Health Coverage Denials on the Rise for Several Insurance Companies

As more and more individuals try and secure quality health insurance, a recent report does not bode well for that task.

A report from the House Energy and Commerce Committee shows that WellPoint Inc., Aetna, Humana and United Health Group denied health coverage to nearly 50 percent more individuals in two years for reasons like pregnancy and the likelihood of adopting a child.

The four insurance companies reportedly turned away 651,000 applicants for illnesses or situations they had prior to applying for coverage. Each company had a business plan to exclude pre-existing conditions, noting internal insurer documents the reporting panel acquired.

Congressional Democrats have been highlighting coverage denials that will be banned by the health care overhaul law signed in March. The four insurance companies mentioned denied 257,100 people one year ago compared with 172,400 in 2007. Enrollment grew by 16 percent in that time period, according to the report.

Among the companies, one noted “improved pre-existing exclusion process” as a way to grow business. One of the insurers’ had a listing of 425 conditions that could be implemented to deny people coverage, including diabetes, heart disease and pregnancy.

According to other documents from the report, individuals who were surgical candidates, female, pregnant, female and “treated for infertility within the past five years,” and “any applicant with a (body mass index) 39.0 or greater” were turned away for health insurance without an internal review by the company.

In a Bloomberg National Poll, 47 percent of likely voters backed the health law’s repeal, while 42 percent indicate it should not be touched.

More numbers from the poll show that there was strong support for many of the law’s provisions.

Three-quarters back its ban on insurance companies denying coverage due to pre-existing conditions; 67 support permitting children as old as 26 to stay on their parents’ policies. Meantime, 73 percent want to maintain the addition of more prescription drug benefits for those on Medicare, the U.S. government’s health program for the elderly and disabled.

The four insurance companies surveyed treat pregnancy as a pre-existing condition and typically don’t make available coverage to expectant mothers, the House committee reported in a second memo that noted company documents.

Expectant fathers and those soon planning to adopt are often turned down as well, and documents indicate the companies have moved to restrict the availability of riders that can be purchased to add maternity coverage. One rider restricted a female to $6,000 in maternity benefits after she paid additional premiums for four years, according to the report.

According to company documents, executives noted maternity coverage resulted in “higher prices, lower margins and loss of market share.”

Another document states one insurance company typically spent 90 percent of the premiums it gathers on medical care for policies with optional maternity benefits, “a money-losing ratio.”

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