Health insurers refuse to limit rescission of coverage »
Posted By bluetexasvalley 5 months ago in Political NewsExecutives of three of the nation's largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.
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bluetexasvalley
I am a 60-plus widow, retired after almost 40 years in the newspaper business. My love of politics was learned, first, from my father, a ...
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bluetexasvalley5 months ago
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FTA:
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An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.
It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.
"No one can defend, and I certainly cannot defend, the practice of canceling coverage after the fact," said Rep. Michael C. Burgess (R-Tex.), a member of the committee. "There is no acceptable minimum to denying coverage after the fact."-
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Candida5 months ago
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If they really want to make sure that there are no preexisting conditions, they should do a more thorough job before accepting the application. Rescinding coverage after the person has paid the premiums for some time is immoral.
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Of course a public insurance option with no exclusion for preconditions would solve the problem. I suspect it would quickly become popular as a result of the simple application process without the need to list every visit to a dermatologist or podiatrist. -
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hyperbola5 months ago
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The answer is pretty simple. Simply pass a law saying that any company that wants to enter the field of health insurance requires a federal licence that REQUIRES them to cover all patients without such terminations. Conditions of the licence could include ten-fold (or more) punitive damages to be paid to the patient and criminal proceedings for attempted homicide against any executives or employees of companies involved in such practices.
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bluetexasvalley5 months ago
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"I want to emphasize that rescission is about stopping fraud and material misrepresentations that contribute to spiraling healthcare costs," Sassi told the committee.
But rescission victims testified that their policies were canceled for inadvertent omissions or honest mistakes about medical history on their applications. Rescission, they said, was about improving corporate profits rather than rooting out fraud.
"It's about the money," said Jennifer Wittney Horton, a Los Angeles woman whose policy was rescinded after failure to report a weight-loss medication she was no longer taking and irregular menstruation.
"Insurers ignore the law, and when they find a discrepancy or omission, they rescind the policy and refuse to pay any of your medical bills -- even for routine treatment or treatment they previously authorized," Horton said.
She and others from around the country accused insurers in testimony of gaming anti-fraud laws to take policyholders' premiums, only to drop people who developed serious illnesses. They testified that they or a deceased loved one had had policies canceled over innocent mistakes and inadvertent omissions on their applications.
A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.
The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him. -
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jordan115 months ago
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PetesakeComment removed: Hard Banned
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flyonthewallzz5 months ago
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It is amazing: these captains of industry.
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Reminds me of the big three..... flying in on corporate jets with tin cups.
In a few moments they undo much of there well paid lobbiest's
efforts.
Year after year paying in thousands of dollars to be "safe and protected" and kicked to the curb on a technicality. Any body that has seen a hospital bill knows that the list price is impossible and that is not what industry pays.
The bills keep coming, the collection agencies keep calling..The land line is the first to go.
The boss calls about having your paycheck garnished. Time to sell the house even though it is underwater. Pretty tough to go chapter 11 these day's.
And all that happened was somebody got sick and you stupidly thought you had it covered.
By the time the dust settles about 9 times as much money is blown than the insurance company saved.
Man those guys really blew it! -
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lfergie8125 months ago
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quackpot, I agree. I believe they made statements that will cost them a lot of money in court. I see a class action suit in the making that could require them to make payments for treatment of insured patients that were victims of rescission.
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willottica-245 months ago
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First, I thank God that I am healthy and don't require expensive medical treatment.
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Then, I thank God (and my parents, and the Social Credit Party) that I live in Canada and we aren't held hostage by insurance companies out to make a quick buck off of our very lives.
And I shake my head in wonder and amazement at those who would defend a system that places money so far above human health.-
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Natureboy5 months ago
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Yep.
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The most frightening thing is not the 40 +million uninsured, their problem is obvious. What's scary is, if you've worked in the industry as I have, you know we're paying for the ILLUSION of coverage - if you develop an expensive medical condition, there is a whole office, maybe a whole FLOOR in an office building, full of employees getting well-paid to find a reason to say "no" to you. And if you can't get the money elsewhere, that "no" can end your life just as sure as a bullet can.
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Natureboy5 months ago
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It's called post-claims underwriting, and it is an unethical, deceptive, bad-faith practice in the insurance industry. Healthcare whistleblower Lee Einer spoke about it in Sicko. Blue Cross of Calif. was busted for it.
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Here's how it works.
You sign up for a non-group policy. As part of the process you undergo a medical exam and you answer questions on the application regarding medical conditions and/or symptoms you have had over the past five years. An underwriter for the insurer reviews this info, determines whether they will cover you, at what rate and whether there would be exclusionary riders attached.
