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Bleeding Heartland
It's what plants crave.

The Insurer's Drop List keeps growing ...

by: jamess

Sun Jul 12, 2009 at 16:08:44 PM CDT


(Thanks to jamess for this important diary. For a first-person account of another way some insurance companies respond to serious illnesses, read How I lost my health insurance at the hairstylist's. - promoted by desmoinesdem)

As you may have learned last week from LA Times reporting, and from Congressional Hearings, that Insurance companies routinely try to drop your Insurance policy, if you happen to get one of their "Hot List" illnesses.

Getting any of these illnesses, can Trigger the Insurance Company's "Cancellation Police", into action.

Denial Specialists scour your medical history, and cross-check that against your application, looking for any reason to Cancel, or rescind, your Insurance policy, thus saving the Insurance Company untold thousands in future payments for your expected Care. Denial Specialists, of course, earn bonuses for each Policy they cancel. What a system!

Those 4 illnesses (out of the 1000+ such Triggers) previously disclosed are:

breast cancer, high blood pressure, lymphoma and pregnancy


Well thanks to the tough questioning of the Oversight and Investigations Sub Committee, at least 2 more Triggering Illnesses have been disclosed, as indicated in the video and transcript of the Hearing:

The 2 other newly disclosed "Drop List" illnesses include:

ovarian cancer, and brain cancer

jamess :: The Insurer's Drop List keeps growing ...
Here's the Congressional Video, where real Reps grill some Insurance Execs, dead-set on defending their perfectly "clinical" Cancellation policies:


Rep. Stupak Questions Witnesses On Rescission Triggers

Video Clip


Here are the specifics of that "Hot Seat" Hearing:


Terminations of Individual Health Policies by Insurance Companies Hearings
Subcommittee on Oversight and Investigations
June 16, 2009

The Subcommittee on Oversight and Investigations held a hearing entitled "Terminations of Individual Health Policies by Insurance Companies" on Tuesday, June 16, 2009 in room 2123 Rayburn House Office Building. The hearing examined the practice of "post-claims underwriting," which occurs when insurance companies cancel individual health insurance policies after providers submit claims for medical services rendered.

Subcommittee website


Unfortunately the Panel Questioning portion of the Hearing and its Transcript is not on that Congressional website yet.


Fortunately however, after much searching, I finally found the Transcript elsewhere, which includes Stupak's Questioning from that Video Clip, plus other choice dialogs.


Here are some of the Grade-A excerpts, from the Hearing Transcript:


Date: 06/16/2009 - Location: Washington, DC
Statements Hearing Of The Oversight And Investigations Subcommittee Of The House Energy And Commerce Committee -

Terminations Of Individual Health Policies By Insurance Companies
Chaired By: Bart Stupak

REP. STUPAK: [...] Now, each of you provided to the committee information that relates to certain medical conditions that automatically triggers an investigation in the possible grounds of rescission.

Mr. Sassi, I left off with you. You had 1,400 different conditions that automatically triggers investigation.

Mr. Hamm, on behalf of Assurant there are 2,000 conditions that trigger investigation that you provide to the committee, these include breast cancer, ovarian cancer, and brain cancer.

Why does cancer trigger investigation?
[...]

MR. HAMM: I will answer it. What triggers the investigation are the types of medical conditions of a chronic nature where there is a high probability that the condition would have preexisted at the time of the application. It is not based on the cost of the claim, it's based on the medical condition. In fact, the people that make the rescission decision are not aware of the cost of claim. It's all about the information gathered --

REP. STUPAK: If it's the medical conditions -- if it's the medical condition, then before you sign them up why don't you get all the medical records, why don't you find it then? Why do you wait and until there is -- there is a claim?

MR. HAMM: If we were to receive all the medical records at the time of application, that would delay the process significantly, delaying people's access to health care and would add a tremendous amount of costs to the product --

REP. STUPAK: Well --

MR. HAMM: -- the vast majority of applicants provide all the information that's asked for at the time of application.

REP. STUPAK: So it's a cost issue.

MR. HAMM: It's --

REP. STUPAK: It's too costly to get the medical records?

