Health Net ordered to pay $9 million after canceling cancer patient's policy

[Newsjock]

Source: Los Angeles Times

A breast cancer patient whose medical coverage was canceled by her insurer was awarded more than $9 million today in a case against Health Net Inc., one of the state's largest for-profit insurers.

The award issued by an arbitration judge was the first of its kind and prompted Health Net to announce it was scrapping its cancellation practices that are under fire from state regulators, patients and the Los Angeles city attorney.

Arbitrator Sam Cianchetti, a retired Los Angeles County Superior Court judge, found that Health Net violated numerous state laws in canceling Patsy Bates' policy and declared the company's actions "despicable."

Cianchetti also blasted the company for tying employee bonuses to the number of policies canceled and the amount of money saved.

"It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive," he said in a 21-page opinion.


Read more: http://www.latimes.com/business/la-fi-insure23feb23,1,5039339.story

---

Full decision here (PDF):
http://www.latimes.com/business/la-fi-insure23feb23-pdf,1,1201576.acrobat

[gateley]

1. This reprehensible policy isn't limited to Health.Net, I don't think.

Isn't that pretty much the MO of all the insurance companies these days?

What I don't understand, is that PEOPLE work at these companies, PEOPLE who have families, loved ones, make these decisions with their priority being profit. How can they sleep at night? How do they justify it?

[Tempest]

2. I heard California's AG was going after the other companies

He was waiting on this ruling first.

[gateley]

5. Excellent! nt

[Liberty Belle]

26. You mean Jerry Brown, our former Governor, now AG. Go, Jerry, go!

[melody]

40. Jerry's the man n/t

[nbsmom]

10. Did you rent Sicko?

It's not just the health plans. There's also denial of care in the for-profit hospitals as well.

We will continue to see this type of race to the bottom until we take the profit motive out of health care in this country.

[catrose]

16. I know of a novelist

who makes his living at an insurance company. When asked how he could do such a thing, he said he's inspired by the Incredibles, how Mr. Incredible managed to give people information on how to win.
Of course, Mr. Incredible eventually went postal.

[Lint Head]

27. It is the policy of insurance companies across the country.

I know that for a fact. This is not the last you will hear of this as universal healthcare becomes a political issue. :dem:

[Demeter]

3. Love That Word--Despicable!

http://re3.yt-thm-a01.yimg.com/image/25/m4/2833118021

[Phred42]

4. Human Beings finally win one over Corporations

:toast:

[Mountainman]

6. That's only because it cost them more to be despicable this time.

If the awards were small enough they would just call them costs of doing business.

[nbsmom]

8. This isn't the first time that Health Net has had to pay a large amount

And if you really follow the money, even the large awards are _still_ part of the costs of doing business for any of the for-profit plans(e.g., WellPoint, United Healthcare)...the large awards just get the press (and more work for the attorneys.)

[Thor_MN]

13. A relative works for a company that you can call for health information

if your company's benefit plan includes them. An executive, who was trying to do things to reduce call times told my relative, who was objecting to the potential consequences, that it was cheaper to pay several wrongful death claims than to have longer call times...

While I'm sure there are some wonderful people amongst them, the only thing that matters to most corporate executives is money.

[nebula]

7. Murderers.

The fine is a slap on the wrist compared to the crimes.
These insurance execs belong behind bars.

[ThomCat]

12. I agree. And the Health Insurance Industry should be dismantled.

x(

[nebula]

37. Agreed.

and if Mr. Son of a Millworker actually gave a damn about the healthcare catastrophe
in this country, he would be leading the charge to dismantle HealthNet et al.

But I doubt we'll be hearing a peep from him, though (until re-election time).

[judaspriestess]

9. My friend was left with crippling medical bills that forced him into a

BK because his wife had cancer and her insurance cancelled her after a period of time. She died shortly there after.

[ThomCat]

11. Wow! How rarely do you ever hear of an Arbitration Judge

ruling AGAINST the company? :wow:

Normally they seem to bend over back-wards to find any possible rationale to side with the corporation.

