The Elder Law Forum by Professor Michael Myers Editor's Note: The Elder Law Forum is a public service of The University of South Dakota School of Law, an extension of the SENIOR LEGAL HOTLINE available at no cost to persons 60 and older at 605-677-6343 and firstname.lastname@example.org during regular business hours. The Elder Law Forum delivers information and educational material by radio, a weekly newspaper column, and Law School research papers placed on the USD School of Law Web site. Professor Myers teaches Elder Law at the School of Law.
55 to 65: Decade of Risk
"She's healthy as a horse!" said the 65-year-old USD Senior Legal Hotline caller (1-800-747-1895, mmyers@usd. edu). "I'm not, but she is. Can they do that?" he asked.
In this case "they" were Wellmark Blue Cross Blue Shield. And what they "did" was attach a rider to his 59-year-old wife's individual health insurance policy, a rider that excluded medical, surgical, or any coverage whatsoever for any condition related to the spine or back.
She had no back or spinal problems. But she did occasionally visit a chiropractor for general health maintenance purposes, in the same way many people visit their medical doctor for check-ups.
I suggested the caller challenge the rider, and offered to help. A week later she called again. "There is no sense fighting it," she said. "We went to another carrier and pulled out the check book. It's costing me $200 to $250 more a month than it should."
There are several lessons to be learned from this transaction:
Lesson One: Health insurers are profit-maximizing entities. They prefer to extract premiums from persons least likely to become sick and file claims.
Lesson Two: The "healthy as a horse" 59-year-old is in that vulnerable 55-to-65 age range: old enough to be a health risk, but six years away from Medicare. The private market prefers youth. It is unabashedly ageist.
Lesson Three: Wellmark, like most Blue Cross Blue Shield plans, is seeped in the syrup of AMA ideology, promoting the only two tools of the allopathic trade � drug therapy and surgery. Everything else, according to this generation of medical school graduates, is quackery.
Lesson Four: The deck is stacked against the consumer. The Wellmark rider was a capricious gesture, rooted in questionable motives. Yet, her "appeal" would be to ask Wellmark to please reconsider its previous determination.
The likely answer: "We meant what we said." There is no "independent" review of the type contemplated in the proposed federal patient bill of rights, legislation that appears to have been permanently derailed.
The 55-to-65 decade can be one of extraordinary risk. The older, and often more expensive, worker is a prime target for a reduction-in-force layoff and the loss of employment-based health insurance.
By then most people have had an encounter with the healthcare system. Such an encounter can make you uninsurable, even if you are "healthy as a horse."