MR. HAMM: It would add to the -- yes, it would add to the premiums that our customers would pay by a significant amount.

REP. STUPAK: So what does it cost $40, to get medical records?

MR. HAMM: I'm not familiar with the costs. But it would also delay the process.

REP. STUPAK: But isn't it better to delay the process to make sure a person is insured as opposed to pulling them when they are going through cancer like Mr. Raddatz?

MR. HAMM: The vast majority of our customers provide the appropriate information.

REP. STUPAK: So did Mr. Raddatz, but you still denied him coverage, right?

MR. HAMM: I unfortunately cannot comment on that particular case.

REP. STUPAK: Mr. Collins, I'm asking the same question of United. You insisted that you also use a computerized system to identify cases to automatically investigate for possible rescission. But there is no one at your company who knew how the computer decides which file should be reviewed. So is it the case that United has put the decision of which patients will have their health care treatment interrupted by a rescission investigation in the hands of a computer that no one understands?

MR. COLLINS: No sir that is not true. I haven't really been privy to the discussions between my staff and your staff on this issue. We've been trying to come to an understanding about how to best provide the data in a format that's easily understandable --

REP. STUPAK: Well --

MR. COLLINS: -- but that means to say --

REP. STUPAK: But can you tell us what conditions the computer considers for a possible rescission investigation?

MR. COLLINS: No single factor is used in our process to trigger an investigation. So we look at -- the system looks as it's screening claims that come in at the effective date of the policy, the effective date of the procedure, the severity, the type of service, and the diagnosis code those are all factors that go into the algorithm that pulls cases out for --

REP. STUPAK: Now, the algorithm, no one from your company could tell us. Will you commit to us today to produce whatever witnesses or documents that are necessary to explain your algorithm, your computer selection process? Could you do that? Will you commit to do that for us?

MR. COLLINS: Yes, sir.

REP. STUPAK: We are still trying to figure it out.


Transcript Link

Nothing like having an incomprehensible Computer Screening Program, "standing in between" you and your Doctor!

==========

REP. HENRY WAXMAN (D-CA): Thank you very much, Mr. Chairman.

Today we're going to hear the results of a year-long congressional investigation into abuses in the individual insurance market.  [...]

Overall, what we found is that the market for individual health insurance in the United States is fundamentally flawed. One of the biggest problems is that most states allow individual health insurance policies to deny coverage to people with preexisting conditions. So if you lose your job and you can't qualify for a government program like Medicare or Medicaid, it's nearly impossible to get health insurance if you're sick or have an illness.

This creates a perverse incentive. In the United States, insurance companies compete based on who is best at avoiding people who need life-saving health care. [...]

But what we found is that when people with individual policies become ill and then they submit their claims for expensive treatments, then insurance companies launch an investigation. They scour the policyholder's original insurance application and the person's medical records to find any discrepancy, any omission, or any misstatement that could allow them to cancel the policy. They try to find something -- anything -- so they can say that this individual was not truthful in that original application.

It doesn't have to even relate to the medical care the person is seeking, and often it doesn't. You might need chemotherapy for lymphoma, but then when the insurance companies find that your coverage was based on a failure to disclose gallstones, well, they want to cancel your policy, after the fact.
[...]

It may come as surprise to most people, but the insurance companies believe they are entitled to cancel the policies even when these omissions or discrepancies are completely unintentional. And they believe that they have the right to cancel policies even when someone else, like an agent who sold the policy, was responsible for the discrepancy in the first place. In addition, they can terminate coverage not just for the primary policyholder, but they go to terminate the policies for the entire family, including innocent children who did nothing wrong.

Some insurance companies launch these investigations every single time a policyholder becomes ill with a certain condition. In other words, if you happen to have ovarian cancer you should prepare -- be prepared to be investigated. It's the same with other conditions such as leukemia.

In the written statement for today the three insurance companies downplay the significance of these practices, arguing that rescissions are relatively rare. But these three companies save more than $300 million over the past five years as a result of rescissions. And I'm sure they view this amount as significant. More importantly however, these terminations are extremely significant to the tens of thousands of people who needed healthcare and couldn't get it during these five years because their policies were rescinded.


