Another Pre-Existing Condition: Rape

[Dominus Atheos]

Huffington Post

Christina Turner feared that she might have been sexually assaulted after two men slipped her a knockout drug. She thought she was taking proper precautions when her doctor prescribed a month's worth of anti-AIDS medicine.

Only later did she learn that she had made herself all but uninsurable.

Turner had let the men buy her drinks at a bar in Fort Lauderdale. The next thing she knew, she said, she was lying on a roadside with cuts and bruises that indicated she had been raped. She never developed an HIV infection. But months later, when she lost her health insurance and sought new coverage, she ran into a problem.

Turner, 45, who used to be a health insurance underwriter herself, said the insurance companies examined her health records. Even after she explained the assault, the insurers would not sell her a policy because the HIV medication raised too many health questions. They told her they might reconsider in three or more years if she could prove that she was still AIDS-free.

Stories of how victims of sexual assault can get tangled in the health insurance system have been one result of the Huffington Post Investigative Fund's citizen journalism project, which is calling on readers to provide information and anecdotes about the inner workings of the insurance industry. The project aims to uncover details and data that can inform the larger debate over how to fix the nation's health care system. As the Investigative Fund reported in September, health insurance companies are not required to make public their records on how often claims are denied and for what reasons.

Some women have contacted the Investigative Fund to say they were deemed ineligible for health insurance because they had a pre-existing condition as a result of a rape, such as post traumatic stress disorder or a sexually transmitted disease. Other patients and therapists wrote in with allegations that insurers are routinely denying long-term mental health care to women who have been sexually assaulted.

Susan Pisano, spokeswoman for the health insurance industry's largest trade group, America's Health Insurance Plans, said insurers do not discriminate against victims of sexual assault and ordinarily would not even know if a patient had been raped.

"These issues you are bringing up, they deserve to be brought up," said Pisano. "People who have experienced rape and sexual assault are victims and we want them to be in a system where everyone is covered."
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Turner's story about HIV drugs is not unusual, said Cindy Holtzman, an insurance agent and expert in medical billing at Medical Refund Service, Inc. of Marietta, Ga. Insurers generally categorize HIV-positive people as having a pre-existing condition and deny them coverage. Holtzman said that health insurance companies also consistently decline coverage for anyone who has taken anti-HIV drugs, even if they test negative for the virus. "It's basically an automatic no," she said.

Pisano, of the insurance trade group, said: "If you put down on a form that you are or were taking anti-HIV drugs at any time, they [the insurance companies] are going to understand that you are or were in treatment for HIV, period," she said. "That could be a factor in determining whether you get coverage."

Some doctors and nurses said that the industry's policy is not medically sound. "The chance of a rape victim actually contracting AIDS is very low. It doesn't make any sense to use that as a calculus for determining who get health insurance," said Dr. Alex Schafir, faculty instructor at Providence St. Vincent Hospital in Portland, Ore.

Nurses who deal with sexual assault cases say the industry's policy creates a significant problem for those treating women who have been assaulted. "It's difficult enough to make sure that rape victims take the drugs," said Diana Faugno, a forensic nurse in California and board director of End Violence Against Women International. "What are we supposed to tell women now? Well, I guess you have a choice - you can risk your health insurance or you can risk AIDS. Go ahead and choose."

Turner, now a life and casualty insurance agent, said she went without health coverage for three years after the attack. She second-guesses her decision to take the HIV drugs. "I'm going to be penalized my whole life because of this," she said.

Several women told the Investigative Fund that after being sexually assaulted they had been denied care or ruled ineligible for health insurance because of what were deemed pre-existing conditions stemming from their assaults -- particularly post traumatic stress disorder, or PTSD.

A 38-year-old woman in Ithaca, N.Y., said she was raped last year and then penalized by insurers because in giving her medical history she mentioned an assault she suffered in college 17 years earlier. The woman, Kimberly Fallon, told a nurse about the previous attack and months later, her doctor's office sent her a bill for treatment. She said she was informed by a nurse and, later, the hospital's billing department that her health insurance company, Blue Cross Blue Shield, not only had declined payment for the rape exam, but also would not pay for therapy or medication for trauma because she "had been raped before."

Fallon says she now has trouble getting coverage for gynecological exams. To avoid the hassle of fighting with her insurance company, she goes to Planned Parenthood instead and pays out of pocket.

