Rape Victim's Choice: Risk AIDS or Health Insurance?

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Huffington Post

Rape Victim's Choice: Risk AIDS or Health Insurance?

Danielle Ivory

Christina Turner feared that she might have been sexually assaulted
after two men slipped her a knockout drug. She thought she was taking
proper precautions when her doctor prescribed a month's worth of
anti-AIDS medicine.

Only later did she learn that she had made herself all but uninsurable. 

Turner had let the men buy her drinks at a bar in Fort Lauderdale.
The next thing she knew, she said, she was lying on a roadside with
cuts and bruises that indicated she had been raped. She never developed
an HIV infection. But months later, when she lost her health insurance
and sought new coverage, she ran into a problem.

Turner, 45, who used to be a health insurance underwriter herself,
said the insurance companies examined her health records. Even after
she explained the assault, the insurers would not sell her a policy
because the HIV medication raised too many health questions. They told
her they might reconsider in three or more years if she could prove
that she was still AIDS-free.

Stories of how victims of sexual assault can get tangled in the
health insurance system have been one result of the Huffington Post
Investigative Fund's  citizen journalism project,
which is calling on readers to provide information and anecdotes about
the inner workings of the insurance industry. The project aims to
uncover details and data that can inform the larger debate over how to
fix the nation's health care system. As the Investigative Fund  reported in September, health insurance companies are not required to make public their records on how often claims are denied and for what reasons.

Some women have contacted the Investigative Fund to say they were
deemed ineligible for health insurance because they had a pre-existing
condition as a result of a rape, such as post traumatic stress disorder
or a sexually transmitted disease. Other patients and therapists wrote
in with allegations that insurers are routinely denying long-term
mental health care to women who have been sexually assaulted.

Susan Pisano, spokeswoman for the health insurance industry's
largest trade group, America's Health Insurance Plans, said insurers do
not discriminate against victims of sexual assault and ordinarily would
not even know if a patient had been raped.

"These issues you are bringing up, they deserve to be brought up,"
said Pisano. "People who have experienced rape and sexual assault are
victims and we want them to be in a system where everyone is covered."

Turner's story about HIV drugs is not unusual, said Cindy Holtzman,
an insurance agent and expert in medical billing at Medical Refund
Service, Inc. of Marietta, Ga. Insurers generally categorize
HIV-positive people as having a pre-existing condition and deny them
coverage. Holtzman said that health insurance companies also
consistently decline coverage for anyone who has taken anti-HIV drugs,
even if they test negative for the virus. "It's basically an automatic
no," she said.

Pisano, of the insurance trade group, said: "If you put down on a
form that you are or were taking anti-HIV drugs at any time, they [the
insurance companies] are going to understand that you are or were in
treatment for HIV, period. That could be a factor in determining
whether you get coverage."

Some doctors and nurses said that the industry's policy is not
medically sound. "The chance of a rape victim actually contracting AIDS
is very low. It doesn't make any sense to use that as a calculus for
determining who get health insurance," said Dr. Alex Schafir, faculty
instructor at Providence St. Vincent Hospital in Portland, Ore.

Nurses who deal with sexual assault cases say the industry's policy
creates a significant problem for those treating women who have been
assaulted.  "It's difficult enough to make sure that rape victims take
the drugs," said Diana Faugno, a forensic nurse in California and board
director of End Violence Against Women International. "What are we
supposed to tell women now? Well, I guess you have a choice - you can
risk your health insurance or you can risk AIDS. Go ahead and choose."

Turner, now a life and casualty insurance agent, said she went
without health coverage for three years after the attack. She
second-guesses her decision to take the HIV drugs. "I'm going to be
penalized my whole life because of this," she said.

Several women told the Investigative Fund that after being sexually
assaulted they had been denied care or ruled ineligible for health
insurance because of what were deemed pre-existing conditions stemming
from their assaults -- particularly post traumatic stress disorder, or

A 38-year-old woman in Ithaca, N.Y., said she was raped last year
and then penalized by insurers because in giving her medical history
she mentioned an assault she suffered in college 17 years earlier. The
woman, Kimberly Fallon, told a nurse about the previous attack and
months later, her doctor's office sent her a bill for treatment. She
said she was informed by a nurse and, later, the hospital's billing
department that her health insurance company, Blue Cross Blue Shield,
not only had declined payment for the rape exam, but also would not pay
for therapy or medication for trauma because she "had been raped

Fallon says she now has trouble getting coverage for gynecological
exams. To avoid the hassle of fighting with her insurance company, she
goes to Planned Parenthood instead and pays out of pocket.

