Insurance Company Targets Cancer Patients for Cancellations
On Apr 22, 11:50*am, hk wrote:
Exclusive: WellPoint routinely targets breast cancer patients
Photo
11:00am EDT
By Murray Waas
LOS ANGELES (Reuters) - One after another, shortly after a diagnosis of
breast cancer, each of the women learned that her health insurance had
been canceled. First there was Yenny Hsu, who lived and worked in Los
Angeles. Later, Robin Beaton, a registered nurse from Texas. And then,
most recently, there was Patricia Relling, a successful art gallery
owner and interior designer from Louisville, Kentucky.
None of the women knew about the others. But besides their similar
narratives, they had something else in common: Their health insurance
carriers were subsidiaries of WellPoint, which has 33.7 million
policyholders -- more than any other health insurance company in the
United States.
The women all paid their premiums on time. Before they fell ill, none
had any problems with their insurance. Initially, they believed their
policies had been canceled by mistake.
They had no idea that WellPoint was using a computer algorithm that
automatically targeted them and every other policyholder recently
diagnosed with breast cancer. The software triggered an immediate fraud
investigation, as the company searched for some pretext to drop their
policies, according to government regulators and investigators.
Once the women were singled out, they say, the insurer then canceled
their policies based on either erroneous or flimsy information.
WellPoint declined to comment on the women's specific cases without a
signed waiver from them, citing privacy laws.
That tens of thousands of Americans lost their health insurance shortly
after being diagnosed with life-threatening, expensive medical
conditions has been well documented by law enforcement agencies, state
regulators and a congressional committee. Insurance companies have used
the practice, known as "rescission," for years. And a congressional
committee last year said WellPoint was one of the worst offenders.
But WellPoint also has specifically targeted women with breast cancer
for aggressive investigation with the intent to cancel their policies,
federal investigators told Reuters. The revelation is especially
striking for a company whose CEO and president, Angela Braly, has earned
plaudits for how her company improved the medical care and treatment of
other policyholders with breast cancer.
The disclosures come to light after a recent investigation by Reuters
showed that another health insurance company, Assurant Health, similarly
targeted HIV-positive policyholders for rescission. That company was
ordered by courts to pay millions of dollars in settlements.
In his push for the health care bill, President Barack Obama said the
legislation would end such industry practices. Making the case for
reform in a September address to Congress, Obama specifically cited the
cancellation of Robin Beaton's health insurance. Aides to the president,
who requested they not be identified, told Reuters that no one in the
White House knew WellPoint was systematically singling out breast cancer
patients like her.
Many critics worry the new law will not lead to an end of these
practices. Some state and federal regulators -- as well as
investigators, congressional staffers and academic experts -- say the
health care legislation lacks teeth, at least in terms of enforcement or
regulatory powers to either stop or even substantially reduce rescission.
"People have this idea that someone is going to flip a switch and
rescission and other bad insurance practices are going to end," says
Peter Harbage, a former health care adviser to the Clinton
administration. "Insurers will find ways to undermine the protections in
the new law, just as they did with the old law. Enforcement is the key."
In a statement to Reuters, WellPoint said various specified criteria
trigger rescission investigations, including certain types of medical
claims. The company said it changed its rescission practices to ensure
they are handled appropriately after a 2006 review of its policies
prompted by public concern over rescission.
WellPoint also said it created a committee that includes a physician for
making rescission decisions. The company also noted that it established
a single point of contact for members undergoing an investigation and
enacted an appeals process for applicants who disagree with the original
determination.
During the recent legislative process for the reform law, however,
lobbyists for WellPoint and other top insurance companies successfully
fought proposed provisions of the legislation. In particular, they
complained about rules that would have made it more difficult for the
companies to fairly -- or unfairly -- cancel policyholders.
For example, an early version of the health care bill passed by the
House of Representatives would have created a Federal Office of Health
Insurance Oversight to monitor and regulate insurance practices like
rescission. WellPoint lobbyists pressed for the proposed agency to not
be included in the final bill signed into law by the president.
They also helped quash proposed provisions that would have required a
third party review of its or any other insurance company's decision to
cancel a customer's policy.
The new law does leave open the possibility of reform in this area,
these sources say. The reason, they say, is that much of the new
legislation is essentially a roadmap, with regulations to be decided later.
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