Why would WellPoint work to improve health care for women with breast cancer while automatically investigating every single woman diagnosed with breast cancer for possible cancellation of their policies? Remember this new “it” word, recission.
| Noun | 1. | recission – (law) the act of rescinding; the cancellation of a contract and the return of the parties to the positions they would have had if the contract had not been made; “recission may be brought about by decree or by mutual consent” |
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.
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.
Oh yes, the answer is $$$$$$. Lots of it.
The investigation last year by the House Energy and Commerce Committee determined that WellPoint and two of the nation’s other largest insurance companies — UnitedHealth Group Inc and Assurant Health, part of Assurant Inc — made at least $300 million by improperly rescinding more than 19,000 policyholders over one five-year period.
WellPoint itself profited by more than $128 million from the practice, and the committee suggested that the figure might be largely understated because the company refused to provide information about cancellations by several subsidiaries.
Cost to the insured/patient…their life. I think stress in this case is just as bad as the disease.
In June 2008, she learned that her insurance had been dropped just as she was about to undergo surgery for breast cancer. She had been recently diagnosed and told her cancer was a particularly aggressive type that would require a double mastectomy.On the Friday before the Monday she was scheduled for surgery, Beaton’s insurance company said it would not pay for the operation. It also informed her that it was launching an investigation of her medical history to see if she had misled the company and would sue if it found that to be the case.
The insurance “out” would require that she had something in prior medical history to indicate that she might have unintentionally omitted or flat out lied about her status, thereby making it a pre existing condition (related or unrelated). Huh? She did the right thing. She contacted everyone who might help her fight this. Five months later waiting to have her surgery caused the tumor to triple in size. That is a death sentence.
Prepare yourself for insult to injury on a whole new level…read on.
In Kentucky, Relling underwent her double mastectomy in April 2008. Anthem Blue Cross and Blue Shield of Kentucky footed the bill. Then in December of that year, she underwent reconstructive surgery, and Anthem paid once again.
The following month, however, her nightmare began.
DOWNWARD SPIRAL
Relling suffered a horrific staph infection caused by her stay in the hospital. She was rushed back there in the early morning of January 15 and was admitted shortly after 5:30 a.m.
The incision from her reconstructive breast surgery was reopened. Her abdomen was flushed with six full liters of antibiotic fluid until the incision was closed. Two days later, her condition worsened, requiring yet another emergency surgery.
This second surgery necessitated multiple blood transfusions simply to keep her alive. The infection was so severe her entire umbilicus, the interior of her belly button, had to be removed, as well as many abdominal muscles, because the infection had already eaten away most of it.
While recovering, Relling started having trouble with her insurance. Her medication after the surgery cost $4,446 a month. But Anthem would only pay for 10 days and then no more, she recalled in an interview.
Luckily, one doctor gave her free samples and another found a dispensary where could obtain the medication at a reduced price. But other days she would go without.
In June 2009, she was informed that her insurance was being canceled — just before she was about to undergo another reconstructive surgery, which she was forced to postpone. She has now gone 16 months without the necessary surgery.
As a result, she is severely disabled. The pain and discomfort often only allows her to be able to stand for 20 or 30 minutes a day, sometimes even less.
Reconstructive surgery might help her to become mobile again and perhaps go back to work full-time. She once enjoyed successful careers as an art gallery owner, interior decorator, and as a writer. She had plenty of money, drove a Mercedes and traveled the world on whim. Not anymore.
Today she is on food stamps. She has taken her Social Security early, which means that when she is older, she will be eligible for fewer benefits. She buys clothes from consignment stores she once donated to. She recently got some part-time work as a copywriter, which she can do from home, but that barely pays for her drug prescriptions, let alone surgery.
She spends her days calling pharmaceutical companies because many now have programs to assist indigent customers.
Relling waits hours to be seen by a doctor at a clinic, if she can be seen at all. “The thing I didn’t understand about going poor is that your time no longer has value to others,” she says.
She seeks out religious charities to pay the rent. “Some have rules that they will only give to people who belong to that church or of their faith.”
