The Democratic candidates for president all have healthcare. All would have protections for pre-existing conditions. One of Trump’s major 2016 promises was to repeal Obamacare and replace it with something better although neither he, nor the Republicans, ever put forward a healthcare plan. Trump, however, has said that “we will always protect patients with pre-existing conditions.” Even so, he is currently asking the courts to strike down the Affordable Care Act, including its protections for pre-existing conditions, although we are still awaiting his healthcare proposal. (I am not holding my breath waiting for it. That would be bad for my health.)

I have had personal concerns about insurance coverage for a preexisting condition. (Funny word, “preexisting.” It seems to mean existence before existence. That doesn’t seem possible. When it comes to insurance, it really means an already-existing condition, but for some reason we use what should be the nonsensical “preexisting.”) I had a bad shoulder. I would have said that I had a dislocation problem, but that was not accurate. The bone did not come completely out of joint. I could pull the arm back into place with my free arm. I might have called it a partial dislocation, but the doctor who replaced my shoulder joint recently defined it as a subluxation.

The original subluxation had happened when playing football in college (that is how I usually explain it, leaving out the fact that it was intramural football), with the next one about six months later. When the bone partially slipped out of joint, it hurt like hell with residual pain for days afterward.  Over time, those disconcerting events happened with increasing frequency. Five years after the initial injury, it was time to get the joint repaired.

I did not have health insurance of my own. I was finishing what I hoped was my last year of schooling, and back then the only health insurance I was aware of was tied to employment. I had already accepted a job to start the following September. I would have health insurance through this employer, but I undertook the fun job of reading the policy and found the preexisting-conditions clause. The plan would not cover any health condition that existed when I first became insured.  Instead, the preexisting condition would only qualify for coverage two years down the road, assuming I was still in the same job. Waiting that long to have the shoulder surgery would not have been the end of the world. It was not as if I had cancer or imminent liver failure or was going blind. But it meant a couple more years of painful, partial dislocations and the awkward lifestyle changes that I had adopted to minimize them—not lifting my arm above my head, sleeping in ways so that rolling over would not cause the subluxation, and so on. It also meant living with a constant level of pain that could be tolerated but still was not exactly fun.

The spouse, however, had a job, and she had a health insurance benefit. I read that policy, too. It said that spouses of the insured were covered, and since she had been working for a while, the preexisting limitation did not preclude my shoulder surgery. I went to a famous shoulder surgeon who was ready to do my repair, but both he and the hospital wanted a notice from the insurance company that my treatment would be covered. We went to the benefits administrator at the spouse’s work, who, to our surprise, said that the company’s insurance would not cover me for anything. “How can that be!?!” I exclaimed. I showed her the clause in the many-paged policy mandating coverage for “spouses” of the insured. The wife was the insured, we all agreed, and she and I were married, so I was the “spouse.” Ergo, I was covered. “No,” the administrator patiently explained, “‘spouse’ meant ‘wife.’” That is what it had always meant, the bureaucrat stated. We learned that female spouses were considered beneficiaries under the plan because, apparently in those distant days, no husband of a female employee had ever sought to be covered under this provision of the policy before. The women utilizing the plan were either single, or if married, had husbands who had their own insurance or were too proud to seek spousal coverage.

I was flabbergasted, but not so much so that I could not pronounce the word “sue.” There are advantages to being a lawyer, even though back then I had little idea how to bring a suit. But the threat produced a further consideration by the wife’s employer and insurance carrier. With much grumbling, they decided that they would cover my shoulder surgery.

The wife left that job a little while later. After I had the surgery.

One thought on “For Preexisting Conditions, Spouse Means Wife

  1. Surprising but not really, we have come a long way baby. Larry has been on my insurance since he opened his own firm. You helped pave you the way!

    Like

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