Failing Grades for Wisconsin: Protecting Health Insurance Consumers

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Jun 18, 2008 No Comments ›› admin

June 18, 2008

“My father in law died of heart disease. He had no insurance,” the woman from Arcadia told me. “He tried for years to get insurance, he couldn’t get any company to cover him. Every insurance company he applied to turned him down.”

“My daughter has epilepsy and she can’t get insurance,” another added.

I was comparing notes Saturday with local people on the mess that is our failing health insurance system. The stories are most unsettling. “I had cancer years ago and no one will cover me today even though I have been healthy for almost two decades,” a Pepin County woman told me. “But I learned that if I lived in California the insurance company would be required to cover me.”

Most of us in Wisconsin like to think we have in place great consumer protections. We even have a department with consumer protection as part of its mandates – the Department of Agriculture, Trade and Consumer Protection. But Wisconsin has failed when it comes to protecting consumers who buy individual health insurance.

Last week Families USA, a national consumer advocacy group, released a study shedding light on the problems Wisconsin families face in getting basic consumer protection when buying individual health insurance coverage. The results show that Wisconsin is far behind other states in protecting health insurance consumers.

The study entitled “Failing Grades” shows Wisconsin and Illinois are the only two Midwest states that failed every measure of consumer protection related to pre-existing conditions. Illinois and Wisconsin joined 16 mostly southern states who failed to set rules on either defining or limiting restrictions on preexisting conditions. Even Louisiana and Mississippi have a limit on how long an insurance company can hold past health history against a person when denying insurance coverage.

Wisconsin was rated as one of the worst states in dealing with pre-existing conditions.  Not only can an insurance company deny coverage to a person suffering from illness, but there are no limits on how long someone can be denied coverage of the very problems for which they most need health insurance. In Wisconsin, there is absolutely no time limit on how long coverage can be excluded.

Even if you have insurance coverage, there is no consumer protection ensuring you will actually have claims paid if you do get sick. There is a hideous practice among insurance companies that allows them to deny legitimate claims when someone becomes sick.

The practice works like this: you develop a health problem and file claims seeking payment for bills related to the new health problem. You paid all your premiums and are up-to-date on all requirements of the policy. The insurance company receives your claims for the new health problem and begins digging back into your medical history – looking back months or even years. The company then alleges you failed to disclose or should have known about some pre-exiting condition for which you are now receiving care. The company denies the payment of your claim based on these allegations.

Wisconsin has some of the weakest consumer protection laws in the country regarding this practice of ‘look back’.

We need the political will to create the basic consumer protections residents of many other states enjoy. It is unacceptable for Wisconsin consumers to have worse protections than Louisiana and Mississippi. These problems are completely solvable. It is time we stand up for consumers and tackle these problems.

The complete study is available on the internet at (

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