Rescinding recission
Causality and the cancellation of health coverage over unreported pre-existing conditions
Laura Clawson at Daily Kos writes about a health insurance company maneuver known as recission, which she suggests “pretty much everyone agrees is a disgusting, immoral practice.”
Recission is when health insurers cancel coverage because they claim they were misled. So, for example, if you mentioned your peanut allergy when you applied for coverage — but not your elbow tendinitis — your insurer could void your coverage if they ever found you had lied.
Stated that way, it doesn’t sound so bad. After all, you did fail to report your condition and violated an agreement with the insurance company.
Yet the reality is often more complex. First, many of the publicized accounts of recission document cases in which patients who are diagnosed with serious conditions — often the most expensive to treat — are suddenly dropped due to an unrelated inaccurately or unreported condition. Second, the conditions cited in recission orders are sometimes unknown the patient themselves, often due to miscommunication with doctors and providers.
Essentially, critics claim that health insurance companies proactively pursue recission to avoid expensive liabilities. It’s the insurance company that’s trying to violate a good-faith agreement, they say.
What makes recission so difficult to evaluate are the emotions involved. Hearing about a breast cancer patient who loses needed coverage for chemotherapy because she forgot to report a back injury 10 years ago offends our sensibilities. And the disjunction between the alleged fib (or omission) and the gravity of the current condition makes health insurance companies seem like heartless monsters.
A better way to evaluate recission would be to imagine a less emotionally distracting example. Imagine that I fail to note a small, non-cancerous mole removed from my back three years ago. Then, I contract a mild throat infection and require an antibiotic. My insurance company, however, recscinds my coverage due to my omission of the cyst from the questionnaire I completed when I applied. I survive the infection without the antibiotic (which I could not afford without insurance). Despite the extra day or two of suffering I endure, was recission unjust?
Consider an analogous situation. Say I run a red light in full view of a police officer. He notes my license plate number, but makes no effort to pursue me. Two months later, I run a stop sign and he pulls me over. I contest the charge and, in court, the police officer only produces camera evidence suggesting I ran the red light two months ago. The judge then penalizes me for running a stop sign.
This penalty would be unjust because there’s a lack of fit between the crime for which I’m being prosecuted and the evidence used to convict me. The problem with recission is similar. It isn’t that insurance companies have no right to complain when applicants fail to disclose medical conditions. It’s that they often use the omission to avoid an unrelated liability.
Causality matters in morality and, in this case, it’s central.
–Sam
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