Wow News To Me!

[crittermom]

I can't believe what I have just been reading...does insurance REALLY cost more for diagnosed celiac? Why? I agree with the last post I read, doesn't it make more sense and cost less money to be diagnosed and take care of it then keep just treating symptoms and testing everything else to find out what's wrong? CRAZY! I am just blown away right now, I have to check out our insurance. I am medical insurance stupid, I have to keep calling ours every couple of months just to try to understand how it all works. Where would I look to see if Katharine's coverage is more expensive than say mine or my husbands?

[Nikki'smom]

I've read where a few people have posted saying that too. I would just call your insurance company.

My DH HAD Ulcerative Colitis yrs ago but since had his colon removed and privately he is uninsurable because he was 'once diagnosed with UC' Which to me is CRAZY because now he won't get a huge host of major illnesses because he has no colon. No colon cancer, can't have an apenisitis among many other things and frankly we don't use the insurance all that much for meds for him any more because he doesn't need meds for his UC anymore. Insurance is crazy!

[kbtoyssni]

If you are insured by an employer, then it shouldn't be any more expensive. If you have your own private insurance, though, that's when you run into problems. Insurance companies want to make money, so they will charge more for anyone with a "prior condition". Which includes celiac. Although all of us know a diagnosed, gluten-free celiac is going to be way healthier than an undiagnosed one, that's not how insurance sees it. Maybe it's due to the high rate of non-compliance with the diet. Maybe it's due to the fact that it takes years to get a diagnosis, at which point many of us have other related health issues. Maybe it's because the medical community doesn't fully understand the disease. Whatever it is, insurance sees celiac and chooses the "convenient" facts - that it can cause many other health problems - and ignores all the rest of the facts - that a gluten-free celiac is going to be perfectly healthy. They charge more because they can.

[happygirl]

If you are insured by an employer, then it shouldn't be any more expensive. If you have your own private insurance, though, that's when you run into problems.

That is a wonderful response. I've been on three employer sponsored plans, and they cost the same for EVERYONE who participates...doesn't matter their health condition. Private health insurance is another story.

[kbtoyssni]

I should add the when employers negotiate with insurance companies to cover their employees, they agree to cover all employees at the same cost, regardless of prior medical conditions. They pretty much average out what they expect everyone to need for medical services and everyone pays the same. This means that someone who is very healthy is probably paying a bit more than they would with a private insurance than someone with lots of pre-existing conditions. It also means that single people pay a bit more to cover costs of other people's children, etc. This is a huge generalization, but for the most part true. I don't mind too much, though. The fact that they have to cover me (and I don't have to disclose pre-existing conditions) is invaluable.

I'd recommend the movie Sicko. It's Michael Moore's latest movie about the health insurance industry, and although it's very biased, it's still good. The whole theme is that insurance companies are out to make money so they'll do whatever they can to do that. This includes denying people coverage for pre-existing conditions and denying reimbursement if you haven't disclosed a condition. I always wonder what would happen in my case if I ever have private insurance, though. I tell all my doctors that I have celiac, but there is no medical proof - I've only got a negative blood test on my records. I'm sure they'd call it pre-existing, but would I be able to argue against that? Heck, I'd even be willing to do another blood test right now I bet it would come out negative

[crittermom]

Thanks for the replies. We are covered through my dh's work so that's probably why I never noticed.

[2kids4me]

My understanding is that because celiac is autoimmune - insurance companies give it a different risk category....because autoimmune conditions can occur together. They insure based on the risk factor and anyone with autoimmune disease is at risk for other conditions. My daughter is un-insurable til she reaches the age of 16 becaus of the diagnosis of Aspergers...related to the risk of autistic kids developing medical condtions...looks like they were right...unfortunately. I was told they would not insure her before she was even diagnosed celiac.

