saw this and thought everyone should be aware. if it has happened to your or someone you know, this offers some steps to help fight back. this must stop.
health insurance and gender discrimination
health insurance and gender discrimination
in most states, health insurance companies can turn a woman down for coverage simply because of her gender. here's what you can do to help make health care fair
by [color=#108896]jenny deam
when the company her husband worked for announced late last year that it could no longer pay health insurance premiums for employees' families, pamela rice panicked. she and their two teenagers who still lived at home had been getting coverage through the small construction firm's group plan for 13 years. but staying on that plan would now cost them $1,600 a month.
that would be a hefty and unaffordable increase over their former $480-per-month payroll deductions. so in january, her husband reluctantly opted out, and rice went searching for private insurance for the family.
after she was unable to get a family policy that would cover them all, the then-44-year-old stay-at-home mother from greenville, ky, applied online to half a dozen insurance companies for individual policies for herself, her husband, and the kids. she assumed that her coverage might cost somewhat more than an average policy because she suffers from [color=#108896]fibromyalgia
, a chronic condition that causes severe muscle and joint pain. however, her occasional flare-ups were well controlled with medication and she'd never been hospitalized, so she hoped her rate wouldn't be too much more expensive than everyone else's.
but what happened was even worse: she was flat-out refused by all six companies. her husband, greg, also 44 at the time, was accepted by the same companies that turned her down--even though during the past 3 years, he'd been to the emergency room 3 times for kidney stones and had been hospitalized for an appendectomy. plus, unlike her, he was a smoker.
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suspicious, rice began re-applying. each time, she filled out the form twice--once as a woman and once claiming to be a man--and checked off exactly the same preexisting conditions, ranging from [color=#108896]arthritis
, for both sexes. when she said she was male, two out of her six applications were accepted; as a woman, she was denied every time. "i was outraged," she says. rice's husband and kids are now covered by a policy that costs $263 a month, but the only option rice found for herself was her state's high-risk pool--which would have charged her about $900 a month. since the family can't afford that, she still has no health insurance.
the insurance gender gap
rice had run smack into the little-known but widespread insurance practice of gender discrimination. "in most states, a man and a woman of the same age and health status will be charged different rates for exactly the same individual health insurance policy, a practice called 'gender rating,' " explains lisa codispoti, senior counsel for the national women's law center, a washington, dc, nonprofit that studies legal and social issues affecting women. "a woman can be charged more or turned down altogether simply because she is a woman."
insurance companies generally aren't required to tell anyone why they're being turned down or billed at a higher rate. but the nwlc's research shows that often, as with fibromyalgia (a condition affecting 7 times as many females as males), preexisting conditions more common in women trigger denials faster than those that tend to affect men. "insurers may deny you for things that seem maddeningly simple--from [color=#108896]acne
to being [color=#108896]pregnant
to having had a c-section," codispoti says.
just ask alysha leidel, a 32-year-old tampa interior designer who lost her employee group coverage when she decided to quit her job after her daughter was born. her husband was self-employed, and his private [color=#108896]insurance
plan covered him and the baby. but when leidel tried to sign on to the policy as an additional insured, she was denied--because, the company explained, her daughter had been delivered by c-section. she appealed but was again denied. "i finally got a 'last and final denial letter,'" she remembers. "it basically said, 'stop contacting us.' it really made me feel like a leper." leidel and her husband want more children, so in february 2011, he reluctantly closed his financially successful business and joined a firm just so leidel would be covered by his employer's group plan.
right now, 37 states still allow health insurance companies to charge women more for individual policies--and to outright refuse them coverage. in 2009, according to an nwlc study of america's best-selling individual plans, 95% of the companies practiced gender rating and/or gender-related denials. for example, 60% of those plans charged a 40-year-old woman who didn't smoke more--up to 63% more--than a 40-year-old man who did, for the same coverage.
and no, women's policies are not more expensive because of costs associated with giving birth--87% of individual policies for 30-year-olds don't cover prenatal or childbirth care. even so, in some cases, 25-year-old women pay 84% more than men of the same age and health, even though maternity coverage is specifically excluded from their policies. so no matter how you twist the excuses, being female just costs you money--or coverage.
what's behind the gender bias?
how do health insurance companies justify gender discrimination? it's just business, they say. the actuarial formula insurers use to calculate rates has been around for decades and is rooted in data that shows that, up to about age 55, women typically go to the doctor more often than men do (at minimum, for a yearly gynecological exam) and take more medications (such as birth control pills).
in their mid-50s, men tend to start seeing the doctor just as often, so their rates usually catch up, says robert zirkelbach, press secretary for america's health insurance plans, a trade association that represents the health insurance industry. but that still means that a woman may have paid as much as 84% more in any given year up until then.
