AMA President: Pregnant women are barred from buying individual health insurance, page 1

AMA President: Pregnant women are barred from buying individual health insurance

www.politifact. com

You've probably heard of "pre-existing conditions," which provide an escape clause for health insurance companies. If you have a pre-existing condition, an insurance company typically won't pay for treatment.

J. James Rohack, president of the American Medical Association, cited them when he was asked during an appearance on Fox News Sunday on Aug. 16, 2009, whether the Democratic health plan would lead to rationing for older patients.

"Well, there's a myth that rationing doesn't occur right no

(visit the link for the full news article)

If you're a woman looking to buy individual health insurance be sure you do it at least a year before you get pregnant. Many insurers consider any condition that arises sooner than 6-12 months after purchase to be pre-existent, and virtually all of them consider pregnancy a pre-existing condition.

James Rohack, president of the American Medical Association, addressed this issue in an appearance on Fox News.

Most women who have coverage under their employers or their spouse's employers generally do get coverage for maternity care, so this affects only the percentage of women without health insurance or who are looking to buy it individually. That is not a huge percentage of women but a significant enough number to be of concern.

Hopefully, if more competition is created among health insurers, such as would happen with a government option, more women would be able to get maternity coverage. A healthy mother with proper maternity care will produce healthier and better adjusted children.

Politifact.com has rated this issue as "true."

www.politifact. com
(visit the link for the full news article)

reply to post by Sestias

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Star & Flag

Alot of people are not aware of this, Thanks for bringing this to

everyones attention. I always thought pre-existing conditions,

were considered something long term, pregnancy is only 9 months,

does'nt really seem fair, I have experienced this myself.

reply to post by truth/seeker

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I do not necessarily agree with pre-existing conditions clauses, but by the same token, I can understand it.

Most of us would like to think that adults can plan pregnancies, and therefor plan their insurance, mortgages, car payments, etc., to coincide with a planned pregnancy. That's a large part of being a responsible adult.

Accidents do happen, however, and an unplanned pregnancy can occur at the worst of times, it seems. Such as during unmployment when people allow their insurance to lapse (both health and auto), or new employ after a period of unemployment.

This Insurance Law signed by Bush in 2002 can be used with a part of the Stimulus package started by Bush and signed into law by Obama to provide assistance for Cobra coverage, thereby almost negating the total Cobra cost. The Stimulus deadline for assistance was extended to Dec 31, 2009.

www.cobralaw.com...

On the one hand, if you bought a car, and drove it with no coolant or water and blew the engine, is it right to take it back and demand the repair it at no cost, or perhaps even a reduced fee?

Perhaps you just bought a car, and didn't get car insurance yet. On the way home, you have a wreck. Should you be allowed to go buy insurance tomorrow and make them pay for it?

I feel the same in this regard. I find it unbelieveable that people expect to go get pregnant and then shop for insurance once they find out what the costs are to self pay. It isn't like this is a secret, insurance has always been this way as long as I can remember.

Even worse to me is people the choose to not have insurance, that can afford it, and the use Emergency Rooms as clinics and skip on the bill. Then, when they get to their mid 30's or so and find they have a major illness, or even a terminal one, they don't have any coverage, yet again.

These types are a huge burden to our society, and one of the reasons health care is in the state it is in now. Health care costs are as high as they are not so much for profits as many would lead you to believe, but to pay for the costs of people refusing to pay, presenting false ID and information in the Emergency Rooms, and flat skipping out on bills.

Couple this with the frequency of people you see come in uninsured with terminal illnesses or traumas, and you have exploding costs.

See, it is either inflate the costs so you can recoup the lost funds, or raise insurance premiums on the ones that are responsible enough to have coverage. People truly in need have a combination of options, such as Medicare/Medicaid. and other state and federal resources.

Does it need to change? Something needs to happen, but I just don't happen to agree with Obamacare. Thats another story though.

I think it is unfair to place the financial burden on other people that insure themselves responsibly, but then, either way we all end up paying for it in the long run, I would just prefer it wouldn't affect my inurance premiums.

A lot of it boils down to personal responsibility.

reply to post by DYepes

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I mean this in the most nicest way possible. I didn't understand your first paragraph about the cuts and bruises thing and insurance, could you reword that perhaps? Maybe I am just tired.

Oh, and it isn't legal to increase someones' insurance premiums once they find out theu are pregant, like you said. There are laws on insurance, consumers do have protection.

reply to post by Libertygal

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Erm... no, it's more like you bought a car, and someone tells you that you only can insure it if you don't start it.

Not all pregnancies are unwanted. I'd go as far as to say the majority (among adults) are in fact wanted. It's true that you should think about the expenses before getting a child, and health insurance won't be the most expensive thing by a long shot. But your accident analogy falls flat.

reply to post by Libertygal

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My pregnancy was planned! my husbands employer, said we would be

covered after 3 months, but neglected to say it would take another 9

months to cover pregnancy, so that is 12 months, seems a little redicules

to me, to have to wait a year!....imo

Originally posted by debunky
reply to post by Libertygal

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Erm... no, it's more like you bought a car, and someone tells you that you only can insure it if you don't start it.

Not all pregnancies are unwanted. I'd go as far as to say the majority (among adults) are in fact wanted. It's true that you should think about the expenses before getting a child, and health insurance won't be the most expensive thing by a long shot. But your accident analogy falls flat.

