Really Sick: If Your Partner Beats You, Insurance Companies Don't Have to Give You Coverage

By Jenny Gold, Kaiser Health News. Posted October 13, 2009.

In 2006, attorney Jody Neal-Post tried to get health insurance but was rejected because of treatment -- counseling and Valium -- 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't prepared for the blow from the insurer. "I was just flabbergasted," says Neal-Post, a 52-year-old attorney. During the altercation with her ex-husband, "I was beaten and choked in my living room," she says. "I'm 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's no longer part of your daily life to remember that and you're feeling good, it's back again."

Advocates say it's 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't prohibit denying coverage for that reason. And even when states do have a law, it doesn't necessarily prevent carriers from initially rejecting applicants who are victims of violence.

It's 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'll 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. "Think of this, you have survived domestic violence and now you are discriminated in the insurance market because you have a pre-existing medical condition," House Speaker Nancy Pelosi, D-Calif., told leaders from women's organizations at a press conference Tuesday. "Well, that will all be gone under this legislation," 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 "still wake me up at night."

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's 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's Public Regulatory Commission's 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's Health Insurance Plans, an industry trade group, has supported laws that explicitly prohibit domestic abuse from being a factor in denying insurance. "We have encouraged all states to adopt the legislation," referring to a "model law" 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.

See more stories tagged with: insurance, health care, domestic violence, domestic abuse, health reform, health disparities, healthcare reform

Jenny Gold is a staff writer for Kaiser Health News (KHN).

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