Simpler health questionnaire may complicate insurance

The penalty for being morbidly obese has gone up. Ditto for schizophrenia and recent breast cancer. And anyone with multiple sclerosis, severe autism or antibiotic-resistant staph infection will now be automatically rejected.

Those are among the hundreds of changes in the latest Washington Standard Health Questionnaire, a lengthy and mandatory health-screening test taken by more than 100,000 state residents each year before they can buy individual insurance coverage.

The test is designed to weed out the sickest applicants and direct them to high-risk — and high-cost — policies.

This is the first substantial revision since the test was imposed in 2000, and will be given beginning in March for all policies that take effect April 1.

It's shorter, with fewer vexing medical terms (goodbye hypogammaglobulinemia) and supposedly better at reflecting actual claims data.

But the upshot is applicants who might have aced the earlier survey might flunk the new version. Or vice versa.

Even the questionnaire's defenders concede it's a rough tool for predicting who will eventually rack up the biggest medical bills. The worry now is that by asking applicants fewer and less detailed questions, the survey could snag even more people who shouldn't be snagged — while letting others with more serious medical problems slip through.

Sean Corry, a Seattle insurance executive who served nine years on the state board that oversees the health survey, said the board struggled to balance the need for detailed health questions and applicants' demand for a quicker survey. Corry said it's inevitable the revised survey will be less precise.

"The shorter it is, the more unfair it will be, almost by necessity," Corry said.

But the current board of the Washington State Health Insurance Pool (WSHIP), speaks confidently that the new survey is an improvement, designed with more current data specific to Washington state and applying the latest knowledge in predictive modeling.

Still, they admit they won't know for sure until the test results start coming back and they "watch closely for any skewed scoring in early returns," said Kären Larson, WSHIP's executive director.

Only state in nation

Washington is the only state that uses a standardized questionnaire to screen individual-insurance buyers. Insurers are allowed to deny coverage to applicants whose health profile puts them among the most expensive 8 percent of roughly 270,000 state residents who have individual coverage.

That threshold was a political compromise in the aftermath of state changes in 1993. Health insurers in Washington were routinely rejecting as many as 20 percent of all applicants they deemed too risky to cover. The Legislature outlawed the practice in 1993 and required insurers to issue policies to even the terminally ill.

Insurers responded by halting the sale of individual policies in Washington altogether.

To lure them back, lawmakers agreed to adopt the questionnaire to sort the sickest people into WSHIP, a high-risk pool for the uninsurables.

People denied insurance in the open market are guaranteed coverage through the high-risk pool. But its premiums are 10 to 50 percent higher than comparable plans in the open market, and only about 15 percent of those referred to the pool actually enroll.

Currently, 3,400 belong to WSHIP, many with serious conditions such as AIDS and kidney failure.

But the health questionnaire can trip seemingly healthy people. The wrong combinations of relatively minor conditions — from acid reflux to back sprain, nose polyps to kidney stones — can add up to enough penalty points on the test to put customers over the limit.

Last year, about 7,000 people flunked the health questionnaire, including more than 1,000 who successfully appealed their scores.

Responding in part to complaints the test was too long and complicated, WSHIP hired a Denver actuarial firm to revamp it. The survey was cut by a third, to 218 questions, and medical conditions were simplified or combined.

The actuary also took claims records from the five largest insurers in the state to better gauge their actual medical costs here. Finally, it grouped separate but related treatment costs to more accurately track the cost of an illness.

The score for failure remained at 325. But the individual scores for a host of conditions were altered.

Diseases penalized

Multiple sclerosis, tuberculosis and lymphomas, even ones that were treated and cured several years ago, now carry higher penalty points.

Autism and MRSA, the drug-resistant staph infection, weren't even in the previous survey. Now they are enough for instant rejection. Same for infants born very prematurely.

On the flip side, Alzheimer's disease, congestive heart failure or high cholesterol get docked fewer points. High blood pressure is now 52 points, but really high blood pressure is 31 points (the applicant presumably will get docked someplace else for related conditions, such as vision or kidney problems).

A woman with an ovarian cyst and a fibroid tumor would fail the old test, not the new.

All this is guaranteed to leave clients stumped, predicted Becky Hart, president of Health Insurance Connection, an insurance agency in Puyallup.

Hart said she keeps a medical dictionary handy just to guide customers through the questionnaire. She complains that some medical conditions have simply vanished from the test.

That leaves Hart guessing, for example, just what "conditions that impact fertility or problems with the female reproductive system" are.

"I suppose I will get more comfortable" with the new survey, Hart said. "But right now, it looks like it will be more difficult finding the conditions our clients may have."

Kyung Song: 206-464-2423 or ksong@seattletimes.com