SC Supreme Court rules for HIV patient dropped by insurance

[dbackjon]

Insurer targeted HIV patients to drop coverage
Murray Waas
WASHINGTON
Wed Mar 17, 2010 1:40pm EDTWASHINGTON (Reuters) - In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance


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.

http://www.reuters.com/article/idUSTRE62G2DO20100317" onclick="window.open(this.href);return false;

[dbackjon]

CEO DEFENDED RESCISSION

On June 16, 2009, the House Energy and Commerce Committee, held a hearing on the practice of rescission by health insurance companies, and among the industry executives who testified was Don Hamm, the CEO and President of Assurant Health.

Hamm insisted before the committee that rescission was a necessary tool for Assurant and other health insurance companies to hold the cost of premiums down for other policyholders. Hamm asserted that rescission was "one of many protections supporting the affordability and viability of individual health insurance in the United States under our present system."

He also suggested that those who had their policies rescinded by Assurant had attempted to intentionally mislead his company: "Unfortunately, there are times when we discover that an applicant did not provide complete or accurate medical information when we underwrote the risk," Hamm said.

But state regulators, federal and congressional investigators, and consumer advocates say that in only a tiny percentage of cases of people who have had their health insurance canceled was there a legitimate reason.

A 2007 investigation by a California state regulatory agency, the California Department of Managed Health Care, bore this out. The DMHC randomly selected 90 instances in which Anthem Blue Cross of California, one of WellPoint's largest subsidiaries, canceled the insurance of policy holders after diagnoses with costly or life-threatening illnesses to determine how many were legally justified.

[danefan]

Stories like this add to my questioning of whether health insurance companies should be for-profit enterprises.

[dbackjon]

Stories like this add to my questioning of whether health insurance companies should be for-profit enterprises.

Yup.

Article states that Assurant profited $150 million a year from recissions

[Ibanez]

F'n companies! I'm glad they got it handed. There is nothing left to say.

[Col Hogan]

On its face, a good ruling by the SC Supreme Court...

This is one of the few areas where I agree with the Obama/Democrat legislation...

But, df, if you made them non-profits, the companies would still look for ways to reduce costs...the only way to stop that is subsidize them with tax dollars...and that would be wrong, IMHO...

[danefan]

On its face, a good ruling by the SC Supreme Court...

This is one of the few areas where I agree with the Obama/Democrat legislation...

But, df, if you made them non-profits, the companies would still look for ways to reduce costs...the only way to stop that is subsidize them with tax dollars...and that would be wrong, IMHO...

I'm thinking purely in the sense of a true non-profit, whereby no private individuals stand to benefit from any profit, but instead the policy holders themselves are the beneficiaries of any reserves that generate profits from investment. This could be "paid back" to policy holders by way of a reduced premium formula for years of "committment" to the pool or something similar.

Maybe its too idealistic, but I just think a cost pooling arrangement is a better fit than an enterprise whose entire intention is to collect as many premiums as possible and pay as little out as possible.

Perhaps in my idealistic example, the government would be there to merely guarantee the coverage if for some reason the underwriting stats don't pan out and more claims are paid than premiums collected. Even then, the government could get that money a small portion of each insurance group's premiums that want to be gauranteed.

Almost more like a co-op. The details are of course fuzzy, because I haven't thought it all the way through yet.

[SuperHornet]

CBS's "The Good Wife" last night was about recission. An insurance company wanted to deny coverage for an experimental in-utero surgery but was facing a class-action lawsuit from recission victims. In the middle of the emergency trial held at the hospital (ironically held up several times by the company's attorney's newborn), it looked like the company was going to lose until they used sneaky surveillance techniques to get them becuase the husband was seen smoking ONCE. So instetead of forbidding the surgery, they dumped the covered husband. As the prosecuting attorney said, it was all delaying tactics so that it would be too late. Finally, the prosecuting attorney found evidence of an illegal (in that state) group at the insurance company that searched for ways to screw people in this fashion. Word was leaked to the state insurance commissioner (it was technically inadmissible due to the manner of finding it), and the procedure was allowed in exchange for an oath of silence on the illegal operatives at the company.

Why does it seem like companies that claim to help are actually out to screw the public?

[Appaholic]

Why does it seem like companies/ politicians/ governmental agencies that claim to help are actually out to screw the public?

fify

[Col Hogan]

On its face, a good ruling by the SC Supreme Court...

This is one of the few areas where I agree with the Obama/Democrat legislation...

But, df, if you made them non-profits, the companies would still look for ways to reduce costs...the only way to stop that is subsidize them with tax dollars...and that would be wrong, IMHO...