A New Mexico woman told the Investigative Fund she was denied coverage at several health insurance companies because she had suffered from PTSD after being attacked and raped in 2003. She did not want to disclose her name because she feared that she would lose her group health insurance if she went on the record as a rape victim. "I remember just feeling infuriated," she said.

"I think it's important to point out that health plans are not denying coverage based on the fact that someone was raped," said Pisano of the insurance trade group. "But PTSD could be a factor in denied coverage."

"That might not be a discriminatory action, but it certainly would seem to have a discriminatory impact," said Sandra Park, staff attorney at the Women's Rights Project at the American Civil Liberties Union. "Insurance discrimination against rape victims will only further discourage them from coming forward to law enforcement and seeking medical help."

Even when patients have coverage, there are fundamental disagreements between insurance companies and doctors about what mental health treatment is medically necessary. The Investigative Fund spoke with doctors, psychologists, and licensed clinical social workers around the country who work regularly with victims of sexual assault. They said that their patients have been experiencing an increase in delays and denials, particularly for talk therapy.

"There's a lot of anger about this in the medical community," said Dr. George Shapiro-Weiss, a psychiatrist in Middletown, Conn. "You don't realize what an Alice in Wonderland web this has become."

"A lot of my patients are being told that their treatment isn't medically necessary," said Keri Nola, an Orlando, Fla., psychologist, who said about 75 percent of her patients are victims of sexual violence.

Several therapists cited problems with managed care companies that specialize in mental health. Such firms generally work under contract with health insurers to hold down costs while still authorizing appropriate care.

WATCH a video about a rape victim's efforts to obtain mental health services:

Some therapists and patients said the managed care companies have cut off necessary treatment for sexual assault victims in the name of cost containment. "The companies are peppering them with questions about their symptoms, and about their histories, and asking, 'Well, are you sure you really need therapy?'" said Jeffrey Axelbank, a New Jersey psychologist. "For someone who has been traumatized, it can feel like another trauma, and it makes the therapy less effective."

Pisano, of the insurance association, said it was not fair to draw a larger pattern from such anecdotal evidence. "These situations are evaluated on a person-by-person basis," she said. "There is nothing routine about this."

Jim Wrich, a Madison, Wis., a consultant who helps employers evaluate the companies that manage their mental health care, said his work has made him wary of the industry. "This is absolutely routine - these denials," Wrich said. "The default position is to reject care."

Magellan Behavioral Health Services, Inc., one of the nation's largest managed-care companies with more than 58 million customers, said that it does not routinely turn down treatment requests from victims of sexual assault or other clients. "We're not denying care. We are exercising our responsibility to make sure that medical necessity is met," said Dr. Lawrence Nardozzi, Magellan's medical director. "I think the process works well."

Asked if cost is a factor in the company's decisions, Magellan spokeswoman Erin Somers said: "If all the safeguards are in place to determine whether treatment is medically necessary and appropriate" then "the cost takes care of itself."

A former care manager for Magellan said in an interview that she felt pressure to deny care for cost reasons. Lois Gorwitz, a psychologist with thirty years of experience who went to work for Magellan in California in 2000, said her superiors would tell her: "We are not denying this person treatment, we are denying them their benefit. If they want the treatment they can still pay out of pocket." But, Gorwitz said, "You know that means that the person is not going to get the treatment because they can't afford to pay out of pocket."

Gorwitz quit after two years. "It's a very uncomfortable feeling of not being able to offer help," she said.

Asked for a response, Magellan's Somers said, "I think you should keep in mind that there have been a lot of changes at Magellan in the last seven years. I think the people who work at Magellan now are not having that experience.

No comment required except to say I hope health-care reform gets passed with a public option available to everyone.

[open_sketchbook]

That... is absolutely disgusting. But the US health care system works fine, huh? No need for health care reform in American, right?

[White Haven]

Complete and absolute scum. If even one customer is cowed by this pattern of denials into failing to report a rape to the police, wouldn't that make the insurance company in question an accessory after the fact?

[Broomstick]

Under the law, no, they are not an "accessory after the fact". The problem is that these denials are perfectly legal.

[Darth Wong]

Anyone who supports private insurance and "corporate freedom" should understand that this is as inevitable as gravity. What the insurance companies are doing is not sound social policy, but it is sound business policy. It makes sense from a standpoint of profitability. Unless the insurer is either government-run or very heavily regulated by aggressive government watchdogs which are immune to lobbying and bribery (cough*yeahright*cough), it will always look for every conceivable excuse to dump anyone who might be considered a risk.

