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Tuesday, October 13, 2009

Victims of Domestic Abuse Need Health Insurance Reform

We've talked about the problem of insurance companies treating domestic abuse as a pre-existing condition and nine states, including South Dakota, not prohibiting such a nefarious practice. We've heard our state Division of Insurance assure us that no insurer is going to try excluding a domestic abuse victim from coverage, and that the state wouldn't let them if they tried.

But even if South Dakota had a specific state regulation against denying insurance due to domestic abuse, battered women would still face challenges in keeping their coverage:

Nancy Durborow, Health Projects Manager for the Pennsylvania Coalition Against Domestic Violence, says she isn't surprised that state departments of insurance haven't heard about the problem. "They don't see it because they're not looking in the right places."

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's medical records, such as repeated visits to an emergency room or a doctor's 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....

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, "especially those who have spent time in shelters with others. Women are concerned about keeping their medical information confidential."

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. "It could be a denial not only for her, but she might also be worried that if she leaves, she won't be able to take her children to the doctor."

But the deterrent effects of these insurance practices don't stop there - 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' ability to get insurance by asking about and documenting abuse [Jenny Gold, "Domestic Abuse Victims Struggle with Another Blow: Difficulty Getting Health Insurance," Kaiser Health News, 2009.10.07].

Representative Herseth Sandlin, take note: Passing health insurance reform this year solves this problem. The bill coming to the House floor tells insurers they can no longer use pre-existing conditions as a justification for denying coverage. Pass this bill, and then when a woman has a history of going to the hospital for broken bones, it won't matter whether it's because she has a bum for a husband or just a calcium deficiency: she can keep her insurance and not go broke.


  1. The flip side of the argument is, who is responsible?

    If you have a car accident and seek medial attention, should your health insurance company pay first? No, the auto policy should be liable first.

    That could be the case here, and the issue be about establishing liability. The insurance company may have a valid perspective in some cases.

  2. I'll be responsible. Cancel my insurance, raise my taxes. We bloggers catch heck for playing the blame game; so should the insurers. Let's just take care of each other first.

    And in this case, who's the insurance company trying to pass liability to? the battered woman? her husband? Why not just help the person with the broken arm?

  3. You know it's not that simple Cory. If you have a buddy over to pound a few nails on your roof and he falls and breaks his arm, should his health insurance policy pay? No, your home owners.

    If your neighbor dislikes you and breaks your arm, should your health insurance policy pay, or he be liable first? He should.

    In domestic situations, the abuser should be held accountable first, financially as well as criminally. It may secondarily help change behaviors.

    If we have a public option, even single payer, it doesn't change that these types of expenses should not be unnecessarily, immediately absorbed by that plan.

  4. Actually, John, it can be that simple, at least at the hospital and the Medicare-for-all office. Woman shows up at hospital with broken arm. Hospital fixes arm, bills insurer. Insurer pays. Then we can work on the blame at a separate level that does not leave the woman or the hospital hanging.

    Under nationalized health coverage, uf my neighbor comes and breaks my arm, my taxes still foot the bill. We'll sic some cops and lawyers on my neighbor later.


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