With the abundance of gluten-free products in natural food stores and restaurants for the past several years, my curiosity was piqued as to the “condition” behind a gluten-free diet. Seeming like a trendy, vegan excuse to avoid carbs, it looks potentially illegitimate, and according to medical research, it basically is. Celiac disease is the official title for serious gluten intolerance, which some people actually have. This digestive condition is triggered by the protein gluten, which is found in carbohydrate-rich foods such as bread, pasta, cookies, and other foods containing what, barley or rye. When someone with celiac disease consumes foods with gluten, a reaction takes place in the small intestines, leading to damage of the organ and being unable to properly absorb certain nutrients.
According to the Mayo Clinic, “Celiac disease can cause abdominal pain and diarrhea. Eventually, the decreased absorption of nutrients (malabsorption) that occurs with celiac disease can cause vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment.” There is no treatment for celiac disease besides avoiding foods with gluten, which may be why the disease is so suspicious and easily claimed by those who just want a diet in disguise. Celiac disease is caused by genetic and environmental factors, though little is actually known about why people with this condition respond the way they do to these foods. Likely, if a person truly has such a reaction, it is just self-induced stress (oh no, not spelt).
Celiac disease can only be controlled by those who decide to change their diet, and therefore no medical intervention is necessary except testing for the disease. They may consult a dietician, rather than a doctor. Infants, children and adults are equally susceptible to celiac disease, and symptoms vary based on age group and other factors. People who truly have celiac disease typically have other immune system-related diseases, including type 1 diabetes, autoimmune thyroid disease, and rheumatoid arthritis, according to the National Digestive Diseases Information Clearinghouse. More than 2 million Americans currently have this condition, many of which have a relative who also has celiac disease. Even more apparently don’t know they have it, according to Celiac.com, which makes even less sense.
Celiac Disease & Individual Health Insurance
Living gluten-free may not affect your eligibility for health insurance too gravely, as it is not necessarily acknowledged as a serious medical problem. However, there are insurers eager to decline anyone, so it is best to be discerning. Unless you have other health problems such as diabetes, premium rates are usually moderately adjusted based on your health. Celiac disease has in some places gained status as a pre-existing condition, which means an insurance company could decline some individuals for coverage. Because there is no treatment (health insurance will not cover your Whole Foods bill) there is no reason a health insurer would issue an elimination rider or exclusion period. In most cases, this condition should not result in a full decline.
As there are no prescriptions, surgeries, or major medical procedures involved with celiac disease itself, a person who sticks to their fanatical gluten-free diet should be welcome to individual health insurance. Once the diagnosis has been made, any medical costs are out of the way for people with celiac disease. As insurers are aware of this minor risk level, they will consider someone who has no other health problems besides celiac to be a minor risk. Those who have an unhealthily low BMI or show signs of a decreased immune system due to lack of nutrients will experience a rate increase for those issues. Those who may legitimately have celiac because of other autoimmune diseases will risk decline or rate increases, also.
Using one of our national carriers as an example, their underwriting guidelines shows a possibility that some individuals could be paying twice as much as a healthy applicant, or declined altogether if the condition proves to be serious and current. Varying by age, rate increases are always contingent upon what you are doing to control existing health problems. If you are treating the illness, or staying on your diet, and have not had any issues for over a year, this health plan is in your favor. Medications refer to the recommended vitamins and supplements people can take to manage their condition, as there are no actual prescriptions for this diet-disease.
Those with celiac disease shouldn’t have any problem getting coverage, though according to Celiac.com and a few other forums, people have been denied. Indeed, there are health insurers out there looking to decline anyone for admitting they have some sort of condition. It seems most of these applicants have buyer’s remorse over mentioning their celiac to the insurer, immediately trying to convince them how mild the condition really is, and not a risk at all. Any diagnosis (even a self-diagnosis) will get you a rate increase, a pre-existing condition label, or a decline. It may be in your best interest as a diet snob to keep quiet in this case, however much you want to share your gluten-free cupcake recipes with the world. Applicants with actual medical concerns should be honest about their health.
Other Health Insurance Options
If you did make the mistake of mentioning celiac disease on your health insurance application, and got declined, you still have a few other outlets for coverage. Given that the vast majority of those who claim gluten intolerance can afford the organic lifestyle, you will most likely be ruled out for Medicaid. This leaves gluten-free health insurance to group coverage, or the worst-case scenario, the unglamorous, government-run Pre-Existing Condition Plan.
Of course, if one private insurer turns you away, you can always try another. Certain companies such as Aetna tend to be more forgiving, and underwriting with most carriers in states like California and Oregon are, as well. Therefore, it is important to keep researching, preferably before you get declined. Get a quote or speak with an agent to find out more about which companies to choose in your area. Call us for expert advice at 888 803 5917.
Employer-Sponsored Coverage
Those who have the the opportunity to receive coverage through their employer should take advantage of such health benefits. Usually a cost-effective health plan, as the employer pays most of the premiums, someone with celiac disease will get a comprehensive set of benefits for themselves, and a spouse or dependent children. Though the employer pays a significant share, this type of coverage is getting more expensive with time, and may be no more or less than individual coverage. Depending on the plan your workplace provides, certain benefits may be excluded, which should not affect an employee with celiac disease.
PCIP
People who have been rejected by a health insurer due to their celiac disease, and have been uninsured for six months, may qualify for PCIP. While it may not be the optimum choice, those who cannot get coverage through an employer or the individual market will not have much else to rely upon. PCIP offers a full range of medical benefits through a select group of providers, for fees similar to a private plan. Normally, it would be mentioned that treating your condition is available without an exclusion period, but this does not apply to those with a gluten intolerance.
If you are simultaneously diabetic or have other illnesses, you may have access to the medications, supplies, and treatment you need as soon as you get approved. Allow several months for your application to be processed in most cases, and make sure you have no other source of coverage, even a short-term plan, as it will disqualify you from PCIP. Also, PCIP is considered a bridge program, to fill the gap between now and the date the health reform bill goes into effect in 2014.
Health Reform and Gluten Intolerance
As many individuals who frequent the organic co-op and enjoy bumper stickers are probably aware, health reform will greatly help anyone with celiac disease, even the fakers. If after January 1, 2014, you profess to a health insurance application that you have a gluten problem, there will be no consequence, and you can receive coverage the same as three years ago before your diagnosis. The individual mandate will require everyone with celiac disease to purchase a health plan or pay a fine. Otherwise, any insurer that would have increased your rates before will not longer be able to do so.
Anyone who has this condition and needs coverage can either purchase a plan through any number of health insurance companies, or use the state health Exchanges that the ACA will have established. Those who were using PCIP will have their choice of either exchange or private carrier, as their plans will become obsolete. More preventive services are also offered, which will keep anyone who is risking their health from a diet craze informed of their current health status.
Conclusion
While majorly fishy as a snobby diet, some people do really have a gluten intolerance. It seems the majority of cases are either coming from those who have heard a celebrity claim they are going gluten-free to lose weight, though no evidence supports that, or feel obligated as an environmentally conscious female. It is moderately justifiable to have a personal belief behind your food choices, such as veganism or vegetarianism, but staying healthy involves eating necessary nutrients. I would like to empower anyone who may feel their gluten-freedom is due to a desire to lose weight (unless your weight is a medical issue) to reconsider and simply balance their diet as opposed to self-diagnosing.
