Insurer revoked HIV patients' coverage

[Spindrift]

Are you all missing the point on purpose? This is not usual or acceptable policy. He sued and won. Are you all that brainwashed??? A wrong was righted. The system of recourse worked. If the government were his insurer would he have been able to recover money? No,you can't sue the government.

Did you read the article? It was standard policy!

Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.

Like other major health insurance companies, Fortis has a "rescission committee" that reviews recommendations to cancel a policyholder's insurance. But in the case of Fortis, Nettles wrote, the committee rarely did more than "rubber stamp" already flawed recommendations.

"There were no rules, no minutes, no notes, and, in accordance with instructions from general counsel not even a record of who was present," the judge wrote about the committee.

 

[Rolfe]

Are you all missing the point on purpose? This is not usual or acceptable policy. He sued and won. Are you all that brainwashed??? A wrong was righted. The system of recourse worked. If the government were his insurer would he have been able to recover money? No,you can't sue the government.

It WAS usual policy. It wasn't legal, and they lost in this case, but how many other similar cases did they get away with? Enough to make £10 million worth it?

The whole point about universal healthcare is that everybody is covered. This simply doesn't happen. It can't happen. Nobody can tell you that you're not entitled to treatment for a disease you have.

This only happens in America. It's the actual death panels. They don't exist in universal healthcare systems, but they sure exist in America.

Rolfe.

 

[jdp]

And you can bet they'll do it again.

 

[Rolfe]

What am I "cool with", exactly?

This.

Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.

Their motive, according to the judge, was obvious: "The court finds that Fortis wrongfully elevated its concerns for maximizing profits over the rights and interest of its customer." In upholding Nettles' verdict, the South Carolina Supreme Court similarly ruled that "Fortis was motivated to avoid the losses it would undoubtedly incur in supporting Mitchell's costly medical condition."

It's normal practice. They don't care if they cancel a policy on wrongful grounds, it's nearly always worth the risk.

Have you read the other document linked above, yet? There are so many particular and general examples there one wouldn't know where to start. It's systemic and endemic and ingrained and SOP.

The employees who flag up the alleged discrepancies are rewarded with bonus payments for denying lifesaving treatment for as many people as possible.

The Committee obtained an annual performance evaluation of the Director of Group Underwriting at WellPoint prepared on February 26, 2004. One objective this official was evaluated for was her ability to meet financial "targets" and improve financial "stability." Under "results achieved," the review stated that this official obtained "Retro savings of $9,835,564," indicating that she helped save the company nearly $10 million through rescissions. For this objective, the official was awarded a perfect "5" for "exceptional performance".

Similarly, the Committee also obtained a performance review for an Underwriting Supervisor at WellPoint prepared on January 29,2004, presumably from within the same corporate unit as the Director of Group Underwriting. This performance review stated that the official "has achieved a high level of performance as evidenced by ... Retro savings of $9,835,564.

The only reason this isn't likely to happen to you is if you have insurance through your work. Better not leave, strike out on your own, try to build your own business. Better hope your employer doesn't just decide to stop offering health insurance. Better hope you don't lose your job.

Wow. Did someone say this was the "land of the free"?



The real problem is "post-claims underwriting". The committee had something to say about that.

An insurer has an obligation to its insured to do its underwriting at the time a policy application is made, not after a claim is filed. It is patently unfair for a claimant to obtain a policy, pay his premiums and operate under the assumption that he is insured against a specified risk, only to learn after he submits a claim that he is not insured, and, therefore, cannot obtain any other policy to cover the loss. The insurer controls when the underwriting occurs.... If the insured is not an acceptable risk, the application should [be] denied up front, not after a policy is issued. This allows the proposed insured to seek other coverage with another company since no company will insure an individual who has suffered serious illness or injury.

