BlueCross BlueShield of Texas' blueprint for denying health policies.

How to fix health policy.
Feb. 10 2010 7:06 PM

How Insurers Reject You

BlueCross BlueShield of Texas' blueprint for denying health policies.

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Moving on to the Standard Rate Condition List of things that disqualify you for the preferred (but not standard) rate, I see "Anxiety/depression" (I'm busted), "GERD (acid reflux)," "Headache" (presumably that means more than the usual kind), "Herpes," "Temporomandibular Joint Disorder,"* "Tobacco use" (that's fair), and "Tourette's Syndrome" (the handbook offers no guidance about what a Tourette's sufferer is likely to say once he's been broken the bad news). Quit smoking for a year and you become eligible for the premium rate, provided you're no longer using a "cessation aid" or "nicotine substitution product."

A lot of coverage decisions are contingent on multiple factors. If you've been treated for anxiety/depression and you're no longer in counseling and you weren't in counseling too long and you take no more than one medication and you have no history of hospitalization, then you can get bumped up to the preferred rate. On the other hand, if you're still seeing a therapist, that's enough to deny you any coverage at all. Got an anorexic teenage daughter? You can still get the preferred rate if she's been completely recovered for five years, is no longer in therapy, maintains a normal weight, and has enrolled in the Radcliffe Publishing Course. (OK, I made that last one up. Anyway it's moved to Columbia.) That first condition alone means there's a good chance the young lady no longer lives at home and has acquired her own insurance policy. If you can't meet these conditions, your policy is declined.


Let's say you fought in Iraq or Afghanistan and lost a limb. Now you're discharged from the Army. If it was only your fingers or toes, you can still get the preferred rate. If you lost an arm or a leg and it was more than a year ago and there are no complications, then you get a rider slapped onto your policy. (A rider typically excludes coverage for a specified pre-existing condition, i.e., the very thing you're likely to need treatment for.) If you lost the arm or leg within the past year, or there are complications, then sorry, soldier. You get no policy at all. Maybe the Veterans Administration can help you.

Unacceptable Medications. These include a lot of anti-arthritic medications, a few anti-cancer drugs (not as many as you'd think), a bunch of anti-coagulants (including Coumadin), various anti-diabetic medications (including all insulin products), various anti-substance-abuse meds (including methadone), a few anti-thyroid medications, just about anything you'd take if you were HIV-positive (which would already have disqualified you), anti-psychotics, anti-Parkinsons drugs (Parkinson's sufferers are also disqualified anyway), and a few miscellaneous meds.

Riders. I mentioned amputation, but I didn't mention acne (you have to be five years past any treatment before they'll drop the rider), bursitis (also five years), carpal tunnel (five years), colon polyp (five years; I don't care what Katie Couric says, you shouldn't have had that colonoscopy!),  tonsillitis (five years), and varicose veins (permanent).

By now you're probably starting to wonder whether anyone in Texas is eligible for a preferred rate, or to be covered at all, under BCBSTX's nongroup underwriting rules. Obviously someone must be, or BCBSTX would go out of business. But it's a pretty select, shockingly healthy bunch. If you want to know who can't get a policy, the underwriting guide provides a helpful list of disqualifying occupations. These include stunt pilots, test pilots, explosives handlers, and rodeo performers (OK, I'll give them all those), but also miners, offshore drillers, and … professional athletes. That's right. The people in absolutely the finest physical condition in America are uninsurable.

Most of these restrictions would become illegal if health reform were to become law. That's a very compelling reason to pass the bill. But both U.S. senators from Texas (John Cornyn and Kay Bailey Hutchison) are Republican, and not a single Republican senator supports Obamacare.

E-mail Timothy Noah at

Correction, Feb. 11, 2010:
This column originally stated, incorrectly, that TMJ is the same as lockjaw. TMJ is one of many conditions (tetanus is another) associated with lockjaw. (Return to the corrected sentence.)


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