"there are many factors that go into determining cost, and gender is just one of them. it's about risk. this is exactly how it works in auto insurance and life insurance too," zirkelbach says, pointing to the higher premiums usually charged to male teenage drivers and men who want life insurance. he also denies that people are shut out of the insurance market, saying that "surveys show that nine out of ten consumers who apply are offered a policy." of course, whether that policy is affordable is another story.
not everyone finds the insurance companies' justifications defensible. similar actuarial data was once used to charge different rates to people of different races, since nonwhite populations had--and continue to have--higher incidences of chronic conditions such as [color=#108896]diabetes
and sickle-cell anemia. despite these "numbers," during the civil rights movement of the 1960s, companies self-regulated and voluntarily stopped race rating, codispoti points out. as for the car insurance comparison: "it's not relevant, since people don't die if they can't get car insurance," she says flatly.
young and middle-aged women do use more health services than men of the same ages, concedes marianne j. legato, md, director of the partnership for gender-specific medicine at columbia university. however, she says, they ought to be applauded for this, not penalized. early testing and exams save lives and can cut medical costs over the long haul for the whole health care system. she adds that insurance companies "are draconian about paying for tests for prevention. i have to fight with them all the time on behalf of my patients."
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the rising risk
within a group policy, such as those offered by large employers, it's illegal to charge men and women different rates for the same coverage. but as the american economy changes, fewer companies are providing health benefits, fewer workers can afford the skyrocketing payroll deductions, and more people are out of work, meaning that increasingly more of us must turn to individual policies--or go without. what's more, even what in the past seemed like safe havens--such as high-risk pools and some group plans for companies that hire mostly women--are also subject to gender discrimination.
in an attempt to protect women against this bias in health insurance, federal law finally outlawed these practices as part of the omnibus health care reform patient protection and affordable care act, signed into law by president barack obama on march 23, 2010. "being a woman will no longer be a preexisting medical condition" is how then speaker of the house nancy pelosi (d-ca) put it at the time.
the provision reaches full force in 2014, when much of health care reform is scheduled to become active. at that point, specific protections and penalties will go into effect to give the law teeth. "massive changes will be implemented to eliminate gender rating and other discriminatory practices in one fell swoop," says judy waxman, vice president of health and reproductive rights at the nwlc.
unfortunately, there's a real danger that this won't ever happen. conservative opposition to health care reform may kill the entire act, allowing gender rating to continue to flourish indefinitely. current speaker of the house john boehner (r-oh) has said of the patient protection and affordable care act, "i'm fighting to repeal this controversial new law so we can start over with commonsense solutions that get health care reform right." however, he doesn't mention how--or whether--his party would deal with the issue of gender rating, and calls and e-mails from our reporter went unanswered.
if you care about ending gender rating, write to your state representative to say so. your life may literally depend on it.
4 reasons why women aren't welcome
insurance companies may deny coverage or charge higher rates for reasons that could pertain to either sex--but apply more frequently to women. some of these causes:
1. working for a company that employs mostly women.
insurers can and do charge a whole firm higher rates based on the gender of most of its employees. linda bettinazzi is president and ceo of the visiting nurse association of indiana county in western pennsylvania, and all but five of her 160 employees are women. in 2010, she paid $7,764 for each worker enrolled in her group health plan. that's roughly $2,700 more per employee than the national average.
2. being a rape survivor.
chris turner, 47, a st. petersburg, fl, woman, was raped in 2002. her assailant was never caught, so her doctor prescribed anti-hiv drugs as a precaution, and she underwent counseling. three months later, her insurer claimed her policy had lapsed because she hadn't paid. (turner says she had.) it refused to consider her again until she wasn't in counseling and could prove she'd been hiv free for 3 years.
3. being the victim of domestic abuse.
in 2006, when albuquerque attorney jody neal-post tried to switch plans, she was denied coverage because 4 years earlier, she'd undergone counseling and taken [color=#108896]antidepressants
after her ex-husband tried to strangle her. neal-post filed a complaint with the new mexico public regulation commission and got the decision overturned. but eight states and the district of columbia still allow domestic abuse as grounds for denying insurance to the victim.
4. considering adoption.
san francisco insurance broker kevin sullivan recalls a healthy client in her mid-30s who was denied coverage because she'd talked to an agency about adopting a child. companies are concerned about adopted kids' possible health problems, he says. in most states, they must cover a child after he's adopted, but can exclude parents still in the planning stages.
how to fight back if you're denied
if you believe you've been declined by a health insurance company because you're female, "the most important thing is to get educated and understand your rights," says joanna morales, director of the cancer legal resource center. below, your first steps.
- get the legal facts. call your state's insurance commissioner to find out whether gender rating is legal in your state. if it's not, the commissioner's office may be willing to help you build a case against the insurance company.
- keep shopping. if gender rating is legal in your state, it's worth trying other insurers, says judy waxman, vice president for health and reproductive rights at the national women's law center. "you can ask the original company to reconsider, but it'll probably be more productive to shop around elsewhere." she also suggests contacting an insurance broker, who may know which providers are likely to be more flexible.
- consider public alternatives. a good starting point is to log on to healthcare.gov, a us department of health and human services web site, which can point you to appropriate state-and federally funded choices. be sure to keep your denial letter, because you may need to include it with your application.