But that's not how it's done. They'll take your money and pocket it so long as you aren't costing them much, and you'll never know you're not covered. Then when you get cancer, someone on a performance-related bonus will fine-tooth comb your file and find the bit where your doctor noted a suspicion he didn't tell you about, which maybe was a false alarm anyway, and deny you coverage based on an undeclared pre-existing condition. Or something like that. And you won't be able to find alternative coverage, because you aren't a risk any more, you're a certainty.

The Prestige, didn't you know that's how it was done?

That's your death panels, right there. The ones the universal healthcare countries (i.e. everybody half-civilised who isn't you) don't actually have.

Rolfe.

 

[theprestige]

This.




It's normal practice. They don't care if they cancel a policy on wrongful grounds, it's nearly always worth the risk.

Please quote any post I have made in this thread where I said I was "cool with" this.

Protip: Don't quote the post where I explicitly expressed the opposite sentiment (and proposed a reform that would address the problem I clearly believe exists).

 

[Rolfe]

Yes, I read all that. You said it was "a jerk move".

You expressed a lot of sympathy for their need to turn a profit, and accepted that they'll cancel policies "all the time, for all sorts of reasons". Oh dear, occasionally they behave like jerks!

You sounded cool enough with it to me.

And just to be even clearer.

Poor bastard only got 10 million. I guess he can pay for his own health care now. He also got heath care at a clinic without the insurance. So he didn't die within a year or two.

A wrong was righted. The system of recourse worked.

Again, sounds pretty cool to me. The system worked. ONE lucky patient found a caring person to fight the system for him, and finally got redress. That's news.

If that had been an isolated mistake, especially if the company had done its best to sort things out when they were notified of the error, yeah, I'd be cool with it too. But it wasn't a mistake, it was deliberate exploitation of a single-digit clerical error, as part of SOP to screw as many HIV patients as possible, and they fought tooth and nail to ignore it and reject it and oppose any redress for as long as they possibly could. There are gadzillions of similar cases.

So no, it's not enough just to say, hey, he's OK, he got compensation. How many didn't?

Rolfe.

 

[Architect]

No,you can't sue the government.

Are you suggesting that, in countries such as the UK, there is no legal redress for those who feel that the UHC system has not provided appropriate healthcare treatment?

Hint: I know the answer to this, and I suggest you look into it before replying. Phrases you will want to study include "judicial review" and "legal aid".

 

[Unabogie]

Yes, I read all that. You said it was "a jerk move".

You expressed a lot of sympathy for their need to turn a profit, and accepted that they'll cancel policies "all the time, for all sorts of reasons". Oh dear, occasionally they behave like jerks!

You sounded cool enough with it to me.

Rolfe.

This seems to be a problem with conservatives.

No, of course they are against letting people die when they sick! But here are 20 reasons we shouldn't be mad at the wonderful insurance companies who drop sick people in the name of profits. No, of course we shouldn't let people get bankrupted for being unlucky enough to get sick once! But here are 20 reasons it's Socialist to cover people who don't deserve "hand outs".

http://www.youtube.com/watch?v=6ik4f1dRbP8&feature=player_embedded

From torture to health care, the cry is always that Conservatives hate the obvious problem as much as anyone, but then they go and become apologists for the perpetrators in the name of "conservatism".

 

[Rolfe]

Are you suggesting that, in countries such as the UK, there is no legal redress for those who feel that the UHC system has not provided appropriate healthcare treatment?

Hint: I know the answer to this, and I suggest you look into it before replying. Phrases you will want to study include "judicial review" and "legal aid".

Oh dear! He might find out about the people that successfully sued when they didn't like a decision that a high-end cancer drug didn't provide much benefit to justify the huge cost.

He might find out about the people who actually had tens of thousands of pounds repaid to them, when they'd self-funded treatment they were later deemed to have been entitled to.

And he might notice that in all of these cases, one time does for all, so nobody else will have to sue to get the same drug.

And you mentioned that the government funded the legal costs, didn't you?