One charity she contacted after being informed that it provides financial assistance to breast cancer patients told her that it does so only for women of color and of a certain age. “This is my full time job now. You go around and around and around,” she says, her voice trailing her off.
Technically, rescission was not the reason Relling lost her health insurance, according to correspondences with the company she provided to Reuters. Rather, it was canceled because she did not answer letters from her insurance company requesting information about her employment history.
Relling says the letter was sent to an address which she hadn’t lived at it for some time, and she never even saw it until recently. When she brought this information to WellPoint’s attention, she said, the company ignored her.
“Rescission is just one method to get rid of someone or no longer provide them coverage,” says Isaacs, the deputy Los Angeles City Attorney. “They can say forms are not filled out properly; they will just find any pretext.”
Congressional investigators for the House Energy and Commerce Committee who have investigated Relling’s claim say they have concluded that WellPoint improperly canceled her insurance. The company declined to comment at all on her case, saying that client confidentiality precludes them from doing so, although Relling says she welcomes the company to talk publicly about the matter.
On her living room table still sits correspondence with her former insurance company.
Deb Moessner, the company’s president and general manager, wrote Relling last July 13: “Ms. Relling, please know that is never pleasant to deliver unfavorable news to our members. However, there are situations that occur, such as yours, that leave us with no alternatives. Because you or your agent did not provide this vital information, your … health coverage terminated effective July 1, 2009.”
In the letter, Moessner added: “Please know that we wish you the best in regaining the healthy lifestyle you described prior to your recent illnesses.”
via Exclusive: WellPoint routinely targets breast cancer patients – Yahoo! News.
April 22, 2010 at 5:45 pm
as long as insurance is a for-profit industry, this is what one will get. either socialize medical care completely or eliminate entirely.
April 22, 2010 at 6:04 pm
I don’t believe in socialized medicine. I don’t believe in elimination. I do believe in torte reform and dropping the anti trust safety net. That would correct the system quickly. Everyone would pay what is fair.
April 22, 2010 at 7:12 pm
insurance IS socialism: it spreads cost among members.
also, that wouldn’t fix the problem of people who work for small companies paying more than their share.
the idea that in a small company the pool is limited to the little itty bitty office, when in reality the insurance companies have the resources of 10′s maybe 100′s of thousands of pools together is evil.
f#ck all insurance!
April 22, 2010 at 8:01 pm
Nom you are entitled to your opinion. I am not quite sure that you understand that there are a million plans. Why should an all male company pay for a plan that includes gynecology? Why should an all female company pay for Viagra? You pay for what you get. Essentially, you want redistribution of wealth to cover everyone equally. It doesn’t work that way. I would never opt for a plan that pays for Viagra. UniCare got into trouble by creating individual plans. That company tried to cater to individuals and small companies. Unfortunately, many did not understand how these policies worked. They won’t be around for long. They have already pulled out of several states.
No it isn’t. Your company chooses what it wants and the insurance company takes the insured and gives them a price for what they need to pay into the pool based on the demographics of the group. That group is not splitting cost across the board evenly because you might include families, significant others, etc. It is all dependent on the pool and the demographics. The generalization that you give is not a true assessment of how the industry works. We have to remember that insurance companies never got into the business to not make a profit either.
The best plan for everyone is to stay as healthy as possible.
April 23, 2010 at 7:20 am
I do understand that there is variety according to plan: I helped to pick the plan for my company: it still cost the freaking earth for a basic high deductible plan.
Why if an insurance company has tens of thousands of customers does it relegate them all to different pools that are based on the size of the company? It’s perfectly obvious that this is a windfall to large companies and a punishment to small ones. It is perfectly obvious that the small plans subsidize the larger ones, because the insurance company’s risk is distributed over all its individuals, not over all its companies.
my friend in a large computer firm’s family got coverage for 4 freaking people that was a hell of a lot better at 1/12 per capita what I had to pay.
You can claim that you get what you pay for but that just isn’t true. else we’d have all been paying $150 per month instead of $460 with poorer coverage. the big guys get the good plans and the little guys get the bad plans that subsidize the big guys.
