Health insurance was originally conceived as a business agreement between two entities: a healthy individual and a company (the Insurer) which would assume part of the financial responsibility (risk) for that individual's medical cost in the event that his health diminished. Because it is protecting you against a risk which has not yet occurred, insurance must be in place prior to its need for use. As with any other type of insurance (life, car, disability, homeowner's - among others),  the emphasis is on protection in the event of unforeseen occurrences.

Any kind of personal protection requires responsibility and accountability: it is the individual's responsibility to seek the necessary protection for their life, their health (and that of their family), and their property. Just as you can't wait till you have a car accident to get car insurance, you likewise can't wait till you need health coverage to apply for it.

Unfortunately,  when people are healthy, insurance is not a priority  as it has no  immediate impact on them. But when people discover that they need surgery or medical attention that they can't afford, they appreciate their insurance - if they have it - or claim that it's "unfair" that no one will cover them.

Again, this is an issue of personal responsibility, not what's fair or unfair. You cannot wait till the need arises to put a plan for protection in place. Individuals suddenly  needing care that they have no coverage for will scramble to find a carrier who will take them - and, as their need has already occurred,  it's unlikely they will be successful. As a high risk specialist, I encounter these panic-stricken, last-minute coverage hunts daily - and no one wants to be the bearer of bad news.

Some states have guaranteed issue "high risk pools" (not to be confused with "portability") whereby no one can be declined, providing he can show proof that he has been unable to obtain coverage anywhere else, and provided he can pay the premiums. Many can't. Where they exist, these plans differ from state to state: in some, you have a choice of medical providers; in others, you are relegated to the county hospital and its facilities.

I have been on both sides of the insurance issue. Years ago, it was easy to feel that everything was unfair when it turned out  that I wasn't as healthy as I thought ("I'm healthy! What can happen?")and had to have surgery - minus insurance. It was easier to spend money on other things, always expecting that my job - the current one  or the next - would provide coverage. It wasn't so easy to pay for surgery after all: in 1989, six days in the hospital for a surgery which took one hour, cost over $17,000. (With today's rates, that same surgery could cost over $25,000.)

If you work for a company which offers a group insurance plan, that carrier cannot decline you. If you have been without coverage in the year prior to obtaining the group coverage, you can be given a 12 month exclusion on a preexisting condition -  in other words, no medical care related to that reexisting condition would be covered for the first 12 months . Then again,  maybe not -  it depends on the group plan and the size of the group.

Some plans - notably PPO or indemnity plans (as opposed to HMOs) will take an applicant with [certain] preexisting conditions and - depending on the severity of those concerns -  offer coverage with an "exclusion rider" on the particular preexisting condition or a possible increase in premium to cover the condtiion. This rider can be as short as 12 months or for as long as you keep the plan. (As a rule, HMO's must take the applicant with any and all preexisting conditions or decline coverage altogether - ergo, they have a high decline rate.) PPOs or indemnity plans can provide coverage to an individual but deny coverage for a specific condition. This is one of the major differences between managed and non-managed care.

The state of Arizona has one program, with three participating health plans designed for small groups (two or more employees): Health Care Group of Arizona. This progrm, through the state, offers varying levels of HMO and PPO coverage in select counties. They cannot decline coverage, regardless of the preexisting condition, provided  the applicant meets the conditions of employment. A 12 month exclusion rider can be placed on conditions, if no insurance was in place prior to the new plan -  and certain conditions are simply not covered (heart, liver, lung and bone marrow transplants, mental health and non-diabetes-related injectable drugs). These plans do cover maternity after 12 months. While they are not high risk plans, they do serve a specific segment of our population. For an individual with medical conditions, who is truly self-employed, there are other options available in the true insurance market - please call our office.

Callers to our office frequently ask "What about the law that says no one can be denied health coverage?" That law is  discussed in more detail in an article on our website, entitled "COBRA, HIPAA....?" The actual law (mandate) provides for continued health coverage to individuals (1) who have completed 18 months of COBRA or (2) who are coming from a group plan too small to offer COBRA and who have 18 months of continuous coverage with the most recent form of that coverage a true group plan (for purposes of this law, a group is defined as two or more employees on an employer- sponsored group health plan; people exiting the military would also qualify). This law is  known as HIPAA (Health Insurance Portability and Acountability Plan), "group-to-individual portability," and  the premiums can range from 300% to 500% what regular rates would run.

There are plans out there, are various levels addressing different needs. Arizona does not have a high risk pool - but, keep inmind, in states that do, the premiums start at over $500 per month per person. A high risk pool is covering people with.... high risks. So, of course, it will cost more. States that do not have high risk pools tend to have three to fourur times more insurance companies doing business in that state than those states which have high risk pools. Exception: a state whereby the high risk pool or plna is subsidized by the state - in this instance, there could be any number of carriers doing business in that state. Colorado, Oregon and Washington would be examples of states that have only a handful of insurance carriers doing business because their high risk pools state that each carrier doing business in that state will accept its proportionate share of "high risk" applicants, as opposed to a designated "carrier of last resort" - Michigan is an example of this.