In 2006, attorney Jody Neal-Post tried to get health insurance but was rejected because of treatment 鈥� counseling and Valium 鈥� she received following a domestic-abuse incident. She says the insurer told her that her medical history made her a high risk, more likely to end up in the emergency room or require additional care.
Four years earlier, Neal-Post says, she had been assaulted by her ex-husband in her home in Albuquerque, N.M. According to police records, both she and her ex-spouse were charged in the incident. The charges were later dropped.
She wasn鈥檛 prepared for the blow from the insurer. 鈥淚 was just flabbergasted,鈥� says Neal-Post, a 52-year-old attorney. During the altercation with her ex-husband, 鈥淚 was beaten and choked in my living room,鈥� she says. 鈥淚鈥檓 trying to keep my family together and get medical care. And then you make it through, with everyone back on track, and years later, when it鈥檚 no longer part of your daily life to remember that and you鈥檙e feeling good, it鈥檚 back again.鈥�
Advocates say it鈥檚 not uncommon for people who have been abused to be denied insurance on the individual market. While the majority of states have barred insurance companies from using abuse as grounds for denying coverage, eight states and the District of Columbia don鈥檛 prohibit denying coverage for that reason. And even when states do have a law, it doesn鈥檛 necessarily prevent carriers from initially rejecting applicants who are victims of violence.
It鈥檚 unclear how often such rejections take place. But it is clear, experts say, that the fact that they occur at all can have a chilling effect on victims, who may be afraid to tell their doctors about attacks out of concern they鈥檒l have trouble getting insurance in the future.
A State vs. Federal Issue
How victims of domestic abuse are treated by insurers now is emerging as part of the health care overhaul debate. 鈥淭hink of this, you have survived domestic violence and now you are discriminated in the insurance market because you have a pre-existing medical condition,鈥� House Speaker Nancy Pelosi, D-Calif., told leaders from women鈥檚 organizations at a press conference Tuesday. 鈥淲ell, that will all be gone under this legislation,鈥� she promised.
The health bill by the Senate Committee on Health, Education, Labor and Pensions would explicitly bar insurers from denying coverage based on domestic violence. In a recent speech, First Lady Michelle Obama said that using domestic abuse as a reason to deny coverage was among the insurance practices that 鈥渟till wake me up at night.鈥�
But for now, the issue is left to the states.
In some ways, Neal-Post was lucky. Her home state of New Mexico has strict laws prohibiting insurers from denying insurance based on a history of abuse. She鈥檚 also an attorney with experience representing victims of domestic abuse.
After her fight with her ex-husband, and the coverage denial by the insurer years later, she filed an official complaint with the state鈥檚 Public Regulatory Commission鈥檚 insurance division. The commission insisted the insurer reverse its decision, which the company did. But had Neal-Post lived in one of the states that does not offer protection against insurance discrimination for abuse, she might have ended up uninsured.
America鈥檚 Health Insurance Plans, an industry trade group, has supported laws that explicitly prohibit domestic abuse from being a factor in denying insurance. 鈥淲e have encouraged all states to adopt the legislation,鈥� referring to a 鈥渕odel law鈥� developed by the National Association of Insurance Commissioners, says spokesman Robert Zirkelbach.
But Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Wyoming and the District of Columbia have not yet done so.
How Widespread Is the Problem?
There have been no recent surveys to gauge how often victims of domestic abuse are rejected by insurers. An informal 1994 survey conducted by the Senate Judiciary Committee subcommittee staff found that eight of the 16 largest U.S. insurers used domestic violence as a factor in deciding whether to offer insurance coverage and how much to charge.
Follow-up surveys by the insurance commissioners of Pennsylvania and Kansas the next year found that one in four responding insurers reported taking domestic violence into account when determining whether to issue or renew health, accident or life insurance policies.
To get a sense of current conditions, Kaiser Health News contacted the departments of insurance in the states that have not adopted a ban. The majority said they had never heard of the issue, nor had they ever seen a question on an insurance application specifically asking about domestic abuse. None found records of complaints from domestic violence victims who had been denied coverage. And several, including North Carolina鈥檚 department of insurance, said they had other stop-gap measures in place to prevent the practice.
鈥淭hey鈥檙e Not Looking In The Right Places鈥�
Nancy Durborow, Health Projects Manager for the Pennsylvania Coalition Against Domestic Violence, says she isn鈥檛 surprised that state departments of insurance haven鈥檛 heard about the problem. 鈥淭hey don鈥檛 see it because they鈥檙e not looking in the right places.鈥�
Insurers never directly ask about abuse status on an application, Durborow explains. Instead, they learn about a history of domestic abuse in a myriad of other ways. They might find evidence in an applicant鈥檚 medical records, such as repeated visits to an emergency room or a doctor鈥檚 notation about abuse. Insurance agents may find out during an interview with the applicant. Durborow has even heard of cases where insurance agents have visited local courthouses to search for Protection from Abuse Orders, which are public information. Insurers may also see reports of domestic disturbances in a local newspaper.
In most states, insurance companies are not required by law to explain their decisions, so a domestic violence victim may never know why coverage was denied. Neal-Post adds that, because victims of domestic violence often remain silent, they wouldn鈥檛 necessarily ask the right questions. In her case, she says, 鈥渢hey just made the mistake of doing it to a lawyer. It鈥檚 flat-out wrong that I had to have professional skills and know-how to get covered.鈥�
Fear Of Denial
Lisa James, director of health for the Family Violence Prevention Fund, a non-profit group that works to prevent domestic violence, says the fear of being denied coverage is almost as menacing as the actual denials. Some women have heard about this type of insurance discrimination, she says, 鈥渆specially those who have spent time in shelters with others. Women are concerned about keeping their medical information confidential.鈥�
In addition, the possibility of being denied insurance could discourage women from leaving an abusive partner. And for a woman with children, she says, the risks are multiplied. 鈥淚t could be a denial not only for her, but she might also be worried that if she leaves, she won鈥檛 be able to take her children to the doctor.鈥�
But the deterrent effects of these insurance practices don鈥檛 stop there 鈥� they also have been known to plague the doctor-patient relationship. According to James, women may not feel comfortable discussing their difficulties with medical providers for fear that the information could be used against them down the line. She also hears from doctors and nurses who are worried that they may be compromising their patients鈥� ability to get insurance by asking about and documenting abuse.
鈥淭he First Real Glimmer Of Hope鈥�
James and Durborow both say that enacting a federal law prohibiting the practice would be the best way to protect victims of domestic violence. But, since 1995, numerous measures have been proposed unsuccessfully in both the House and Senate. One such proposal failed in the Senate health committee as recently as 2006.
Durborow, who has been lobbying for a federal law for the past 12 years, says health reform is 鈥渢he first real glimmer of hope鈥� that a ban on the practice will pass. 鈥淔or many years they told us that enacting protections would bankrupt the insurance companies, but we鈥檝e never heard that it鈥檚 been a problem鈥� she says. 鈥淏ut people are now finally taking on the insurers.鈥�
鈥淲hen you look at statistics on the prevalence of family violence, you can see why some bean counter would think this is certainly a way to save money,鈥� adds Neal-Post. 鈥淏ut the consequences are far reaching.鈥