A New Mexico woman told the Investigative Fund she was denied
coverage at several health insurance companies because she had suffered
from PTSD after being attacked and raped in 2003. She did not want to
disclose her name because she feared that she would lose her group
health insurance if she went on the record as a rape victim. "I
remember just feeling infuriated," she said.

"I think it's important to point out that health plans are not
denying coverage based on the fact that someone was raped," said Pisano
of the insurance trade group. "But PTSD could be a factor in denied

"That might not be a discriminatory action, but it certainly would
seem to have a discriminatory impact," said Sandra Park, staff attorney
at the Women's Rights Project at the American Civil Liberties Union.
"Insurance discrimination against rape victims will only further
discourage them from coming forward to law enforcement and seeking
medical help."

Even when patients have coverage, there are fundamental
disagreements between insurance companies and doctors about what mental
health treatment is medically necessary. The Investigative Fund spoke
with doctors, psychologists, and licensed clinical social workers
around the country who work regularly with victims of sexual assault.
They said that their patients have been experiencing an increase in
delays and denials, particularly for talk therapy.

"There's a lot of anger about this in the medical community," said
Dr. George Shapiro-Weiss, a psychiatrist in Middletown, Conn. "You
don't realize what an Alice in Wonderland web this has become."

"A lot of my patients are being told that their treatment isn't
medically necessary," said Keri Nola, an Orlando, Fla., psychologist,
who said about 75 percent of her patients are victims of sexual

Several therapists cited problems with managed care companies that
specialize in mental health. Such firms generally work under contract
with health insurers to hold down costs while still authorizing
appropriate care.  

To watch a video about a rape victim's efforts to obtain mental health services, click below.

Some therapists and patients said the managed care companies have
cut off necessary treatment for sexual assault victims in the name of
cost containment. "The companies are peppering them with questions
about their symptoms, and about their histories, and asking, ‘Well, are
you sure you really need therapy?'" said Jeffrey Axelbank, a New Jersey
psychologist. "For someone who has been traumatized, it can feel like
another trauma, and it makes the therapy less effective."

Pisano, of the insurance association, said it was not fair to draw a
larger pattern from such anecdotal evidence. "These situations are
evaluated on a person-by-person basis," she said. "There is nothing
routine about this."

Jim Wrich, a Madison, Wis., a consultant who helps employers
evaluate the companies that manage their mental health care, said his
work has made him wary of the industry. "This is absolutely routine -
these denials," Wrich said. "The default position is to reject care."

Magellan Behavioral Health Services, Inc., one of the nation's
largest managed-care companies with more than 58 million customers,
said that it does not routinely turn down treatment requests from
victims of sexual assault or other clients. "We're not denying care. We
are exercising our responsibility to make sure that medical necessity
is met," said Dr. Lawrence Nardozzi, Magellan's medical director. "I
think the process works well."

Asked if cost is a factor in the company's decisions, Magellan
spokeswoman Erin Somers said: "If all the safeguards are in place to
determine whether treatment is medically necessary and appropriate"
then "the cost takes care of itself."  

A former care manager for Magellan said in an interview that she
felt pressure to deny care for cost reasons. Lois Gorwitz, a
psychologist with thirty years of experience who went to work for
Magellan in California in 2000, said her superiors would tell her:  "We
are not denying this person treatment, we are denying them their
benefit. If they want the treatment they can still pay out of pocket."
But, Gorwitz said, "You know that means that the person is not going to
get the treatment because they can't afford to pay out of pocket." 

Gorwitz quit after two years. "It's a very uncomfortable feeling of not being able to offer help," she said.

Asked for a response, Magellan's Somers said, "I think you should
keep in mind that there have been a lot of changes at Magellan in the
last seven years. I think the people who work at Magellan now are not
having that experience."

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