FYI - The full article has just been posted by Medscape. Several other
cases of women newly diagnosed
w/ BrCa being dropped by insurers were detailed in the rest of the article.
Older working women would be differentially affected because sporadic
BrCa usually occurs post-menopausal
but has few predictable risk factors. So, these women have been
generally healthy,
in the workforce and paying for commercial insurance, and still too
young to get Medicare.
It isn't just WellPoint - the entire industry operates like this.
Note that the fines these companies face, even when they are caught &
ordered by courts to pay,
are just a couple of percentage points off the hundreds of millions of
dollars they grab in profits
by getting "rid of policyholders with expensive diseases" - women
diagnosed with breast cancer, people with HIV.
And, as icing on the cake, they turn the intent of the federal Health
Insurance Portability and Accountability Act (HIPAA)
on its head to protect themselves, at the expense of the people who
desperately need medical services.
There's still a lot of work to do patching shortcomings like this in
the medical care coverage reform
enacted by Congress - at least until Americans have something
resembling single payer/universal access.
-- Alice Furumoto-Dawson
From Reuters Health Information
WellPoint Routinely Targets Breast Cancer Patients
By Murray Waas
LOS ANGELES (Reuters) Apr 22 - 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 came 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......
......Why would WellPoint on the one hand 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?
Karen L. Pollitz, a research professor at the Health Policy Institute
at Georgetown University, offers one possible explanation: "It is
important for these companies' profit margins that they get rid of
policyholders with expensive diseases," she said. "If one company were
to stop, it would no longer be competitive with the others. They argue
they have to do this to stay in the game."
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.
During the yearlong debate over health care reform, as the White House
and Democrats in Congress savaged insurance industry practices,
WellPoint took as much heat as any company. Among other things, it was
slammed for trying to raise premiums by as much as 39% for some
customers. One in nine of all Americans are policyholders with
WellPoint or one of its subsidiaries.
Braly, who was named CEO of the Indianapolis-based company in February
2007, appeared before a U.S. congressional hearing two months ago and
defended the rate hikes as reflecting higher medical costs.
Losing her policy had serious consequences for Beaton, the retired
Texas nurse. 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.
Beaton's insurance problems stemmed from a visit to the
dermatologist's office just before her breast cancer diagnosis. A word
written on her chart was mistakenly determined to be precancerous, she
said in testimony last year before the congressional committee. In
fact, she was being treated for acne.
Even after her dermatologist told the insurer he indeed had only
treated her for acne, her lack of insurance meant Beaton could not
schedule her surgery.
Her doctors had told her that even the slightest delay might endanger
her life, so Beaton was frantic. She contacted anyone who might be
able to help her. As a nurse, she knew which charities and hospitals
to plead her case. Still, she got nowhere until her congressman,
Republican Representative Joe Barton, successfully took up her cause.
Five months elapsed between the time her surgery was originally
scheduled and the time WellPoint agreed to pay for it. During that
delay, the cancerous mass in her breast had more than tripled. She had
to undergo a radical double mastectomy and her likelihood of survival
is a fraction of what it would have been had she been allowed to have
the surgery earlier.
"Blue Cross and Blue Shield will do anything to get out of paying for
cancer," Beaton said at the hearing.
After her surgery, Beaton joined a cancer support group. Four of the
women in her group, she says, had their insurance canceled as a result
of a cancer diagnosis. Two of the four subsequently had to declare
bankruptcy because of staggering medical bills.
Earlier, in November 2006, WellPoint dropped the policy of another
Texas woman -- shortly after she too was diagnosed with a cancerous
lump in her breast, according to congressional investigators who have
reviewed internal company records.
WellPoint told the Energy and Commerce Committee the cancellation of
the woman's policy was justified because she had not told them that
she had osteoporosis and bone density loss -- even though neither has
anything to do with breast cancer and an insurance agent rather than
the woman herself may have been responsible for those minor omissions.
Investigators for the committee stumbled upon the woman's case during
their inquiry into rescission. But in the records that WellPoint
produced, the woman's name and contact information was blacked out.
When the committee asked WellPoint for more information about her, the
company refused to provide it, citing federal privacy laws for their
policyholders.
Committee investigators said they then suggested WellPoint could
itself inform the woman that a congressional committee had interest in
her case. If the woman wished to talk to the committee, they
suggested, she could contact it on her own.
WellPoint declined to do that as well, according to the committee records.
Stephen J. Northrop, WellPoint's vice president for federal affairs,
wrote to Energy and Commerce Committee Chairman Henry A. Waxman, a
California Democrat, explaining why the company could not comply:
"You asked that WellPoint send a letter to certain policyholders whose
de-identified files WellPoint produced to the Committee earlier this
year. The letter you would have proposed would explain that there is
an ongoing Committee inquiry and would invite the policyholders to
call a Congressional staff member who works for the committee.
However, as WellPoint's outside counsel advised your staff by
telephone yesterday, we are prohibited by the federal Health Insurance
Portability and Accountability Act (HIPAA) from using our
policyholders' protected health information for this
purpose.".........
.....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."
To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1
|