Preventative Care on Individual Health Insurance

We’ve all heard the adage that an ounce of prevention is worth a pound of cure, yet it often seems that most people ignore this advice.  Otherwise people would not be dying from smoking-related cancers and the plethora of illnesses caused by obesity.  It’s easy to say that these are personal problems and that people need to take better care of themselves.  But it’s worth considering whether the insurance industry has any moral obligation to do more in terms of preventing major illnesses before they manifest symptoms in people. 

Most of our business is individual/family health insurance in Colorado, and we are very familiar with all of the major policies offered in Colorado.  In the PPO market, we have been conditioned to think that if a health insurance company is offering $300 or $500 in preventative care each year, they are providing “great preventative benefits.”  By Colorado law, all policies are required to cover mammograms for women and PSA exams for men, with no deductible.  That’s it as far as what insurance companies HAVE to cover.  Notice that pap smears are not on the list.  Nor are colonoscopies or blood screenings or stress tests.  If you have a policy with a $300 annual limit on preventative care, it’s pretty easy to use that up with one pap smear and a basic check up.  It would be nice to think that everyone is concerned enough about their health that they would be willing to save enough money to pay for their own colonoscopies (not a cheap procedure) and dermatologist skin screenings.  However, I think we all know that it’s not likely to be something that a significant number of  people can or will pay for themselves.  Instead, most people who don’t have insurance coverage for these things (especially the expensive ones) just don’t get them done. 

Without considering the moral obligations of companies whose job is to pay for healthcare, why not consider the financial ramifications of paying for preventative care.  In the past, many diseases were nowhere near as treatable as they are today.  Some diseases that were considered terminal even 10 years ago, now have longer survival rates and in some cases can become manageable chronic conditions.  Let’s look at this as a purely numbers-based issue (a bit morbid considering it’s peoples’ lives we’re discussing, but I understand that insurance is a business).  15 years ago, perhaps it made financial sense for insurance companies to limit coverage for preventative care.  That way, illnesses wouldn’t be detected until they were at an advanced stage, and sadly enough, the person might die before the health insurance carrier had paid out much money for treatment.  If the disease had been caught early, the health insurance company would have likely paid much more for the treatment.  With all of the advancements in medical technology, even diseases that are caught in later stages today often have a decent prognosis, and treatment can add years to patients’ lives.  So insurance companies will be paying for extended treatment whether the disease is caught early or not.  And often the treatment for advanced-stage diseases is much more expensive than it would have been had the condition been caught early (for example, consider the cost of open-heart surgery versus a regimen to lower cholesterol before the problem warrants a quadruple bypass).  Removing colon polyps detected early through a colonoscopy is much less expensive than treatment for colon cancer, yet colonoscopies are almost never covered by Colorado health insurance companies.  This seems counter-productive.  Doesn’t it make more sense for the health insurance carrier to pay for the colonoscopy (since very few people will pay for this themselves) and then the small cost of removing polyps, instead of paying for chemo, radiation and radical surgery? 

I believe that if health insurance carriers devoted significantly more resources to paying for regular preventative care, they would eventually save money on the big-ticket treatments that result when undetected small problems turn into big problems. 

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

Comments

  1. 60 years ago, Dr. Sidney Garfield discovered that preventive medicine is not only morally right, it’s a sound business model. Dr. Garfield was paid a nickle a day to care for each worker building the California Aqueduct in the middle of the California desert. If he kept them well, he came out ahead. At one point, he was confounded by a rash of foot-puncture injuries. So after clinic hours, he and his staff went to the worksite and pounded down the exposed nails in the scaffolding. Puncture wounds and the inevitable infections declined. Now that’s the looking at preventive health care in the broad sense.
    The industrialist who had lured Dr. Garfield to his Aqueduct project liked what he saw. He invited Dr. Garfield to set up a clinic to care for ship-builders in Oakland. So it was that Dr. Garfield and Henry Kaiser pioneered pre-paid medical care, bringing preventive medicine to blue color workers and an affordable price.
    Kaiser Permanente is their creation.

  2. Kaiser is the one exception to the problem of health insurance companies not providing adequate preventive care on individual plans. But on the other hand, they have 5 individual health insurance plans in Colorado and only 1 of them ($4,000 deductible HSA) covers prescriptions. In addition to that, they are consistently 10% – 20% more expensive than comparable plans in the Colorado market. Even if they do get the $4,000 deductible HSA, most people decide against paying an extra $450/year (or so) to have a plan with good preventive coverage when they’re already strapped as it is.

  3. Diane Lucas says

    Where can I get information on the Colorado law covering coverage for colonoscopy?

  4. Diane,
    You can contact the Division of Insurance, but as of March 2007 Colorado had no mandate for colonoscopy coverage and I don’t know of any changes to that.

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