You get your coverage and all is good. Good, that is, until the insurer gets a bill for your care that trips one of two triggers - high dollar amount or potentially expensive diagnosis.
Once this happens, the insurer pends your file for "medical investigation." None of your medical bills are paid. Now they go through your application and medical exam, again, an they request medical records for every doctor and pharmacy that has treated you over the past five years. If those records mention any hospitals, clinics, etc they will request THOSE records. The process can sometimes take a year or more, and since your medical bills aren't being paid, you may be forced to stop paying premiums so you can pay your providers.
Even if not, this is a witch hunt, and they are going through your records with the intent of proving that there was something, ANYTHING you may have neglected to disclose on the application. Michael Moore interviewed one woman who had her policy recinded over a vaginal yeast infection which she had several years prior to applying for coverage. I have seen people kicked off their policy over a rectal polyp or even mention in the record of blood on toilet paper (wiped too hard? No coverage for you!)
If they can't rescind you ab initio, they will look to jack your rates or issue an exclusionary rider for your medical condition. We called it "the three Rs (Rescission, rate or rider.) A final fallback is the "pre-existing condition" exclusion.
If, on the other hand, you pay your premiums and don't have any expensive medical bills or potentially costly diagnoses come up, the insurer will gladly keep taking your money.-
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willottica-245 months ago
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When my wife had to have her broken ankle looked at in a California hospital, we didn't have our insurance card on us. So we put a deposit down on the credit card, and called the insurer when we got home to Canada.
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The policy specifically explains that you MUST contact them before getting treatment. We didn't. They covered us anyway. I think that shows a huge difference between Canadian and American systems, ours is their to help, yours is their to pay up if they absolutely have to and can't find a way to weasel out of it. -
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jovial5 months ago
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It's mind boggling that any American citizen living in America could see Universal healthcare as a bad thing unless they are an insurer or directly or indirectly reaping benefits from a privatized system. Thanks for posing that natureboy, it explains the whole mess thoroughly, and gives good examples.
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AnteUp5 months ago
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quackpot hit the nail on the head! I've read the book and seen the movie................The Rainmaker by John Grisham!
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Even down to the employees getting rewarded for ditching
the most customers. The only difference is that in the
Grisham story the executives tried to HIDE the practice -
these guys are SHAMELESS! -
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AnteUp5 months ago
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FTA:
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Sassi said rescissions are necessary to prevent people who lie about preexisting conditions from obtaining coverage and driving up costs for others.
See that fear factor thing coming into play? They are never
without it. It's like the tort reform bogus argument about
"driving up the costs of others"
And if once wasn't enough Mr.Sassi says again:
"I want to emphasize that rescission is about stopping fraud and material misrepresentations that contribute to spiraling healthcare costs," Sassi told the committee.
"spiraling healthcare costs" - like I said, they are never
without the fear factor and the "we are trying to protect you from people trying to get something for nothing on your dime"
Is there such a thing as TERMINAL BS??-
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Candida5 months ago
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Yet, they are afraid, that they couldn't compete with a public insurance option that would insure the "uninsurable."
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FTA: "But they would not commit to limiting rescissions to only policyholders who intentionally lie or commit fraud to obtain coverage, a refusal that met with dismay from legislators on both sides of the political aisle."
It is not dismay that is needed from the legislators but action.
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canadianrancher575 months ago
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As I read through the articls one thought comes to mind and that is that some of those who wish not to have a change to the medical system always say that they do not wish to support those who cannot support themselves. After reading some of the information provided here about how your system works and how it seems anyone can end up losing their coverage, and also knowing that the costs of any medical treatment can be very expensive, I hope that some of those who are so against a change in the way things are done don't end up losing their coverage. Some of these people are so concerned with money that if they lost everything because of medical cost they would not be able to handle the insult of being poor and having to be supported by programs that they seem to hate so much.
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The medical profession is based on the idea of CARE, and that goes for most of those who work in it. The insurance industry is based on the idea of PROFIT and has very little to do with care, and trying to make two industries with different objectives work together is next to impossible.
I am a supporter of universal health care, I can't say whether it provides better or worse care, but it does provide fair treatment of all. Would going to a universal plan get rid of alot of jobs and increase the unempolyment rate, I don't think so since a new plan would have to be run by someone. Could a new plan save money or would it cost more, now this is the tricky one, by having one agency purchasing drugs and equipment for the plan the suppliers may be forced to compete, so maybe lower costs. Would the plan cost more? By not having any fact to back this up this is just a guess, Right now there are people who are paying for insurance and there are those who are not, and the money for a new plan has to come from somewhere, so it will come from taxes I can't say that it will cost more or less but when one takes out the profit of the insurance comapanies that is generated from premiums maybe the cost would go down even for those who are paying premiums right now.
