Question

Do you believe that insurance companies (medicare and medicaid included) should be required to pay for the treatment of patients with medical conditions that are the result of life choices that they have made; even though the general public has knowledge of the consequences of these types of lifestyle choices? (Some examples may include: treating lung cancer of a patient that chose to smoke for 40 years, and continues to smoke. Or a patient that is suffering from neurological deterioration after contracting Syphilis from unprotected sex).

Answer 1

The health insurance companies are federal, joint federal or private organization that offers financial help to individuals with minimum premium. These companies is approaches by almost all organizations who enroll their employees to various health scheme. There functions are supported by central or state government and sometimes by corporate. In order to get enrolled in any insurance company, there are various criteria that one should fulfill. Everyone cannot avail every insurance plans. Example: some plans are for kids, some for old age, some for health and hospital stay coverages. Medicaid insurance is basically for people with low income. None of the insurance company has a criteria that a smoker or a person having unprotected sex cannot enroll himself to a health insurance scheme.

At the very time of enrollment to a scheme of insurance, the individual may not be diseased but may have a lifestyle which may or may not effect the person in future. He /she is supposed to pay a small premium monthly or yearly till its maturity. The insurance company who have not set any conditions prehand that the person with this particular lifestyle cannot enroll themselves, are responsible to give them insurance coverage when admitted to the hospital for treatment. A lifestyle that is harmful to health may or may not cause illness in individual's body then how a person predict that he will be diseased.

There are many insurance company who do not educate their clients adequately regarding the health coverage schemes. The promises made by such companies are very attractive but when you avail them for services they tend to reject our claims mentioning a condition which was not explained to the client at the time of enrollment or by just assuming that the client already knows about the condition. To explain this let me quote an example that my parents had to suffer:

My mother had three blocks and she had to undergo angioplasty. She was admitted to hospital for five days. At the time of discharge, my father took all the necessary papers required to claim the health insurance from that institution. When my father claimed for the insurance benefit, they rejected the request with an explanation that my mother already had diabetes and hypertension at the time she enrolled herself for the insurance plan. The heart attack is the consequence of the existing disease. So our insurance plans do not cover such cases.

In the above scenario, my mother who used to have a average to normal intake of sugar, developed diabetes. As per our culture for food preparation, oil and coconuts are a essential part of cooking. She must have never thought that it would result in heart blocks. My father was disheartened because of the action of the insurance company. He borrowed the huge money from others.

If insurance company provides help at the time of treatment to a family who is struggling for financial help to sustain the treatment, then it will surely be a great help despite of the lifestyle he chose that brought to him illness. So I am in support of the notion as a disease do not affect the individual himself but also his family who is affected mentally and economically.