The long-running debate about whether liberals are right about corporations being evil or conservatives are right about corporations just being rational is completely worthless in this case: in this case, "rational" leads directly to "evil".

[Serafina]

Private insurance companies can work - if you slap a shitload of regulations on them.
Insurance companies, private or not, would never be able to pull of shit like that - heck, they would get slapped with heavy fines, this happened quite often when they denied care to transexuals.

Actually, german private insurances try to provide better and broader services than the non-private ones (eg: you only get basic dental replacements on a non-private insurance, a good incentive to get a private insurance).
Why?
Well, they simply can not make more profit by providing less care - thus, they have to find another avenue where they can compete.
This, of course, creates two classes of health care - a basic one, and a good one.
But that's not necessarily bad, as long as everyone gets basic care and the difference is not too big.

[Netko]

Another example of insanity (taken from SB) from, apparently, the same company that had this wonderful rape consequences explanation for denying coverage:

Get Sterilized Or Die: Insurance Company Tells Mother Her Fertile Womb Is “A Pre-Existing Condition”
By Mark Ames

Just when you thought you’d seen all the health-insurance evil possible, now comes another shocker: a UnitedHealth subsidiary in Colorado denied coverage to Peggy Robertson, mother of two, because she wasn’t sterilized after her caesarian-section delivery procedure, according to a letter made public. Almost 1/3 of all deliveries are done by c-section–meaning that in Colorado and likely elsewhere, fertile women are regularly denied coverage unless they agree to sterilize their wombs. This comes after reports that a health insurance company considered rape to also be a “pre-existing condition.” The meaning is clear: America’s health insurance industry hates us all, and they hate fertile women most of all, if only because they represent two detestable Americans in one body.

In the letter, UnitedHealth’s Colorado subsidiary tells Robertson that normally they would simply waive coverage on her womb for a period of three years following a c-section, but since Colorado banned pre-existing waivers, poor UnitedHealth had no choice but to deny the mother of two coverage of any sort [full letter below, hat tip to eXiled Online reader Tyler]:

In order to consider coverage without a rider, we require certain requirements to be met. One requirement is that some form of sterilization has occurred since the caesarian section delivery. Also, women age 40 or over, who had their last child two or more years prior to applying for coverage, will not require a rider.

The letter was dated 2007–that same year, UnitedHealth profits rose to over $4 billion, on earnings of over $70 billion, pushing the company’s Fortune 500 ranking up to number 21 from 37 in 2006. 2007 was an interesting year for UnitedHealth on a lot of fronts: the SEC slapped a $468 million fine on the CEO, William McGuire, who created the UnitedHealth monster, for stock option fraud. That may sound like a serious punishment until you realize that UnitedHealth gave McGuire a golden parachute retirement package worth $1.8 billion–on top of his 9-figure annual pay packages.

This year, UnitedHealth was forced to pay $350 million to settle a class-action lawsuit after it was discovered that UnitedHealth used a rigged database designed to defraud American doctors and policyholders.

Watch Peggy Robertson explain how UnitedHealth is preventing her from having a third child here:


No wonder UnitedHealth denies coverage to rape victims and fertile mothers: UnitedHealth is the largest mass-rapist in America, why the Hell would it want to cover people for something they’re doing every minute of every working hour? And who hates fertile wombs more than serial rapists?

The link contains the full rejection letter.

Just wow. This excerpt from the letter sums up the evil with US healthcare and shows why it is a fundamentally broken and insane system:

As a general rule, our underwriting guidelines require that we issue coverage with a rider excluding benefits for caesarean section delivery for three years. However, the Colorado Division of Insurance no longer allows us to place that rider. Without the rider, we have decided that we cannot provide any coverage for the individual. Unfortunately, we cannot collect sufficient premium to offset the risk of paying for a repeat C-section delivery druing the first three years of coverage.

In order to consider coverage without a rider, we require certain requirements to be met. One requirement is that some form of sterilization has occured...

Its a lovely quotation yet again openly showing that the health part of "health insurance" might as well be car, household or other property in the eyes of the US health industry, with not even an iota of care that this is, you know, a bit different. Or, putting it a bit differently, the whole thing is a scam for getting premiums out of healthy people while letting the sick, or merely not perfectly healthy, die.