I don’t believe in insurance or socialized medicine. I believe in fairness. And fairness is not me paying someone else’s medical insurance share or their health care. But if I had to pick between the two, I’d settle for health care not insurance.
April 23, 2010 at 9:06 am
How many people were in the pool Nom? What were the health histories? What are the demographics of the group?
That’s correct Nom…large firm with many people paying into the pool. What are their demographics? It is all formulary, just like car insurance. You got what your company could afford to pay for…in other words you got what would be a fair return for what you paid into the pool. That stands against whatever the future may hold for your pool. Your argument about fairness is not logical. I would never expect my plan for a tiny company to provide the same benefits as Microsoft. There is a larger and younger pool of people at Microsoft. Chances are that they won’t be using end of life charges as soon as mine will. You are comparing apples to oranges. Your plan was fair. How long had your group paid into the system? It cannot be compared. If you have one person in that pool who had a history of cancer, chances are that the pool will be accessed for more money. Cancer recurrence is figured into your plan. Do you have any idea what cancer protocols can run? Usually $5,000 – $24, 000. That doesn’t even figure into other therapies Nom. Did your group pay enough to sustain that possibility? Chances are that a small company will not have paid sufficiently into the system to take care of that one person. I know an attorney who had to drop from their pool in order for the rates to not soar through the roof. The rates went up when he had heart surgery. The rates tripled for everyone else. He ended up going into a high risk pool by himself. That was fair to the company. Try a super staph infection where someone might need a round of IV antibiotics at $66,000 for a 6 week course. Is it fair for a 24 year old to pay for the company’s boss’s wife’s bout with a nasty complication that requires this? In a pool of 8 people, you bet you have to pay more. Your are less in the pool. Your plan can be as high as and as great as you want, can you afford it? Health Savings Accounts are great. Why didn’t your company go for one? Probably because the up front hit is a nightmare. Usually, these are $5,000 -$10,000 deductibles. I have seen them as high as $25,000. If you are healthy and your bank account is healthy, that is the way to go with no lifetime maximum. I don’t know about you, but I don’t have that kind of money sitting in the bank for a catastrophe. That is why we usually opt for a plan of some sort. If you don’t like the amount that you were paying, then you need to self insure (make your own plan) or find a job with a huge company. To be fair, many plans also give you high discounts for staying healthy. They don’t increase your numbers. Who do you think is going to pay for the people in your small company who are taking out far more than what your company has put in? Stay healthy. Avoid health pitfalls. It’s the best that anyone can do.
When someone tells me that they spent boatloads of money in the ER, I wonder why they didn’t take care of the problem when it was manageable? I think that there is some personal accountability. I had a neighbor who adored the sun. Blistering sunburns and no regrets until melanoma appeared on his back. He was warned over and over by everyone. He didn’t really care about what anyone said. His illness came. He had no insurance. He died. He died with the best care that anyone could have received because he was friend to all and everyone loved this man. His care was paid by those that do carry insurance. At the end of the day, could avoiding the sun made a difference? Imo, yes. I don’t believe that is the answer all the time. I do believe that staying as healthy as possible makes a huge difference in your care and outcome.
April 23, 2010 at 12:21 pm
“It is all formulary, just like car insurance.”
those formulas come from statistical averages of sh#tloads of people. I am not all those people, I am me. Unless I am paying only for my personal history, genetics, and lifestyle, then it is socialism and inherently not fair. Fuck that. I’m not interested. Nor am I at all grateful that insurance has hiked the cost of everything such that care is not merely unaffordable without it but impossible.
“a fair return for what you paid into the pool”
complete and utter bullshit: I paid far more than I ever took out
I am healthier than those people I described that pay 1/12 what I did. I exercise more, eat better, have a far better weight: I do stay healthy.
I can run 10 miles without difficulty, I can walk over 30 miles without difficulty, I can do 200 pushups without stopping. On my fingertips. I should not have to pay more than they: I am demonstrably more healthy and less likely to cost an insurer money.