Oh, and he might even notice that none of these cases involved treatment that was standard care at the time - like antiretrovirals, and so on. They all involved new, expensive drugs not yet proven to extend survival by a significant amount. These people were all getting standard state-of-the-art care while all this was going on.

You will NEVER find a legal resident of Britain diagnosed with HIV who is denied antiretroviral drugs. Hell, we even give them to illegal immigrants or asylum seekers, and I know of at least one case of a woman who fled here with AIDS specifically to seek treatment, and got it, but the government decided she had no right to stay and deported her. Her neighbours in England formed a pressure group to try to have her allowed to stay, because they believed that care should be everyone's right.

Why are Americans so cold and hard-hearted about healthcare? They seem generous enough in other areas.

Rolfe.

 

[ARubberChickenWithAPulley]

I've read tons of similar stories, and they send a chill down my spine. I don't understand how all the US posters who seem so happy with their great coverage can be sure something like this could never happen to them.

Because it is very very unlikely. There are over 200 million Americans covered by private insurance. Note the three largest health insurers rescinded approximately 20,000 policies over a 5 year period. There is data missing there, and that's just three companies (though WellPoint and United alone account for 67+ million people), so let's say the real number is... 10 times that amount. Let's say there were 200,000. That's maybe .1% of all policies in the country. The vast majority of Americans will not face this issue.

That doesn't make it right of course. Our system needs to fix that and the pre-existing condition issues, and certainly a host of other issues, and we need to implement a UHC of some kind.

However, IMO, there is some danger in over-doing horror stories (and similarly, vilifying one segment of the health care industry, which has been a blatant, yet ham-fisted strategy in some circles for the past several months), just as there is in picking out horror stories from the the UK, Canada, etc. as proof that the entire system is evil and wrong. Just as British people and Canadians bristle when a UHC opponent picks some anecdote from either country to "prove" that your systems are terrible, the same can happen here. Millions of people have health coverage and do fine. The worst I have personally had were one or two very minor issues. Could something like this happen to me? Sure. Is it very likely? No.

We certainly shouldn't ignore problems like these by any means, but if you overdo the criticism or over-generalize, people will get defensive. It's human nature.

 

[JoeTheJuggler]

Insurance companies cancel policies all the time, for all kinds of reasons. Should they pay out on an invalid policy, simply because their audit happened to coincide with some bad health on the part of the policyholder?

That said, I'm sure many insurance companies have policies or procedures in place such that any time a policyholder applies for coverage from their policy, this triggers an audit.

Please read the report I linked to that was the "supplemental memo" of the House's investigation into this matter.

Rescission and post-claim underwriting is a horrible practice. They reward employees for finding an excuse to rescind a policy. This is most definitely not a matter of "some bad health" that just "happened to coincide" with a routine audit.

As Rolfe said, their goal is to leave seriously sick people high and dry. It would be analogous to a casino being allowed to return a bet and not pay off on a long shot bet where the house loses.

 

[JoeTheJuggler]

Because it is very very unlikely. There are over 200 million Americans covered by private insurance. Note the three largest health insurers rescinded approximately 20,000 policies over a 5 year period. There is data missing there, and that's just three companies (though WellPoint and United alone account for 67+ million people), so let's say the real number is... 10 times that amount. Let's say there were 200,000. That's maybe .1% of all policies in the country. The vast majority of Americans will not face this issue.

That doesn't make it right of course.

I'm glad you say it doesn't make it right. The number of people with hugely expensive medical conditions where the insurance company could find some flimsy excuse to rescind their policies is relatively low.

So? These relatively few cases are vastly disproportionately expensive. That's why I made the analogy above to a long shot bet winning in a casino. It wouldn't be fair if we let the casinos find some excuse to return their bet and not pay off the 10,000 to 1 winners.

 

[ARubberChickenWithAPulley]

I'm glad you say it doesn't make it right. The number of people with hugely expensive medical conditions where the insurance company could find some flimsy excuse to rescind their policies is relatively low.

