When Health Insurance Isn't Health Insurance

[babylonsister]

When Health Insurance Isn't Health Insurance
Posted by Karen Tumulty


In May, 2008, Robin Beaton, a retired registered nurse from Waxahachie, Texas, went to her dermatologist to be treated for acne. He mistakenly wrote down something on her chart that made it appear that she might have a pre-cancerous skin condition.

Not a big deal, right? It shouldn't have been, except that soon after that, she was diagnosed with something far more serious--invasive and agressive breast cancer. Three days before she was scheduled for a double mastectomy, her insurance company, Blue Cross, called her and told her they were launching an investigation into the last five years of her health records. It turned out that dermatologist's note had been a red flag, and the company was looking for a way to cancel her policy on the grounds that she had been hiding a serious medical condition.

What Robin went through after that was a nightmare, one she tearfully described Tuesday morning in front of the House Energy and Commerce Committee's oversight and investigations subcommittee. "The sad thing is, Blue Cross gladly took my high premiums, and the first time I filed a claim and was suspected of having cancer, they searched high and low for a reason to cancel me," said Robin, whose hair is just beginning to grow back in from chemotherapy.

The subcommittee took a look today at an immoral--and illegal--practice in which some health insurance companies engage. It's called post-claims underwriting, and you should know about it. Because you or someone you love could be a victim if they buy insurance on the individual insurance market. Robin got her mastectomy, but only after her congressman, Joe Barton, leaned on the head of the company. (This is constituent service, in the very best sense of why we elect these guys. But the best thing they could do is to make sure it doesn't happen to anyone's constituent.)

There were other witnesses, too. Like Peggy Raddatz, whose brother Otto Raddatz lost his insurance coverage right before he was scheduled to receive an expensive stem-cell transplant to treat his lymphoma. Why? Because Fortis Insurance Company discovered that his doctor had found gall stones and an aneurysm on a CT scan--conditions that had nothing to do with his cancer, and that never bothered him, and that he wasn't even aware of. And Jennifer Wittney Horton of Los Angeles, whose coverage was canceled because she had been taking a drug for irregular menstruation. Now, she can't get coverage anywhere else. "Since my recission, I have had to take jobs that I do not want, and put my career goals on hold to ensure that I can find health insurance," she told the subcommittee. "Fortunately, after my husband and I got married, I was able to gain coverage through his company's group health care plan. However, if he ever loses his job, or I don't have employment with a company that offers group health insurance, I might have to go without insurance."

The insurance companies will argue that cases like these are rare, and that they have to be vigilant against fraud so that they can hold down costs for everyone else. But an investigation by the subcommittee found widespread instances where the insurance companies rescind coverage even over discrepancies that are unintentional, unknown to the policyholder or immaterial to the more serious health conditions for which the policyholders are filing for benefits. The three insurance companies called before the committee--Assurant (full disclosure: this company's was part of a cover story I wrote for TIME about my brother), Golden Rule (a UnitedHealth subsidiary), and WellPoint--were a case in point. "The three insurance companies downplay the significance of these practices, arguing that recissions are relatively rare," says Energy and Commerce Committee Chairman Henry Waxman. "But these three companies saved more than $300 million over the past five years as a result of rescissions. I am sure they view this amount as significant." You can find a summary of the subcommittee report here.

more...

http://swampland.blogs.time.com/2009/06/16/when-health-insurance-isnt-health-insurance/#more-13803

[izquierdista]

1. "I might have to go without insurance"

If they won't pay when you need it, you ARE going without insurance. You just don't know it yet, because they keep cashing the checks you send in for the premiums they bill you.

[patriotvoice]

12. And you're not even paying for the "assurance" of health care.

You're paying simply paying for the "privilege" of medical care.

[sarcasmo]

2. National Health Care NOW! Get the insurance companies out of the Health Care business.

We are one of the worst Industrialized Nations on this Planet.

[dipsydoodle]

3. Indeed you are one of the worst

In theory you're ahead of the UK but then I must confess we've actually only had universal healthcare since 1948.

:sarcasm:

[Doctor_J]

4. Anyone who hasn't yet seen Sicko needs to - now

The companies are in the health care denial business. They need to be wiped off the face of the earth (legally, of course)

[sisters6]

5. Congress should --and the WH should be made to view it and

then follow up on essays about the video--and post them for transparency.

[Faryn Balyncd]

6. K&R - & after these folks are denied insurance, they then are billed 200-600% higher amounts for...

......medical procedures than insurance companies pay:

http://journals.democraticunderground.com/Faryn%20Balyncd/1


The fantasy "full pay" rates charged to those Americans denied insurance (and other uninsured "self pay" patients is the AVERAGE.

In Allan Barnett's case, Northwest Hospital in Houston demanded 800% more than the $8200 they regularly charge insurance companies for his OUTPATIENT shockwave lithotripsy:

http://www.chron.com/CDA/archives/archive.mpl?id=2003_3679711


(And in Northwest Hospital's case, they NEVER BACKED DOWN, even when their billing practices were exposed in the Houston Chronicle.)

[Uncle Joe]

7. Kicked and recommended.

Thanks for the thread, babylonsister.

[NorthCarolina]

8. Latest polls show 82% now in favor of a public plan and yet Harry Reid

insists "We don't have the votes"?? Maybe I misunderstood the role of elected government officials from civics class, but aren't they supposed to support the will of their constituents through their vote? When did all this change?

[HamdenRice]

9. Harpers: Ins cos want two completely separate groups: those w/ insurance, who don't need it; and

those who need it and don't have it.

[nashville_brook]

11. the insurance model is completely inappropriate to health care. health care is a commodity

that we all need to consume -- not a risk we can avoid or mitigate.

[checks-n-balances]

10. You can bet that Joe Barton (R-TX) won't be voting for

public health insurance, even if he did help the constituent whose story is told in the article.

This is really sickening. And I use that word intentionally.

[quidam56]

13. Health care in America is a disgrace

http://www.wisecountyissues.com/?p=62 I have seen with my own eyes what is deemed, defended and supported in E.TN & SWVA as quality health care.