Transcript Link

"There ought to be a Law to stop this stuff!" ... Hmmmm?

==========


REP. JOE BARTON (R-TX): [...] The letter further informed Ms. Beaton that an investigation into her claim for benefits, when the company had thoroughly reviewed her medical records that she submitted when she applied for the coverage, and that they discovered that she had misinformed them on several pieces of information.

One of them was that she didn't list her weight accurately. And the other, that she failed to disclose some medication that she had taken for a preexisting heart condition. The record will show that she was not taking that medication at the time that she submitted her initial application for coverage.

Robin's claim in June of 2008 was not for weight control, it was not for a heart condition. It was for cancer surgery, double mastectomy for breast cancer.

Yet her policy was rescinded three days before that surgery was scheduled to take place. It was bad enough that she had to deal with the trauma of breast cancer. But to be denied coverage right before potentially life-saving surgery, quite frankly is something that no human being should have to undergo.


Transcript Link

Great "bed-side manner" those Insurance Giants have, eh?

I bet Ms. Beaton is still raving about that wonderful "form letter" she got!

(We wish her well, sometimes, that's all you have left, wishes ...)

==========


REP. STUPAK: Well, thank you.

And thank you all for your testimony. We'll go to questions.

Mr. Sassi, let me ask you this because you're -- you threw a bunch of statistics at us, but I was just looking at the State of California alone and it seems to me, if I remember correctly, in July of 2008 Anthem Blue Cross, which is a subsidiary of WellPoint, paid a $10,000 fine and had to reinstate 1,770 rescinded policies. And in February of '09, once again, California Anthem Blue Cross, again, one of your subsidiaries, had to pay a $15 million fine and reinstate over 2,300 rescinded policies. And then another settlement, ($)5 million, and another 450. So it seems like in the last year you've had to reverse 4,500 rescissions and pay a fine of $30 million just in one state. Is that true?

MR. SASSI: I don't believe the numbers are exactly accurate, but the premise is accurate. The issue of rescission first surfaced in the media particularly in California, [...]

MR. SASSI: -- or individuals enter into settlements for a variety of reasons.

REP. STUPAK: Let me ask you this. And I'll ask all three of you, why don't you just vet these policies before you ever collect a premium? Why don't you just go through these policies and make sure there's no problems with it before you insure the people? Only one state requires you to do that and that's Connecticut, right?

MR. SASSI: Chairman, we do investigate. The applicants are -- we have very rigorous underwriting requirements. As we review an applicant's application, we rely on the applicants to be truthful and completing.

[...]
MR. SASSI: -- there were over 16,000 investigations triggered, 92 percent of those were dismissed.

REP. STUPAK: Okay.

MR. SASSI: And no action was taken --

REP. STUPAK: Right. But why do you have 14 different conditions which trigger an investigation now? What's the common theme amongst these 1,400 that would trigger an investigation?

MR. SASSI: I would say there is no common theme other than these are conditions that had the applicant disclosed their knowledge of a condition at the time of initial underwriting. We may have taken a different underwriting action. And so that is what the investigation really is about is to determine did the applicant have the condition? Did they know about the condition?

REP. STUPAK: I thought you said you did pre-screening before, you screen them before.

MR. SASSI: We do, but in many of these applications --

REP. STUPAK: Well, then why would you have to go back? If you screened them before and there wasn't a problem, then why would you have a list of 1,400 different conditions that triggers investigation? If you prescreen, if your prescreening is good, you wouldn't need a list of 1,400, would you?


Transcript Link

So I guess, it's OK to Mr. Sassi, that ONLY 1280 of his patients were left in the lurch --

Since they were actually gunning for 16,000 of them?

1280 -- no BIG Deal -- it's only a number!

==========



Well, as noted in the next blurb, at least Congress is shocked, about it all, about this cold-hearted Practice of Rescission, once a person gets sick. Hopefully their amazement will turn into finally Standing UP for the People, for a change!