I don't get your inent by the first line of your reply. It doesn't make any sense in regards to this conversation to me. No one can take your insurance for getting pregnant, you just have to meet the guidelines. This is no different than meeting the guidelines for car insurance, homeowners insurance, or any other type.

I never said the pregnancies were unwanted. I said unplanned, that's a whole other ballgame. I had an unplanned, yet very much wanted pregancy.

Since my car analogy fell flat for you, how about a man goes to the doctor and finds out his PSA is high, the markr in a blood test that says he may have prostate cancer. He is 27 years old and never felt like he needed health insurance, so he never opted to buy it though he could afford to. He follows up on the blood test and finds out that indeed he does have prostate cancer. Should he be allowed to buy health insurance now, after the fact, to cover the expenses for further diagnosis and treatment?

Originally posted by truth/seeker
reply to post by Libertygal

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My pregnancy was planned! my husbands employer, said we would be

covered after 3 months, but neglected to say it would take another 9

months to cover pregnancy, so that is 12 months, seems a little redicules

to me, to have to wait a year!....imo

I am sorry you had a misunderstanding about the policy. It can never be said to read, re-read, and read again all documentation that applies to you in this case. I recieved an insurance handbook that detailed my health plan and everything involved, so I knew where I stood in regards to all limitations on coverage.

I agree the time limitations are extreme though. A lot of newly married couples wish to start their families right away, so you are correct IMO that it doesn't seem fair to have to wait a year.

Like i said, something needs to be changed, I agree 100% with that. Just wish there were more choices and options, but I don't want the government to be the only option people can fall back on in times of need.

Originally posted by Libertygal
reply to post by truth/seeker

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I do not necessarily agree with pre-existing conditions clauses, but by the same token, I can understand it....

I think it is unfair to place the financial burden on other people that insure themselves responsibly, but then, either way we all end up paying for it in the long run, I would just prefer it wouldn't affect my inurance premiums.

A lot of it boils down to personal responsibility.

Ok, I have finally hit the limit. How anybody can support the concept that it is irresponsible to get pregnant in a supposedly civilized society without being insured first is completely beyond me. That issue is so foreign in our country that it is to laugh.

Get a clue, please. There is a kinder world out there where one doesn't let ones fellow citizens fall through the cracks set by mercenary corporations.

I simply don't freakin' believe it!

Tougher to believe is that y'all have been conditioned to think it's normal!

reply to post by Libertygal

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The government did'nt pay my hospital or Dr. bills, my husband took a

second job to pay the bills.....thankyou very much, you seem to presume

alot.

reply to post by truth/seeker

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Pardon me? Where did I presume the government paid your bills? I think you misread something I said, or attributed something to me that I didn't say. Either way, I never insinuated or suggested the government did anything. I don't know you from Adam, how could I say such a thing?

Please point this out for me. Thanks in advance.

reply to post by DYepes

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Thanks for your reply to my comments.

I have had the same insurance plan for 8 1/2 years. I have had 3 surgeries, two of them considered major surgeries, where I was placed on life support. One of the surgeries, the bill (if I had to self pay) was over 39 thousand dollars, and I was in the hospital for les than 24 hours. Another one, two weeks ago, I haven't recieved a statement for yet. I am sure it will be well over 39 thousand. The insurance payout on the first one was 5 thousand, mine 200.

I have been going to a pain clinic and having epidural spinal injections for 3 years. Each one is considered outpatient surgery. Again, no issues at all.

All of this was from a pre-existing condition, from a bad car accident in 1993. I have been denied no services, except an MRI, which was actually denied within my employer as opposed to the insurance company, on its way to approval. In the end, it was actually alllowed, so no drama.

I have had no issues with the insurance company paying what they are supposed to, and I know my copays and handle them. I just haven't had a problem, and they sure haven't dropped me, so perhaps because I haven't had such an experience, I find it hard to identify.

Thanks for bringing up this important matter. I do want to make sure that one point is clear to others reading this thread (not that it's been misrepresented, I just think it's important for people to know their rights about this).

As the article linked in the OP states, pregnancy can be considered a preexisting condition in the individual insurance market and used to refuse to sell a new policy to a woman who is pregnant, just as they can refuse to sell coverage to someone with cancer or another "condition".

However, pregnancy cannot be considered a "preexisting" condition as far as coverage purchased through an employer goes. So, for example, if a woman were to marry and get pregnant right away, the pregnancy would have to be covered by her husband's insurance if she is covered by her husband's insurance (assuming the policy includes maternity coverage), although other preexisting conditions might not be covered right away. This is guaranteed by the Federal Pregnancy Discrimination Act of 1978 (as is mentioned in the article linked by the OP.

On the other hand, medical coverage often does not begin immediately at a new job, and maternity coverage may be subject to additional requirements.

If all that just made things more confusing, my apologies. No wonder we need health care reform so badly.

I think the thrust of the article is that a woman who is pregnant and does not have health insurance may find herself unable even to purchase insurance, and that if a woman has purchased insurance for herself individually (an expensive thing to do, btw), the insurance company can refuse to cover some conditions (including pregnancy) for a certain period of time (6-12 months usually).

[edit on 9/10/2009 by americandingbat]

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