The American people like the ideas of fairness and equality but they also like the idea of money, especially their money. This is going to be quite the battle, I rooting for the fairness and equality side, since up here and in many places in the world that side has already won.-
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oldslowjim5 months ago
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canadianrancher57: I am a supporter of universal health care, I can't say whether it provides better or worse care, but it does provide fair treatment of all.
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No it doesn't! Those who can afford additional coverage will get better treatment when the "universal plan" doesn't cover new treatments or drugs or when you have to wait an unreasonable amount of time to see a doctor.
I don't agree with the way the current insurance companies currently run the system. Some regulatory oversight is badly needed for these situations. However, universal health insurance also has many pitfalls and those who can pay will still get more "fair" treatment. -
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lfergie8125 months ago
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Here's where they should be arrested.
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"A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne."
"The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him."
These are bogus reason to cancel an insured because the "medical" problem had absolutely nothing to do with the condition being treated.
This is all the more reason we need a national health care program that will put these con artist out of business. Of course there would have to be something done about people running to the emergency room every time they sneeze. :)-
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hyperbola5 months ago
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All the national health schemes in other countries deal with the "sneezers", and it is not so hard. One mechanism is that you co-pay a percentage of your health costs (e.g. 20%) up to a maximum payment (e.g. $2000 per year) on your part. This means that if you go to the GP every week for "sneezes" you pay a financial penalty. The "maximum" clause protects those who are seriously ill from being bankrupted.
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Something else to think about in the light of pandemics like swine flu is that systems which essentially exclude a part of the population (those who can't pay easily) are those most vulnerable to spread of the disease. We should never forget that public health systems started as a means of controlling epidemics.
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lloydm655 months ago
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I've had no trouble with my insurance in the past forty years.I have enjoyed the peace of mind it has given me.Some of the stories sound reasonable,others don't.Remember the two sides of the story concept.I hear some they paid premiums for years,and upon filing a claim,their dropped.I would like to read that policy,there may be cause for action,maybe not.I know when you get an offer in the mail that promises the moon,and stars for an unreasonable low premium,it's junk.You may tell yourself it will at least get you admitted,don,t bank on it.I believe if an insurer has been in business for decades,they do not practice these tactic.
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lfergie8125 months ago
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What bothers me is the time element from the time they got their health coverage until the time they made a claim. I was always under the impression that insurance companies had a year to fact check the accuracy of their client but I've found nothing that even stops them from going back to childhood after 30-40 years. Somewhere along the way the government is going to have to crack down on them for canceling a policy for an infraction that has nothing to do with the illness.A person could forget to mention the fact that they had a broken wrist 30 years ago and they may cancel their policy because of a heart attack. That's like the Texas nurse with breast cancer being canceled because she forgot about the doctor visit for acne. Absolutely ridiculous.
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PanamaLaw5 months ago
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Insurance companies do not give a flying pick on a stake about the majority of patients. How can anybody feel sorry for them? They are in the business of helping people and setting up plans for them so they can receive adequate health care. And then they don't get it. No testicular fortitude.
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lfergie8125 months ago
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Good point. I believe the "government health care" would use the same doctors and pay them the same as Medicare. The price has already been established by Medicare but doctors have a right to not accept those fees. Hence the requirement to see certain doctors.
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mrlecher5 months ago
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Well, you all pay more for government health care than most nations that have socialized medicine. The average American pay $2600 in taxes per year to cover the various gov't health programs(Military, gov't workers, congress, medicare and medicaid). In France, their socialized system cost each taxpayer $2300 a year...AND THEY ARE COVERED!!!! And regardless of what the Fox Noise and other ignorant morons tell you, France basically is the Gold Standard when it comes to healthcare. In France, doctors receive bonuses if they keep you healthy and cure any problems quickly. With the American HMO system, doctors are paid bonuses if they deny you care...with a special bonus if you die before the HMO has to pay any bills.
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harpro2085 months ago
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In 2006, the ceo of United Health Care walked away with a platinum parachute estimated between $1.2 anbd 1.6 BILLION dolkars. That's just wrong. First of all, I can't for the life of me figure out why a guy who's been making millions per year for years needs any kind of "parachute. How much goddamn money does one person need? At ten thousand per annum for premiums, that money could have insured 120,000 to 160,000 fasmilies.
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StevieGee5 months ago
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I will support nothing less than single payer health care for everybody in the US. The insurance industry is nothing more than a mafia protection racket. You pay and pay and when you need them it's your problem. Shoulda read the micro print.
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