I'm thinking purely in the sense of a true non-profit, whereby no private individuals stand to benefit from any profit, but instead the policy holders themselves are the beneficiaries of any reserves that generate profits from investment. This could be "paid back" to policy holders by way of a reduced premium formula for years of "committment" to the pool or something similar.

Maybe its too idealistic, but I just think a cost pooling arrangement is a better fit than an enterprise whose entire intention is to collect as many premiums as possible and pay as little out as possible.

Perhaps in my idealistic example, the government would be there to merely guarantee the coverage if for some reason the underwriting stats don't pan out and more claims are paid than premiums collected. Even then, the government could get that money a small portion of each insurance group's premiums that want to be gauranteed.

Almost more like a co-op. The details are of course fuzzy, because I haven't thought it all the way through yet.

Sounds a little like USAA Insurance...if you have it, every year you get a check back...sometimes small, and sometimes big, from what is called the Subscriber Savings Account...it's the excess "profit" over and above operating costs and prudent reserves that the company took in...there's a formula that I don't completely understand...but the key is, it's a customer owned company...The CEO makes good money...but works for the customers...

That's the good news...

The bad news is...USAA will drop you quick AFTER paying a big claim...

As long as you pay on time, their rates are low...service is good...the CUSTOMER owns the company...and they pay their claims quickly...but if you file too much...you're out....I have my horror story with USAA, as do lots of folks...

[OL FU]

Friggin' hick state.

Oh wait

[ASUG8]

Friggin' hick state.

Oh wait

I was going to say it sounds oddly progressive for SC.....

[danefan]

I'm thinking purely in the sense of a true non-profit, whereby no private individuals stand to benefit from any profit, but instead the policy holders themselves are the beneficiaries of any reserves that generate profits from investment. This could be "paid back" to policy holders by way of a reduced premium formula for years of "committment" to the pool or something similar.

Maybe its too idealistic, but I just think a cost pooling arrangement is a better fit than an enterprise whose entire intention is to collect as many premiums as possible and pay as little out as possible.

Perhaps in my idealistic example, the government would be there to merely guarantee the coverage if for some reason the underwriting stats don't pan out and more claims are paid than premiums collected. Even then, the government could get that money a small portion of each insurance group's premiums that want to be gauranteed.

Almost more like a co-op. The details are of course fuzzy, because I haven't thought it all the way through yet.

Sounds a little like USAA Insurance...if you have it, every year you get a check back...sometimes small, and sometimes big, from what is called the Subscriber Savings Account...it's the excess "profit" over and above operating costs and prudent reserves that the company took in...there's a formula that I don't completely understand...but the key is, it's a customer owned company...The CEO makes good money...but works for the customers...

That's the good news...

The bad news is...USAA will drop you quick AFTER paying a big claim...

As long as you pay on time, their rates are low...service is good...the CUSTOMER owns the company...and they pay their claims quickly...but if you file too much...you're out....I have my horror story with USAA, as do lots of folks...

That's exactly the sort of thing I was thinking about. And that's an issue I didn't think about. What happens when one person has exhorbant (althought justified) claims? That would have a direct effect on the bottom line the other policy holders and thus there would be pressure to drop that one person. Perhaps there needs to be some sort of contractual guarantee of a coverage period (x number of years) built in?

Then again, if you file too many claims with any insurance company they'll eventually drop you or raise your premium so high as to price you out of the plan anyway.

[OL FU]

Friggin' hick state.

Oh wait

I was going to say it sounds oddly progressive for SC.....

Mark Sanford is no longer allowed to give his opinion

[ngineer]

CBS's "The Good Wife" last night was about recission. An insurance company wanted to deny coverage for an experimental in-utero surgery but was facing a class-action lawsuit from recission victims. In the middle of the emergency trial held at the hospital (ironically held up several times by the company's attorney's newborn), it looked like the company was going to lose until they used sneaky surveillance techniques to get them becuase the husband was seen smoking ONCE. So instetead of forbidding the surgery, they dumped the covered husband. As the prosecuting attorney said, it was all delaying tactics so that it would be too late. Finally, the prosecuting attorney found evidence of an illegal (in that state) group at the insurance company that searched for ways to screw people in this fashion. Word was leaked to the state insurance commissioner (it was technically inadmissible due to the manner of finding it), and the procedure was allowed in exchange for an oath of silence on the illegal operatives at the company.

Why does it seem like companies that claim to help are actually out to screw the public?

Because they are all about one thing..profit. Regardless of their "mission statement". As long as decisions are made based upon profits and more profits it will never change. That is our system for good or for ill. Our local hospital (2 miles away) is for profit. We drive 25 minutes to another that is non-profit because the care is so much better.