This is really not a diary, so I apologize. It's one of those self-indulgent pleas for help that people occasionally post here, and I figure if we are all due at least one, I'll take my shot this time.
My partner's employer does a bi-annual "health assessment" with all employees. My partner is very physically fit, and has always passed these with very high (96%+) scores.
So we were pretty shocked when his last health assessment came in only 60%, and he was told his premium would be more than doubled, with $300 in 'back premium' taken from his next paycheck.
When we pressed for a reason, after calling a number of people, we were finally told he was now being classified as "a smoker" and would be charged the increased "smokers rate"
Funny thing, he is NOT a smoker -
This company is so concerned (perhaps with some justification) about insurance rates that the agency contracted to do the health assessment does a blood test for nicotine. My partner was NEGATIVE for nicotine with the last health assessment, and has been negative with every blood test before that.
So what changed?
Apparently, the company arbitrarily changed their policy to define a 'smoker' as anyone who admits to having EVER smoked a cigarette and is not on record as completing a "smoking cessation program" - - - even if that person smoked his/her only cigarette years ago, or smoked one cigarette on midnight each New Year's Eve.
In the 14 years we have been together, I have seen him smoke perhaps 6 times... in a bar, on vacation, and once to 'guilt trip' his parent who was still smoking after heart issues, but did not want see the kids smoke because it was 'bad for them...'
This is not an academic question for us - both of our employers have done hour cutbacks this year because of the economy, and the loss of wages is starting to hurt. My employer still hasn't decided to allow same-sex partners on our insurance policy (though they have been debating it for over three years now). I've been afraid to sit down and look at how this is going to hit our budget, but it is not going to be good, and we've already cut things as tight as we can, so I don't know what we'll do to adjust.
I've additional suspicions, in that my partner is a naturalized US citizen, and comes from a culture where lying to an authority figure is considered rude (or perhaps, dangerous) so he's probably overly honest in saying "yes, I have smoked a cigarette once or twice in my life." So I wonder about cultural competency concerns in the way this 'survey' is being done, and how the results are interpreted. He is the only non-white employee at this branch of the company, and overall the company has less than 5% non-white employees across the state. I'd bet what little money we have left that nobody non-white was consulted in the construction of this 'survey' process, or that the health aides doing the survey had any cultural competency training.
He's also gay & out at work. I'd like to not make "teh gay" a paranoid reason for everything bad that can happen, but there it is - it's impossible to totally discount when a decision that has such an impact is made in such an arbitrary fashion.
It also doesn't help that they originally LIED to him about his blood test, saying it was POSITIVE for nicotine, until I had him request copies of the bloodwork under HIPAA. THEN they said that, while the blood test was negative, they were still raising his rates based on his response to the interview questions alone.
The CDC even has a definition they have used for "smoker" when doing health research - anyone who has smoked 100 or more cigarettes in their life, and is currently not 100% abstinent from smoking. MMWR on Smoking in Adults So I wonder under what POSSIBLE justification are we being forced to pay the same premium as a three-pack-a-day smoker would be paying? [Debate on the fairness of having smokers charged more in an insurance pool aside, it's moot because he is NOT a smoker under any reasonable definition, and his blood tests confirm that].
I WORK in the frikin' health industry, and I'm struggling to deal with these asshats without totally blowing up over the phone... it's even more frustrating that I know more about health, smoking & diesease prevention that the idiot bean-counters I've ben trying to (politely) talk to... I'm sure a total 'lay person' would be totally lost in trying to fight this.
So, this is partly just venting, and party asking for advice and commiseration - - and yet another example of how the insurance-dominated, profit-above-people model of health care is totally, 100% broken in this country.
Thanks for putting up with this ....
UPDATE [10:50 CST]
To make things wores, I've just talked with the Office of Insurance Regulation for our state - my partner's employer is "self insured" ... so the OIR has NO jurisdiction over how they set up rates or pay claims!! WTF???
I've been told by the person at OIR - who was honestly appologetic that she could not be more helpful - that I should try to contact the Department of Labor and see what they suggest...