Even if I worked for a big company with a big pool and got the same rate as they I am statistically FAR MORE HEALTHY than my gender-age-race-marital status-education counterparts; I have no history of any illness, which is what those fucking rates are based upon; therefore I would still be paying more than my share, because I’M THE HEALTHY ONE IMPROVING THE POOL.
you certainly cannot convince me that it is in any way ethical to reward people of poorer habits such that they pay 1/12 that of another because they happen to work for a larger company. that is just plain fucking asinine, I am not buying it.
insurers should have to judge everyone singly on their own merits or lack thereof, or be put out of business, because they are operating an evil fucking racket.
April 23, 2010 at 12:43 pm
Then an individual plan would be perfect for you as opposed to a group plan. Nom, you are healthy.
What if a bus hits you? No fault of your own, you recover but must have a ton of extra surgeries to correct defects? Then what? Let’s say you recover and have horrible problems as a result of the surgeries that keep you alive. You get rated differently through no fault of your own. The other people in the pool may not like their rate increases because you require special equipment, etc to live. This is not just about habits. You can complain all you want, but the bottom line is you are in a group or individual plan. You pay along the way. I am not trying to convince you of anything, but you are adamant about this being about fairness. The larger the pool, the more money to take from. The younger people will always get breaks. Those that eat like crap will get a higher rate. It may not come now, but it will on the first visit to the doc that signals cholesterol. When it comes to genetics and bus accidents, it is still a stat and you may win the lotto. Either way, a hospital cannot deny you care in the US so you and I are taken care of for the moment with or without insurance.
April 23, 2010 at 1:47 pm
So what you are saying mcnorman is that a bunch of filthy rich people get to gamble on whether or not they think other americans live or die, and then their gambling should be the basis for regulating how much people pay for health care. Uh…no thx. I’ll pass.
April 23, 2010 at 2:10 pm
Who are you calling filthy rich? I am certainly not that. You don’t have to have a group plan Nom. Heck you could do an HSA and be very happy because you will probably never use it barring an accident.
April 23, 2010 at 2:31 pm
the insurers are the filthy rich gamblers
April 23, 2010 at 5:49 pm
I am an insurer. I am not an insurance company, but I am an insurer as well. And you think I am filthy rich (I don’t believe that you do.) because I gamble on insuring someone who probably will have problems with cancer in the future? Come on, that makes no sense. I take a huge risk covering employees. I don’t know if their kids are going to be knifed during a drug deal and the coverage has to take care of them. What I am trying to tell you is that I gamble as well. What if one of my employees decides to get married and that girl has a high risk pregnancy? Come on. If we take her on, she becomes part of the pool and we ALL get to pay for her high risk pregnancy. Any self insured trust fund can feign ignorance, but they choose their plans every year. I can tell you that few if anyone ever asks exactly how something will work. All they want to know is whether they can save money. Well guess what, saving money means cutting back on services. NOTHING is free in this world. We are all insurers Nom. We all pay for Medicaid and Medicare. We don’t get to use it until we meet the age criteria or are disabled. We are not alone when we function as part of the pool. We decided long ago that cosmetic surgery was never to be covered. We also said that when someone had cancer, there would be coverage for reconstruction. We do make decisions. It is unfortunate that as you age, chances of getting ill are greater. You have the option of finding a plan for you alone. The government wants to take that option away. I don’t think that is right.
April 23, 2010 at 6:41 pm
the cheapest individual rate plan I could find was still almost $300/month: that’s still twice what my friend, spouse, & 2 kids had to pay for all of them to be covered.
that’s just not right. and nothing you say can ever make me believe it’s right I should have to pay what 8 people pay.
I don’t think it’s at all ethical to gamble on people living and dying; I don’t think it’s at all ethical to charge one person one thing and another 8 times that when the 2 people are statistically similar, let alone when the first person is in better health. there is absolutely no way that is ethical.
April 23, 2010 at 2:11 pm
For the record, HSA are good for very healthy people. You accumulate for any untimely event. Your points drop as long as you stay healthy. I know a lot of physicians who use these plans. It really pays to stay healthy.