There are actually some sociopaths over on SB arguing that this is the fault of Colorado for not allowing riders.

[Superboy]

Despite all of these cases of people being refused coverage, cases which seem ridiculous on the surface, I can't really find a lot of fault with the insurance companies. They aren't acting any more evil than any for-profit businesses. If they decide that insuring someone who has recently had a c-section without sterilization will cost them money, or even just fail to be profitable, then of course they aren't going to insure them. Their entire purpose is to make profit, and they act accordingly.

I don't really understand why people hold up these cases of individuals being refused insurance as some sort of proof of the depravity of insurance companies. It's simple: if it's not profitable to insure someone, the insurance companies won't insure them. This should be obvious to everyone. People seem shocked when they hear stories about how some individuals aren't profitable to insure; they think it's an outrage that someone can be denied isurance for something that's beyond their control. I hear this sentiment even from those who oppose universal healthcare, people who fail to realize that outrage is only appropriate if you believe healtcare is a right, not a privalige.

[Duckie]

"No more evil than any for-profit business" is a damnation by faint praise. You're splitting hairs, trying to find a way of not casting this as utter evil, by saying it's evil with a motive. It's still evil, and depraved, and profitable. Those things aren't mutually exclusive.

I'd like to see you attempt to back up your assertion that refusing rape victims health insurance is not depraved because a profit motive, incidentally. You can follow it with a theoretical scenario outlining the lack of depravity found in murder if a company serves to gain wealth by murdering innocents.

[Serafina]

Despite all of these cases of people being refused coverage, cases which seem ridiculous on the surface, I can't really find a lot of fault with the insurance companies. They aren't acting any more evil than any for-profit businesses. If they decide that insuring someone who has recently had a c-section without sterilization will cost them money, or even just fail to be profitable, then of course they aren't going to insure them. Their entire purpose is to make profit, and they act accordingly.

I don't really understand why people hold up these cases of individuals being refused insurance as some sort of proof of the depravity of insurance companies. It's simple: if it's not profitable to insure someone, the insurance companies won't insure them. This should be obvious to everyone. People seem shocked when they hear stories about how some individuals aren't profitable to insure; they think it's an outrage that someone can be denied isurance for something that's beyond their control. I hear this sentiment even from those who oppose universal healthcare, people who fail to realize that outrage is only appropriate if you believe healtcare is a right, not a privalige.

Oh, you gotta be kidding me...

They forced woman to get a sterilization!

How would you feel if a single doctor did this - forcefully sterilizing women for profit?

Seriously, how would you feel if an individual harmed people for profit?
Is that not evil, too, because it's for profit?

You know, you could actually have argued that with the rape-victim - "we do not want to insure her because she might have AIDS". I would have disagreed, but at least there would have been some sense to it.
But in this case, you are just bat-shit insane.

They told women to sterilize themself, or they might either loose a lot of money or their life.
Because that IS the potential consequenze of non-insurance.

Face it, putting profit over the life and well-being of people IS EVIL!

[D.Turtle]

Despite all of these cases of people being refused coverage, cases which seem ridiculous on the surface, I can't really find a lot of fault with the insurance companies. They aren't acting any more evil than any for-profit businesses. If they decide that insuring someone who has recently had a c-section without sterilization will cost them money, or even just fail to be profitable, then of course they aren't going to insure them. Their entire purpose is to make profit, and they act accordingly.

I don't really understand why people hold up these cases of individuals being refused insurance as some sort of proof of the depravity of insurance companies. It's simple: if it's not profitable to insure someone, the insurance companies won't insure them. This should be obvious to everyone. People seem shocked when they hear stories about how some individuals aren't profitable to insure; they think it's an outrage that someone can be denied isurance for something that's beyond their control. I hear this sentiment even from those who oppose universal healthcare, people who fail to realize that outrage is only appropriate if you believe healtcare is a right, not a privalige.

Thats because there is a difference between the health of a person and some object they own.

Not being able to insure your laptop means you won't get it refunded if its stolen.

Not being able to get health insurance means you will die if you get seriously sick.

That is why health care is a right.

[Broomstick]

Despite all of these cases of people being refused coverage, cases which seem ridiculous on the surface, I can't really find a lot of fault with the insurance companies. They aren't acting any more evil than any for-profit businesses.

