Celiac.com 09/18/2009 - Little did the parents of 17-year-old Brianna Rice realize that her February diagnosis for celiac disease would make her into a poster child for insurance reform. That's because when Brianna was first diagnosed, she was covered by health insurance. Thanks to some extra scrutiny by her insurance company, that is no longer the case.
In the months following her diagnosis, Brianna's insurance company, American Community Mutual Insurance, took a microscope to her medical records and canceled her policy after it ruled that her parents had lied on her application last November.
American Community not only canceled her policy, effective in May, but also denied coverage all the way back to November 1st, 2008, the day Brianna's coverage began.
After Brianna was diagnosed with celiac disease in February, American Community initiated a review of her medical files and found instances of dizziness, elevated cholesterol levels, ongoing fatigue and a persistent cough. The family received a letter from American Community dated 12 May announcing their choice to rescind coverage.
The letter stated that "coverage you applied for would not have been issued for Brianna if we had known this medical history at the time of application."
Dale Rice claims the firm cherry-picked the instances from different doctors' visits, and that Brianna had no ongoing health issues. He noted the dizziness to was due to a brief bout with dehydration, the fatigue a result of Brianna staying up late surfing online, and the elevated cholesterol due to an inaccurate test, and said her cough was short-lived.
The Rices insist they were honest and forthcoming on Brianna's application and say American Community is trying to back out of covering their daughter because of the February diagnosis.
American Community claims it would not have granted coverage based on Brianna's full medical record.
The Rices have lodged a complaint with the Illinois Department of Insurance. "We are livid," said Dale Rice, who, along with his wife, is out of work. "When a private insurer gets legitimate claims and seeks to find excuses not to pay them, they are clearly demonstrating morally and ethically bankrupt behavior."
Insurance companies look for "anything that they could say 'you didn't tell us about,'" says Rice. "They hope that people just lay down and die and don't fight."
The Rices are not alone. The director of the Illinois Department of Insurance, Michael McRaith, notes that his department has investigated about 400 rescission-related cases industry-wide since 2005. He calls the rate at which customers have complained about American Community 'alarming,' and calls American Community Mutual's rescission numbers 'cause for concern.'
The family's situation shows just how quickly health insurance problems can lead to financial ruin. With their daughter's unpaid medical bills exceeding $20,000 and mounting, the Rices fear losing their home. Brianna's mother, Pat Rice says she has liquidated some of her retirement account to pay bills.
"The next step is really bankruptcy," her husband said.
This story should strike a nerve with everyone who has celiac disease, or knows someone who does. I wonder how many people with celiac disease might risk cancellation of their insurance if they lost their jobs? How many people who obtain insurance in good faith, and later find they have celiac disase, risk being with a 'pre-existing' condition label? It seems to me that a crafty insurance company could make an argument that nearly all celiac disease is 'pre-existing,' especially in older people.
Let us know your thoughts by commenting below.
Source: Chicago Tribune