatment, was climbing the ratings, attracting new and dedicated viewers. The New York Times recently reported on the soaring popularity of its main character Paul Weston, an empathetic psychoanalyst, as the show portrays him in a session each night with his different patients: a young woman in a relationship crisis, an Iraq war veteran, a teenager with a troubled family, a couple having marital problems, and even Dr. Weston himself whom we see visit his own therapist. In Texas, Blue Cross would cover none of these people, and the state legislature would have no problem with that. Viewers apparently find the show’s dialogue, setting, and premises to be authentic and compelling. And after viewing a few episodes, I agree that it’s a good show – so much so that it’s my hope that John McCain, the Texas state legislature, the actuaries at Blue Cross, and our federal government, might themselves catch an episode, and say “Wow, maybe I could use some of that…”

Because – honestly - they really could.

I’m Leo Gold. This is The New Capital Show.  www.newcapitalshow.com
Posted on Apr 24 by Registered CommenterLEO GOLD | Comments3 Comments

PrintView Printer Friendly Version

EmailEmail Article to Friend

Reader Comments (3)

Love your show. Great insight for a average joe like me. I would like to meet someday and pick your brain if possible.
What an amazing story! Here is a blogpost I made about it. http://www.imaginaryplanet.net/weblogs/idiotprogrammer/?p=83399872

Wow, your reasons for being denied were even more ridiculous than mine. Is this some kind of bad joke?! haha

I was also denied coverage with BCBS in Texas for

"ongoing symptoms of headaches with no definite diagnosis, as communicated during the telephone interview."


"ongoing symptoms of lack of motivation with no official diagnosis or treatment, as communicated during the telephone interview."

I kid you not!! Those were the exact two reasons given. And in my telephone interview, and in the questionnaire, I stated that both these conditions mainly only happen around my period... so basically, I feel I was denied coverage for having occasional "PMS." The "lack of motivation" excuse popped up due to my stating I'm being treated by a Chinese practitioner for occasional mild depression, in which I explained over the phone as the occasional feeling of a "lack of motivation." Don't we all experience lack of motivation on a regular basis anyway? Because I was looking for a boost in this area, I'm considered uninsurable. I haven't been diagnosed with anything or even had to see a doctor (a regular M.D.) in over 10 years!

In my questionnaire, it should have been obvious to BC that I avoid doctors as much as possible and seek out alternative therapies, like Chinese Medicine (which I strongly believe in, due to my own and family/friends' experiences). Most likely, if something bad happened to me, I wouldn't cost BC a fortune in medical bills, as I'd seek alternative therapies that cost a fraction and that BC wouldn't cover anyway (at least I don't think they cover alternative therapies).

It's absurd that they won't cover someone like myself who would probably never cost them a dime. I could file an appeal, but even if it worked, I'm not sure that I'd even be interested after this.

PostPost a New Comment

Enter your information below to add a new comment.
Author Email (optional):
Author URL (optional):
All HTML will be escaped. Hyperlinks will be created for URLs automatically.