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    Celiac Disease 'Pre-Existing,' Firm Cancels Health Insurance for Girl, 17

    Jefferson Adams

    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

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    Guest Janet LaRue

    Posted

    This is disheartening for the Celiac Community in general. I have also wondered if this would indeed start occurring with celiac patients. For this issue alone, I have not recommended having genetic testing for family members as it would be seen as a pre-exisiting condition should a member have the gene and a predisposition to celiac disease.

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    I am disgusted with the insurance company, and that's the only thing I can say that is printable!

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    Guest Eric Young

    Posted

    Is there any question in anyone's mind about the need to fix our health system in this country? Where else on the face of the earth is profit put ahead of someone's well-being? Wouldn't it be poetic justice if the CEO of American Community Mutual was diagnosed with celiac disease, something that I would not wish on anyone. I hope Illinois steps up to the plate for this 17 year-old!

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    Guest former nurse case manager

    Posted

    It is unfortunate you have tied losing medical insurance to the diagnosis of celiac disease. The reality for this family is that they are unemployed, therefore they lost their medical coverage. I believe a simple letter from their daughter's physician stating the facts of her diagnosis would be helpful in fighting this denial of coverage. Their right to challenge the decision to deny insurability needs to be highlighted and pursued by these parents.

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    Guest concerned parent

    Posted

    Truly, this is a concern. I have worried about such an event since my daughter's diagnosis. Luckily, we still have coverage -- but what if we have to switch companies? When she grows and gets insurance as an adult -- will she even be able to get a reasonable and fair policy?

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    Yes, this is one clear reason for health care reform. It's just business as usual for this insurance company; maximize profits at the expense of subscribers' health. The whole issue of denial and the subsequent games the patient has to play with the insurance company is expensive too. We are the only industrialized nation where medicine is a (profitable) business, and the incentive is for patients to come in sick (as opposed to health maintenance and prevention). I had to fight my insurance company regarding testing my daughters (I am a Celiac), but they finally understood it would be cheaper to do the genetic test than to go fishing with numerous doctor visits.

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    Guest Abigail

    Posted

    I have come to the conclusion that anyone associated in any way with insurance companies is allied with the devil. It's all about the Benjamin, Baby.

    Not that having the government run our health care would be much better. It's really a lose-lose situation, it seems.

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    It is unfortunate you have tied losing medical insurance to the diagnosis of celiac disease. The reality for this family is that they are unemployed, therefore they lost their medical coverage. I believe a simple letter from their daughter's physician stating the facts of her diagnosis would be helpful in fighting this denial of coverage. Their right to challenge the decision to deny insurability needs to be highlighted and pursued by these parents.

    A simple letter stating the facts? What universe are you from? When did you retire? Twenty years ago? First the insurance company loses the paper work repeatedly then it stonewalls. They are just hoping you will give up or die. And they don't ever have to give you a reason. Read the newspapers; watch something other than Fox...

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    This is disheartening for the Celiac Community in general. I have also wondered if this would indeed start occurring with celiac patients. For this issue alone, I have not recommended having genetic testing for family members as it would be seen as a pre-exisiting condition should a member have the gene and a predisposition to celiac disease.

    I have a similar case pending with Indiana DOI for this same insurance company. Go figure and I will be sending this article to the Indiana DOI on tomorrow.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

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