Clearly, you do not realize or understand that there still exist non-profit health insurance companies. Sure, they have to make enough money to cover their costs but do NOT require a profit above that or need to please stockholders.

[Superboy]

I'd like to see you attempt to back up your assertion that refusing rape victims health insurance is not depraved because a profit motive, incidentally.

I didn't say they weren't depraved, simply no more depraved than any other for-profit business that doesn't donate massive amounts of it's profits to help people.

How would you feel if a single doctor did this - forcefully sterilizing women for profit?

Seriously, how would you feel if an individual harmed people for profit?
Is that not evil, too, because it's for profit?

They didn't force her to get steralized, they just said that they won't insure her if she isn't. There IS a difference between the two. Yes, the consequences of not being insured can be severe, but I don't see why the responsibility should rest on that one particular insurance company to lose money in order to help her.

Clearly, you do not realize or understand that there still exist non-profit health insurance companies. Sure, they have to make enough money to cover their costs but do NOT require a profit above that or need to please stockholders.

I understand this completely, and I have no problem with not-for-profit insurance. In fact, I think it's the only acceptable option with health care.

My point was that if you allow a system to exist which depends on for-profit health insurance, you can't scream "EVIL" when these companies make profit their priority.

[TheLostVikings]

[
They didn't force her to get steralized, they just said that they won't insure her if she isn't. There IS a difference between the two. Yes, the consequences of not being insured can be severe, but I don't see why the responsibility should rest on that one particular insurance company to lose money in order to help her.

Do you even know what the purpose of an insurance company is? Because it clearly seems you don't have the faintest clue.

[Superboy]

[quote="TheLostViking]Do you even know what the purpose of an insurance company is? Because it clearly seems you don't have the faintest clue.[/quote]

In America? The purpose of an insurance company is not to help people. It's to make a profit.

[Serafina]

Do you even know what the purpose of an insurance company is? Because it clearly seems you don't have the faintest clue.

In America? The purpose of an insurance company is not to help people. It's to make a profit.

You forgot an " there

And you see no problem with that?

Besides, that is hardly an excuse for immoral behaviour. And yes, "making money" is not a moral goal - it does not care about morals at all.

And insurance companies CAN run profitable, even with harsh restrictions. German private insurances are actually offering better coverage than non-private ones, AND they are required to insure everyone (albeit only to the standard set by non-private insurance), and they STILL make money.

[Superboy]

And you see no problem with that?

I see a huge problem with that, I just don't place the blame on the insurance company itself. The way the health care system is set up in America is incredibly immoral, but the insurance companies are just acting the way any other non-profit company would, because they're allowed to.

Let me be clear, I think that the health care system in America is evil and immoral and depraved. I just don't understand why people point at the insurance companies when those companies are acting exactly the way the system expects them to.

[Serafina]

Ah, so the system makes them do it, so they are completely irresponsible for their actions?

Hm, i think i heard that argument elsewhere *points to location* - and it was as fucked up then as it is now.

You are responsible for your actions, wether they are favored or even forced by a system or not.

Edit: Of course, there are conditions that change morality - certain things are acceptable for survival that are unacceptable otherwise.
However, making profit is no such circumstance, and and the health care system clearly does not count

[Thanas]

And you see no problem with that?

I see a huge problem with that, I just don't place the blame on the insurance company itself. The way the health care system is set up in America is incredibly immoral, but the insurance companies are just acting the way any other non-profit company would, because they're allowed to.

Let me be clear, I think that the health care system in America is evil and immoral and depraved. I just don't understand why people point at the insurance companies when those companies are acting exactly the way the system expects them to.

That argument would actually be worth anything if it did not completely forget to take into account the fact that the insurance companies are fighting any change tooth and nail.

[Nathaniel]

That argument would actually be worth anything if it did not completely forget to take into account the fact that the insurance companies are fighting any change tooth and nail.

In this context, refusing to insure a rape victim and fighting change are essentially the same thing. They are both an attempt to maximise profits. The first may be in the short term, and the second in the short term but they have the same motive.

[Oskuro]

A friend of mine has private insurance here in Spain, and after his father had a recent cardiac arrest, they were trying to make the family pay for the expenses. This makes me think, what's the point then? Why pay for health insurance if they are going to dump you when you really need them? How can anyone justify a services provider who weasels itself out of the service they are being payed to provide?