I am in Australia and feel very fortunate when it comes to public health services. When we opt for Private Health Insurance in Australia, it is so that we can get additional cash back on selected services and also more easily afford non-Government medical practitioners and hospitals. Private Health Insurance is also priced around age and services you would like covered, not around your medical history or risk (even though there are eligibility periods for certain claims). But you don’t need Health Insurance to get good medical care in Australia, as is the case in other countries. For that I am grateful.
But that is not what I wanted to talk about here. I just stated it to clarify what Insurance I am referring to in this post. I am referring to other kinds of insurances and the Mental Health Exclusions that are so broadly and freely applied. Policies like Life Insurance, Income Protection Insurance and Total & Permanent Disability (TPD) Insurance. Insurances that people take to ensure they and their loved ones are financially cared for and covered in the event of fatal or debilitating accidents/illnesses.
I have Life and Income Protection Insurance that costs me over $150 per month. The purpose is to ensure my family are protected and provided for financially in the event I can no longer work or provide for them. Yet, because I have anxiety and depression listed in my medical history, my policy includes a “Mental Health Exclusion”. I took this policy out in 2010 and at the time did not question the exclusion. To be honest, at the time I felt a little embarrassed talking to the agent about my anxiety and depression – stupid male pride – so didn’t question it when they applied the exclusion. However I am now more confident talking about it and phoned them today to ask what my exclusion means and request it be reviewed. They are going to get back to me 🙂
I was told in 2010 (when I took out the policy) that if I did not see a doctor for any mental health related reasons in the next few years I may be able to have the exclusion removed. So, even though I have had some difficult times these past years, I have avoided talking to my doctor directly about any anxiety or bouts of depression I have experienced. My doctor who knows my history frequently looks me in the eyes when I see her for other medical appointments and asks very deliberately, “So how are You?” … to which I always reply, “Yeah, you know, good. I’m doing well” … or words to that effect. I dare not say how I have been feeling or recounting a bad experience in case she records it in her notes on the computer – thereby extending the period of my exclusion.
Beyond Blue did some research earlier this year and found that Insurance Companies in Australia can legally discriminate against a person with a disability if their discrimination is reasonable with regards to actuarial or statistical data. If there is no such data, insurers can instead rely on ‘other relevant factors’ particular to the individual.
However what was also clear to Beyond Blue is that the data being used by Insurance Companies is questionable and lacks transparency. Some insurance companies even apply exclusions to people who have not been diagnosed with a Mental Illness, but have a record of visiting a counselor or psychologist. Worse than this, data is not freely or easily accessible regarding the actuarial judgments made by insurance companies in order to determine if it is in fact reasonable for them to apply such broad exclusions.
In my case, because I had anxiety and depression, I am excluded from ANY Mental Health claim at all.
Let’s apply the same principle to physical ailments. If I had a broken arm in my medical history, I should receive a “Broken Bone Exclusion” for every bone in my body – right?
I also have a friend who has an exclusion on his left knee because of a past sports injury. Interesting that he didn’t get a “Joint Exclusion” for every joint in his body.
There are two things that don’t sit right with me here:
- Big Insurance Companies Stigmatizing Mental Illness: They do this by bundling ALL mental illness into one broad category. How can they exclude all mental health claims because of the existence of one particular kind of illness – when the same approach is not taken with physical health?
- Big Insurance Companies Discouraging Mental Health Treatment: The agent I spoke to encouraged me to aim for a period of being symptom and treatment free in order for the exclusion to be lifted … “Just make sure you don’t discuss anything more with your doctor for a few years and I am sure we can remove the exclusion.” What sort of advice is that? Seeking help is hard enough, without having an Insurance Company encouraging me not to do so.
Based on the research and reading I have done today, I have options and so does my Insurance Company. It seems there is no real standard to how these exclusions are applied or judgments are made. Therefore, when they call back in the next few days, I will be asking them to remove or narrow the exclusion … or I will find an Insurance Company that will.
I know each country has different healthcare systems and structures, but I am certain I am not alone in my experience with broad and ambiguous Mental Health Exclusions.
What has been your experience?
Some additional reading from Beyond Blue:
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