[triguy46]

14. This practice is well described in Sicko...

and in some ways also in "The Rainmaker." I've worked in health care administration for 32 years and truly believe that insurance companies routinely reject claims or deny coverage at a predetermined, random basis. Some percentage of those denials, small percentage, will never be challenged because the screwed consumer is unable to take on, challenge, or fight the companies.

We get claims sent back asking for "additional information" when the data they ask is on the claim we send. Its a way to work the float and with multimillions being held for an additional 30 days as the investigate, they accumulate interest income.

[knitter4democracy]

15. I'll bet that's binding, too. No appeal.

*insert evil laugh here*

Yes!!!

[brentspeak]

21. I sure hope so

These rare for-the-people decisions too often get overturned by some conservative-appointed stooge.

[knitter4democracy]

35. I read through the decision--it is!

The patient asked for it, and the company went along, probably thinking they'd win it. Instead, it's binding on them! Whooo!

[lifesbeautifulmagic]

17. What needs to happen is legal charges of murder or manslaughter

needs to be levied against some of these executives. I know that there have been cases of insurance company shenanigans that have resulted in death. Jail time, and a long sentence at that, and not in any country club facility, might change some insurance executive attitudes.

As a matter of fact, why hasn't this been done, if it is indeed breaking the law? Oh wait, insurance executives are above the law, not too mention big repuke donors.

[sarcasmo]

18. This country is beyond fucked up. Greatest page material.

[ingac70]

19. 'bout damn time these murderers got punished...

if it only included criminal charges and jail time for the CEO... oh well, one step at a time.

[brentspeak]

20. K and R

:kick:

[pinto]

22. Good finding, detailed and documented.

:thumbsup:

[DaveJ]

23. Don't worry, the insurance executives will be fine.

Another day, another lawsuit for insurance companies. The cost will be past on in premiums.

As long as there are no government policies in place to control it, and especially if McCain is elected, this won't change much. Expect much shorter life spans.

Republicans believe it's better for the bottom line, and that we don't need sick or old people to live (except if they're rich). Repukes: "What does it matter if they die with the afterlife and all?"

--

They should not have been sued, but brought up on criminal charges.

[Canuckistanian]

24. When are you people going to wake up?

It's stories like these - and there are a MULTITUDE of them that should shock you to your core.

You're being had by the health insurance companies. To the tune of BILLIONS of dollars a year - yet there's NO major movement to change or stop it.

Did Michael Moore's SicKo do NOTHING to spark any interest in MAYBE trying a new way of providing affordable health care??

I just about broke down in tears seeing SicKo - and I'm not even affected by this.

Well?

[DaveJ]

25. Republicans

It's sad that our two party political system has basically devolved to good vs evil. I think that perhaps our constitution has failed us.

[Canuckistanian]

28. So, do you just give up?

Do greedy Republicans control everything? Is there NOTHING you can protest, lobby or advocate?

NOTHING is purely good-vs.-evil, ESPECIALLY where health care is concerned.

95% of the evolved world uses single-payer GOV'T-financed health care.

And yet, those governments are NOT collapsing.

How can that be?

[DaveJ]

30. I didn't mean to seem defeatist.

It's just that, even if we win the next election (a big IF) the Republican party will still exist, embodying every evil human inclination. I think that if my local candidate is elected, it will go a long way to extinguishing the Republican ideology. But if we don't win in November, it's going to be really tough. We really will be a nation in complete servitude.

There is no mechanism within our constitution that can make changes happen quickly. The way it is now, corporate executives have time and financial resources to employ methods of overcoming any adversity. Regular citizens do not have that ability. We have a tough road ahead of us. It is tiring, to be honest, sometimes simpler to just give into the servitude. That's what Republicans do though. Just do what bosses say, problem solved. Pray for an afterlife, because that's the only aspiration they have.

