Sabrina Corlette is going through all of the conditions that used to be cause for an insurer to either never write a policy or to go back through medical records and rescind a policy once someone got expensive:
AIDS, diseases associated with AIDS, arthritis, gout, lupus, herniated disc, TMJ, carpal tunnel, disease/disorder of back or spine…
— Sabrina Corlette (@SabrinaCorlette) November 18, 2016
An insurer only needs to find a diagnosis once in the medical records to attempt to rescind in the pre-ACA days. Even if that diagnosis was wrong, if it was in the records and the current set of claims was expensive enough, an insurer could fight for years to throw a person off of coverage. Gout leaped out at me as it triggered a memory.
About four years ago, I was refereeing an adult soccer tournament. I like this tournament as I get to see and work with a bunch of really good referees for some pretty good games and we have fun. I showed up to the fields on Friday afternoon, did two evening games and then went out with the crew for burgers and a few beers. The burger was amazing. Half a pound of beef with some blue cheese crumbles and a couple of local IPA’s. It is one of the better burgers I’ve had.
Saturday was a full day on the field. I ran six games, four on the line and two in the middle. It was hot, it was humid and as the fields got used, the surface got worse. After the last game, we again went out for a burger, a beer and some no-shit story telling.
Sunday morning I only had two games before I could go home. First game went fine, Over-23 women who were still in good enough shape to play a full ninety. I had the middle and in the 87th minute, my left foot tweaked a bit on a divot in the field. No big deal, I stretched it out at the end of the game and got ready to go to my pre-game for the line I had to run. This was a men’s open game with mostly former PDL players so it was an up and down game with a well disciplined defensive line that had no problem running a thirty yard sprint trap (bastards). My left foot was not feeling great. And then it failed. I attempted to stop an upfield run, plant hard and change direction to a full sprint to the goal line. My foot folded in on itself and it hurt like a bastard with eight minutes left.
Thankfully the game was out of reach (3-0). I hobbled for the rest of the game and then hopped to the referee tent. A friend of mine is an athletic trainer. She looked at my foot and said it was either a break or an arch sprain. I should get an x-ray. I got into my flip flops and drove the the local urgent care center.
At the urgent care center, I said my left foot near the big toe was in extreme pain. The clinician asked if I had any red meat or alcohol this week. Yes, I had two burgers and three beers since Friday night. “Mr Mayhew, you have gout” This was within the first two minutes of the examination. I protested, explained that it was a sports injury and an atheletic trainer thought the problem was either a sprain or a break in the metatarsal. “Mr. Mayhew, you have gout, here is your scrip and you don’t need an x-ray”
Bull — I made an appointment with my PCP for Monday morning. He looked at my foot, ordered an X-ray and determined it was a nasty sprain where 6 weeks of PT would be needed. He saw in my electronic health record that I had not filled the scrip for the gout medication and saw the diagnosis for gout. He thought it was absurd and ordered a uric acid blood test for me. I got the results the next day and mine were low-normal.
I had a structural skeletal injury not gout. The mis-diagnosis did not effect my treatment or recovery. It did not effect my eligibility for coverage as I am covered through work. However if I was to go on the pre-ACA underwritten individual insurance market and I ran up $100,000 in claims, that gout diagnosis would be a probable hook for a pre-ACA insurer to rescind my coverage. I would probably win eventually but I would be fighting for a year or more and running up large legal expenses for a bad diagnosis.