Health insurers have long shunned skydivers and hang gliders. Seems they are now thinking hard about extreme athletes of all types. If you were one of the half a million Americans who ran in a marathon in the last year, this might mean you.
There was an article in today’s New York Times that discussed how long distance runners, such as marathoners, are having a harder time getting health insurance coverage because they are prone to injuries that cost insurers money. How ironic.
Insurance carriers have been beating the drum about exercise for years, culminating in significant incentive-based programs for their healthy, exercise-oriented clientele. Today many major insurance carriers offer rewards in various forms to beneficiaries that participate in exercise programs to lose weight. These rewards come in the form of everything from points for prizes to significant discounts on copayments and better insurance benefits.
I recently went to the Health 2.0 Conference in San Francisco where it seemed like half of the companies there were touting products and websites that help people engage more actively in athletic pursuits in order to lose weight. FitBit (for adults) and Zamzee (for tweens), both devices worn on the body to track movement and encourage people to exercise more, were examples of the kind of technology being touted for those eager to get moving in earnest. It is no secret that part of the effectiveness of these products lies in their ability to provoke one’s competitive spirit, driving people to exercise beyond their usual limits by inviting comparison to others in their orbit.
Everywhere you go are inducements to exercise competitively. An entire industry of extreme run/walk/bicycle races has evolved to meet the dual goals of encouraging greater athleticism and raising money for health related charities from breast cancer to leukemia to autism. As thousands of people rise up of their couch, put down their Diet Cokes and remote controls and lace up their sneakers to get a move on for various cures, including a cure to their own couch-induced chubbiness, they are also stampeding to their nearest sports orthopedist. I had my own such experience when I got a nasty case of plantar fasciitis during my training for the Avon Walk for Breast Cancer a few years back. I raised about $15,000 for the charity and my insurance company spent a few grand getting my feet to function again after my 26.2 mile odyssey.
It turns out that as many as 80% of extreme athletes, such as distance runners and walkers, sustain injuries in the pursuit of their personal best, and that behavior can make them athleta non grata with the insurance carriers. It seems that the insurers want to you exercise but not too much. Too little exercise: bad; too much exercise: bad. A moderate amount, Goldilocks; that is all they ask. The NY Times article discusses how Group Health Inc., a NY-based health insurer, focuses their marketing on tennis tournaments and other non-extreme sports events to help them attract the right athletes (emphasis mine) to their products.
If the new Affordable Care Act (health reform law) stays intact this issue won’t matter much, as no one who seeks insurance will be able to be excluded for pre-existing conditions such as plantar fasciitis or torn ACLs. However, it is interesting to contemplate the actuarial gymnastics that the insurance carriers will undertake to decide how to underwrite the extreme athlete’s policy. Just because you can’t be denied an insurance plan doesn’t mean said plan will come cheaply. Will the perceived risk of sports injuries cancel out any incentive benefits a runner might have received for engaging in activities that promote good cardiovascular health?
Heart is healthy, knees are a disaster. Life is full of trade-offs. Go figure.