So? These relatively few cases are vastly disproportionately expensive. That's why I made the analogy above to a long shot bet winning in a casino. It wouldn't be fair if we let the casinos find some excuse to return their bet and not pay off the 10,000 to 1 winners.

I think few people would disagree that it is wrong. But if we're talking the wider issue of health care reform, I think most people would say, "Okay... so rescission is wrong. Pass a law that makes it illegal except in cases of outright fraud." Pretty simple. It's neither here nor there on the entire health care system. In fact, if they wanted to pass a Federal law next week doing just that, I'd bet they could. Several states have already done it.

It's essentially being used as a political tool to beat health insurers over the head because they've become the convenient boogeymen. It's not a coincidence that about the time Nanci Pelosi started calling insurance companies "villains," she and Obama also started suddenly (with no explanation) referring to their plan as health insurance reform -- a subtle shift from calling it health care reform. I'm not interested in defending health insurers on this issue. Rescission should be stopped. They should stop it themselves. But in the context of the entire health care system, it's a tiny issue that is being played up for maximum political impact, and little more.

 

[Frank Newgent]

Why are Americans so cold and hard-hearted about healthcare? They seem generous enough in other areas.

You know what these Americans are? Instant jerks. Just add over-prescribed prostate treatments, heartburn surgery, and implanted defibrulators.

 

[theprestige]

Yes, I read all that. You said it was "a jerk move".

From which you deduced that I was cool with it?

You expressed a lot of sympathy for their need to turn a profit, and accepted that they'll cancel policies "all the time, for all sorts of reasons". Oh dear, occasionally they behave like jerks!

I'm certain this is all your interpretation. The reason I'm certain is because I know what I meant, and it wasn't that.

You sounded cool enough with it to me.

To you. To me, it sounds a lot different. But then, I know what my own opinion actually is. I'm sorry if I wasn't clear enough to cut through your bias.

And just to be even clearer.

Even less clear, actually.

Again, sounds pretty cool to me. The system worked. ONE lucky patient found a caring person to fight the system for him, and finally got redress. That's news.

That's nice. The only problem is, I never wrote the last passage you quoted.

So, to review: you've grossly misinterpreted my point of view, and attributed other people's opinions to me to support your interpretation.

In conclusion, ask yourself this: If you've correctly interpreted my opinions, why am I repudiating your interpretation?

 

[Wildy]

Are you all missing the point on purpose? This is not usual or acceptable policy. He sued and won. Are you all that brainwashed??? A wrong was righted. The system of recourse worked. If the government were his insurer would he have been able to recover money? No,you can't sue the government.

Are you saying that if he was on a government plan they would have kicked him out when he learned that he was HIV positive?

 

[joobz]

Are you all missing the point on purpose? This is not usual or acceptable policy. He sued and won. Are you all that brainwashed??? A wrong was righted. The system of recourse worked. If the government were his insurer would he have been able to recover money? No,you can't sue the government.

Would you mind pointing to the part of the bill which states government run insurance?

 

[quixotecoyote]

Suing the Government: A How-To Guide

 

[Mr.D]

This only happens in America. It's the actual death panels. They don't exist in universal healthcare systems, but they sure exist in America.

That's because "Death Panels" with a profit motive are OK.



or something.

(I have no idea how that "Death Panel" stuff got so much media traction in the first place)

 

[Architect]

Suing the Government: A How-To Guide

In the UK there would also be the option of Judicial Review; in these circumstances the courts are asked to conduct a rapid review - if there is a pressing medical need it can be done very quickly - and reach a decision as to whether the Government (or in this case NHS) has acted reasonably. It's relatively cheap compared to, say, suing someone over the course of 2 or 3 years. And get this - depending upon your income (and with exceptions for frivilous claims) - it is likely that the government will pay your legal costs in advance!

But, of course, this kind of real fact is wasted on those who would die in a ditch rather than accept UHC. "Death Panel" is a much snappier catch-phrase.