Perhaps you don't understand, the Republican appeal is specific to the bottom 50 percentile. They understand capitalism, but do not know how to apply it. They do not understand that money is a human invention. They glow with pride when they mention supply and demand, because understanding it is the total extent of their knowledge.

So, we're up against good vs evil, not good vs excellent. That's what happens with a two party system like ours. I think we need to rewrite the constitution entirely, a grueling tiring process.

[Canuckistanian]

31. Perhaps I don't understand

Is it really that hopeless? Can there really be no meaningful change?

I don't hold out any hope for Obama. He just doesn't have the "fire" that Edwards has.
All this "change" and "hope" are just meaningless phrases without specifics.

But you're wrong on one point. Your Constitution is fine the way it is. It doesn't need to be re-written. It just needs to be ENFORCED.

[DaveJ]

32. You picked up on the one phrase I hoped you'd ignore...

Anyway, Edwards will have an important role to play if Obama or Hillary wins the GE. The idiots in the U.S. have selected McCain and Hillary or Obama to run. We have to live with that fact, right?

I think Obama has potential because Chicago has a proven ability to marginalize the Republican party. Being from the South side unscathed is no small accomplishment.

Chicago also has strong social ties to Florida, Texas, and midwestern states. And, for some weird reason, Texans like Chicago, and Chicagoans love Florida. Don't tell me to explain it. It's just that way. I'm not from here -- they just are the way they are.

Then there's McCain, the embodiment of evil, who wants to end any form of health care coverage for those who can't afford it.

There IS potential if we win the GE, but as long as we continue this two party system, we are going to be separated by fiscal lines. So, it is gong to be rich vs poor. The caring vs the uncaring. As long as we allow this we are in turmoil.

[Canuckistanian]

33. No, it's a question I always ask myself

No offense taken.

Seeing that I come from another country, I always wonder if I truly have a grasp of what's really happening down there, despite my years of observations.

I can sense the frustration, but do I really understand the dynamics? It's easy for me to say "get yer shit together, guys", but the reality may be quite something else.

As for your point, I'm glad not only to see that Obama is black, but that he's from the north, which is almost unheard of for a president in the late 20th/21st century.

Perhaps he may be able to do SOMETHING about the rich/poor gap.

[melody]

43. No, you don't understand -- you're not from the USA

This is a different culture. You don't understand. I don't judge people in other cultures where I don't fully understand
the traditions, so I won't return fire about various problems in Canada (and I could).

Also, Bush is NOT from the south. Bush originally is from Connecticut -- he spent a few weeks every year in Texas but his accent is fake. Incidentally, most southerners do not consider Texas to be in the south either. Reagan was from Tampico, IL, Bush Sr
is from Maine ... both northerners. In fact, the only arguably "southern Presidents" have been among the most liberal.

In this case, you're not only judging one culture you don't understand, but two.

[Maat]

39. I wish there was a way to organize healthcare marches all over the country.

I can talk to an activist friend of mine about doing one in April (I think that it will take that long to get it organized) out here in the Riverside/Orange/San-Diego area.

I wonder if Skinner would let us use DU to organize national marches.

[melody]

42. When will you wake up and stop yelling at the safe Americans?

We've all seen Sicko ... we all PERSONALLY suffer this on a DAILY goddamned basis. You think you know more
about this than ANY American?

Want to yell at Americans? Why not show some real gumption -- go yell at a RW Republican board.
All you're doing is blaming the victims.

[michreject]

29. Left me speechless.

[HuffleClaw]

34. for each one of these cases that turn out well i bet there are a THOUSAND that don't end well

at least, though the even more sickening thing i saw in 'sicko' was how the insurance companies will pay for treatment then take the money back AFTERWARDS.

[lonestarnot]

36. K & R!

[Vinca]

38. $9 million is chump change to the insurance industry.

They probably get to deduct is as a cost of doing business.

[Doctor_J]

41. Holy shit! That's probably a week's profits!

they'll never try that again :eyes:

[ileus]

44. My wife says Healthnet is a bunch of goons that never approve anything.