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