Haven't we had enough of weasely Executive Testimony, who never admit guilt, but who are always quick to excuse their own lies and their reversal of "good faith" contracts?  Haven't we have enough of Executive Excuses, (ala Tobacco Execs) which claiming the shield of it's just "marketing facts of life" in today's ruthless "competitive world"?  If they didn't play hardball, they couldn't "survive"!  (Say ... WHAT about the Survival of their Patients!?)

Hah! Those pencil-pushing Execs, should try competing with a Public Option plan, so that they can learn first hand, what Care is All About!  They should be "encouraged by market forces", to become the enablers, NOT the deniers, of Health Care.


It's True! Health Insurers Tell Congress They Cancel Policies of Sick Patients
July 6 2009

Rescinding health policies of 20,000 people in past five years saved health insurers $300 million

Patient testimony at the congressional hearing told a different story. Patients revealed that, time after time, insurance companies dropped people for technicalities, honest mistakes, or inadvertent omissions.

For example, because a Texas nurse failed to disclose a visit to the dermatologist for acne, her insurance coverage was dropped when she was diagnosed with breast cancer. A Los Angeles woman was dropped for failing to report a weight-loss medication she no longer takes and because of irregular menstruation.

To the utter amazement of the congressional committee, the health insurance executives refused to commit to limiting rescission to only policyholders who intentionally lie or commit fraud.

The committee discovered that health insurers target up to 1,400 expensive conditions or illnesses. These include breast cancer, high blood pressure, lymphoma and pregnancy. It was also revealed that employees at these health insurers are rated in performance reviews for high-dollar rescissions.

Both democrats and republicans condemned these practices. Rep Michael C. Burgess (R-Tex.), said, "No one can defend, and I certainly cannot defend, the practice of canceling coverage after the fact." Rep. John Dingell (D-Mich.) added, "This is precisely why we need a public [insurance plan] option."


http://www.darkdaily.com/healt...



Thank goodness, that such Congressional Oversight, is finally happening, even if much too slowly!

Now if only there were some equally serious Congressional follow through, on their outrage!


Insurance Companies that Deny Care, after-the-fact, only to save a buck, should be a criminal offense -- a breach of a "good faith" contract, with the People they supposedly serve.


But alas, this is the legacy, that "Compassionate Conservatism" has given us. No Regulations, and No Watchdogs... Only Millions of Victims ...


Let's hope that this legacy finally ends here.

Let's hope the Insurers, DON'T manage to "Cancel Our Voices" in DC, once again -- like they can somehow, always manage to do; somehow, always manage to AFFORD!

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Waxman's comments (4.00 / 1)
are right on target, especially this part:

Overall, what we found is that the market for individual health insurance in the United States is fundamentally flawed. One of the biggest problems is that most states allow individual health insurance policies to deny coverage to people with preexisting conditions. So if you lose your job and you can't qualify for a government program like Medicare or Medicaid, it's nearly impossible to get health insurance if you're sick or have an illness.

This creates a perverse incentive. In the United States, insurance companies compete based on who is best at avoiding people who need life-saving health care. [...]

But what we found is that when people with individual policies become ill and then they submit their claims for expensive treatments, then insurance companies launch an investigation. They scour the policyholder's original insurance application and the person's medical records to find any discrepancy, any omission, or any misstatement that could allow them to cancel the policy. They try to find something -- anything -- so they can say that this individual was not truthful in that original application.

It doesn't have to even relate to the medical care the person is seeking, and often it doesn't. You might need chemotherapy for lymphoma, but then when the insurance companies find that your coverage was based on a failure to disclose gallstones, well, they want to cancel your policy, after the fact.

That is why we can't afford to listen to people like Chuck Grassley, who want to protect private insurers from competing against a public health insurance option.

Invite other Iowa political junkies to join us at Bleeding Heartland.


Congress is finally catching up (4.00 / 2)
with common sense. As long as private insurers are motivated by profit and quarterly bottom lines, they will do everything in their power to ensure they land in the black. Not only is this a "perverse" incentive as mentioned above, it's immoral. And I love how these compassionate conservatives will do anything in "their power" to help protect this practice. If ever there was a time to ask the question W.W.J.D.?, this is the occasion.

"For every political action, there is an equal but opposite satiric reaction." Political Fallout: http://www.political-fallout.blogspot.com/

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