Tuesday, April 24, 2007

Broken System or Thoughtless Folks?

Bob sent me a link to this story in the Akron (Ohio) [ed: where else?!] Beacon Journal. Seems that an elderly couple adopted an 11 year old girl, only to find out that they're stuck with a lot of medical bills and no insurance:
Reading the story, it's tempting to blame the health insurance system for the family's travails, but even a cursory examination tells us that this is most decidedly not the case.
How so?
Well, the Johnson's, a couple on Medicare, adopted little Shaunell when she was 11 years old. Shaunell has asthma, and because of the adoption is no longer eligible for the state's SCHIP program (a state-run health insurance alternative for lower income kids). Her folks, despite the fact that daddy has a "part time financial services" job, are on Medicare, but for some reason make too much money for Shaunell to be added to their plan.
Yeah, made no sense to me, either.
But that's not the only disconnect in this "story:"
The Johnson's apparently tried to obtain health coverage for Shaunell from a local insurer, SummaCare. SC isn't exactly the biggest name around (they rate only a B++ by A M Best), and they declined her. The story doesn't say what other carriers the Johnson's tried, but Shaunell's asthma must be pretty severe, because the underwriting guides for a number of major carriers indicate that this is not usually a declinable condition.
In the event, they applied to SummaCare, which not only turned her down, but then proceeeded to blame "our broken health-care system." Um, no: it's not the health care system at fault here, but I can immediately see at least one other "system" that has some 'splainin' to do:
How come the authorities allowed a couple on Medicare to adopt a child, without first ascertaining that that child would have access to adequate medical care, and appropriate insurance coverage? Given her obviously acute medical condition, wouldn't that have been prudent? And how come the Johnson's themselves didn't make sure that this was, indeed, the case, given that Mr J is apparently a financial whiz?
There are a LOT of questions left unanswered here. (And Thanks, Bob!)
UPDATE: It actually gets more interesting. I was pretty sure, but just confirmed with several carriers, that if the Johnson's had had an individual medical plan in place, it's likely that they could have avoided this whole mess.
How's that, you ask?
Most individual plans allow one to add a newborn (or newly-adopted) child onto the plan, with no underwriting or pre-ex limitations, within 31 days of the event.


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