[lovegrov]

One problem for the insurance companies is whether or not a person with celiac is sticking to the diet. Folks on these forums generally do, but there are many who don't. I recently met a woman who every few months just can't stand it and eats regular pizza. Her reaction in relatively mild.

richard

[tarnalberry]

The compliance rates for the diets are actually shockingly low, and insurance companies don't have a way of knowing if you suddenly change your habits and either stop or start following the diet. So, the overall picture is a huge risk for them, even if a compliant celiac is not.

Also, employers are starting to not charge everyone the same based on health. Smoking, obesity, cholesterol levels, blood glucose levels, and blood pressure levels are all on the table as items for which to charge employees more if they don't keep them under control. And it appears to be perfectly legal. Open Original Shared Link

[Merika]

I've talked with one of the Blue Cross's for individuals and apparently "celiac" is difficult to get insurance for but "gluten-intolerant" is ok.

Merika

[mommyagain]

Smoking, obesity, cholesterol levels, blood glucose levels, and blood pressure levels are all on the table as items for which to charge employees more if they don't keep them under control.

Those are all things that a person supposedly has direct control over. For instance, an employer cannot charge you more for your insurance if you're diabetic... but they can (in some cases) charge more if you consistently end up in the hospital because you don't control it. Same with high blood pressure or cholesterol. The easiest one is smoking, because no one has naturally occuring nicotine in their system, so it's easy to check. As far as I know, at this time, employee provided health plans are only allowed to charge extra for things that you have control over, not a disease. Although, for celiacs that may eventually extend to testing blood levels to determine compliance with the diet...

But, you can fight it. I had a friend (a bodybuilder) who got a letter from the insurace company saying that his health insurance cost was going to increase because his BMI put him in the "obese" category. He sent back a picture of himself all flexed out, with a letter from his doctor showing results of a body fat analysis (less than 5%!). They never bothered him again

[SunnyDyRain]

I should add the when employers negotiate with insurance companies to cover their employees, they agree to cover all employees at the same cost, regardless of prior medical conditions. They pretty much average out what they expect everyone to need for medical services and everyone pays the same. This means that someone who is very healthy is probably paying a bit more than they would with a private insurance than someone with lots of pre-existing conditions. It also means that single people pay a bit more to cover costs of other people's children, etc. This is a huge generalization, but for the most part true. I don't mind too much, though. The fact that they have to cover me (and I don't have to disclose pre-existing conditions) is invaluable.

I'd recommend the movie Sicko. It's Michael Moore's latest movie about the health insurance industry, and although it's very biased, it's still good. The whole theme is that insurance companies are out to make money so they'll do whatever they can to do that. This includes denying people coverage for pre-existing conditions and denying reimbursement if you haven't disclosed a condition. I always wonder what would happen in my case if I ever have private insurance, though. I tell all my doctors that I have celiac, but there is no medical proof - I've only got a negative blood test on my records. I'm sure they'd call it pre-existing, but would I be able to argue against that? Heck, I'd even be willing to do another blood test right now I bet it would come out negative

I was working for a comapny that unfortuantely came down with a rash of cancers and other serious medical problems - seriosuly we were looking around thinking "who's next?". The next year our insurance skyrocketed 30%!

[kbtoyssni]

Also, employers are starting to not charge everyone the same based on health. Smoking, obesity, cholesterol levels, blood glucose levels, and blood pressure levels are all on the table as items for which to charge employees more if they don't keep them under control. And it appears to be perfectly legal. Open Original Shared Link

My company used to reimburse us if we were a non-smoker and if we took a health quiz every year. And reimburse for gym club memberships. It makes a ton of sense to do it that way. Then my company got bought out and all those nice benefits went away.

But, you can fight it. I had a friend (a bodybuilder) who got a letter from the insurace company saying that his health insurance cost was going to increase because his BMI put him in the "obese" category. He sent back a picture of himself all flexed out, with a letter from his doctor showing results of a body fat analysis (less than 5%!). They never bothered him again

This is the one problem with the BMI system. People who are very physically fit will often have a BMI that is much higher than it should be because muscle weights so much. There is a BMI formula tailored for athletes, but I doubt any insurance company uses it.