A story out of Indiana explains the pre-existing dilemma. A pizza shop hired an obese male 340lbs to work in the kitchen. This guy hit his back on a freezer door and the pain was so persistent that it required surgery. The pizza shop agreed to pay for this being that it happened at work.
So how is this describing a pre-existing condition. His doctor told him for the best results any back surgery would require him to lose weight. So he sued his employer to pay for weight lose surgery costing between 20,000-25,000 dollars The courts found in his favor ordering payment for both surgeries.
This is why insurance companies don't insure pre-existing conditions. You can't insure against something that has already happened.
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Exactly, insurance is all about calculating risk and then charging to insure against those calculations being wrong.
ReplyDeleteHere is a sample telephone call:
Hello, State Farm, Stacy speaking may I help you.
Yes, my house is on fire so I need insurance right away.
Or maybe a better example is flood insurance. Most people elect not to pay higher premiums for flood insurance and then get angry when their insurance doesn't cover their flooded out house after the sump pump fails.
Yup, I agree with you on this. I don't know how widespread a case this extreme is, but, as I wrote elsewhere, if 71% of costs are lifestyle based, then real reform would require us to do something about those lifestyles. Tax payers, employers, and insurance companies shouldn't be on the hook for years and years of a person's bad choices... At the same time, though, I think we need to get a better understanding of WHY so many people make so many bad health choices, and look at doing something about that.
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