Rescissions, Rescissions

[Welcome Kaiser Network readers!]

Out on the left coast it seems the attorney's favorite sport is challenging policy rescission's.

So far the major players in this game (from the carrier side) are Kaiser, HealthNet, Wellpoint (Blue Cross) and United Healthcare.

Aetna has not been a player.

But in a pro-active move, the Hartford based carrier is taking a stance on rescission's.

According to the Hartford Courant, Aetna will now let members appeal rescission decisions to an independent panel of doctors either before or after contesting them via its own internal-review process.

I applaud this effort.

Anything that can stave off a nasty legal fight is good for all parties.

the company says it’s revoked only 165 of the 570,000 individual-insurance policies it’s issued since 2005. Most of those policy cancellations involved fraud,

That is a very small number. Apparently they are doing something right.

But there is this bit of information that I find most curious.

Consumer Watchdog also argues that the legal standard for rescissions needs to be tightened to cases where policyholders intentionally misrepresented application information, not simply made inadvertent mistakes.)

Sounds great, but how does one prove it was an inadvertent mistake?

In a case involving HeatlhNet that was reported here, it seems the applicant "inadvertently forgot" their true weight and failed to disclose she had serious heart damage as a result of taking Phen-Fen.

In the case of Phen-Fen, she had filed a claim, and collected a judgment from the drug manufacturer based on medical records substantiating her heart damage.

Fraud or inadvertent mistake?

Either way the carrier lost.

Read More

Rescissions, Rescissions

[Welcome Kaiser Network readers!]

Out on the left coast it seems the attorney's favorite sport is challenging policy rescission's.

So far the major players in this game (from the carrier side) are Kaiser, HealthNet, Wellpoint (Blue Cross) and United Healthcare.

Aetna has not been a player.

But in a pro-active move, the Hartford based carrier is taking a stance on rescission's.

According to the Hartford Courant, Aetna will now let members appeal rescission decisions to an independent panel of doctors either before or after contesting them via its own internal-review process.

I applaud this effort.

Anything that can stave off a nasty legal fight is good for all parties.

the company says it’s revoked only 165 of the 570,000 individual-insurance policies it’s issued since 2005. Most of those policy cancellations involved fraud,

That is a very small number. Apparently they are doing something right.

But there is this bit of information that I find most curious.

Consumer Watchdog also argues that the legal standard for rescissions needs to be tightened to cases where policyholders intentionally misrepresented application information, not simply made inadvertent mistakes.)

Sounds great, but how does one prove it was an inadvertent mistake?

In a case involving HeatlhNet that was reported here, it seems the applicant "inadvertently forgot" their true weight and failed to disclose she had serious heart damage as a result of taking Phen-Fen.

In the case of Phen-Fen, she had filed a claim, and collected a judgment from the drug manufacturer based on medical records substantiating her heart damage.

Fraud or inadvertent mistake?

Either way the carrier lost.

Read More

This is Another Fine Mess

Laurel & Hardy were silent screen, then later "talkie's" comedy stars in the early to middle 20th century.

Stan Laurel played the dim-witted sidekick to Oliver Hardy's bumbling "brains" of the duo. In true comedic fashion it seemed that Stan's crazy idea's usually worked out but not without following a circuitous route with seeming disastrous effects.

Before our hero's found the solution, but while in the middle of a mess, Oliver would turn to Stan and pronounce "This is another fine mess you have gotten us in to."

Seems this AIG mess has their own version of Laurel & Hardy.

Don Weiner is a political and labor consultant who weighs in on the AIG takeover. Among his suggestions are the following.

He states that AIG has health care policies and presumes they have "turned down tens of thousands of people because of their pre-existing conditions."

Hate to burst your bubble Donny, but AIG isn't really in the health care business. They do offer medical reinsurance for large employer plans as well as some specialty, indemnity plans to individuals. But in the group market they cannot reject someone due to a pre-ex condition.

Their indemnity plans offer limited benefits and have almost no underwriting standards.

But let's humor him for sake of discussion.

Now that we are each stakeholders in AIG, we should insist it review those rejections and insure some number of people in each state who are without insurance. Better yet, why not force AIG to open up a month-long window in which people who have been turned down by other health insurers can re-apply to its agents?

Noble idea I suppose but how does the federal government, who has no stake in regulating insurance carriers, single out a carrier for punishment and presume to tell them to change their business model? Why not force WaMu and Wachovia to offer no interest loans to anyone who applies, regardless of their credit history?

Makes about as much sense.

Second, now that AIG is akin to a quasi-federal agency, the unions should demand collective bargaining rights, as they do with other government entities.

The company employs 117,000 individuals, most of them unorganized. There are thousands of clerical workers, for example, at AIG's main offices who have seen the company shares in their 401(k)'s shrink by 95 percent.

Great.

Kick them while they are down and force them to increase their costs by taking on union employees.

That's like offering a drowning man a drink of water.

You really can't make up this stuff.

Read More

This is Another Fine Mess

Laurel & Hardy were silent screen, then later "talkie's" comedy stars in the early to middle 20th century.

Stan Laurel played the dim-witted sidekick to Oliver Hardy's bumbling "brains" of the duo. In true comedic fashion it seemed that Stan's crazy idea's usually worked out but not without following a circuitous route with seeming disastrous effects.

Before our hero's found the solution, but while in the middle of a mess, Oliver would turn to Stan and pronounce "This is another fine mess you have gotten us in to."

Seems this AIG mess has their own version of Laurel & Hardy.

Don Weiner is a political and labor consultant who weighs in on the AIG takeover. Among his suggestions are the following.

He states that AIG has health care policies and presumes they have "turned down tens of thousands of people because of their pre-existing conditions."

Hate to burst your bubble Donny, but AIG isn't really in the health care business. They do offer medical reinsurance for large employer plans as well as some specialty, indemnity plans to individuals. But in the group market they cannot reject someone due to a pre-ex condition.

Their indemnity plans offer limited benefits and have almost no underwriting standards.

But let's humor him for sake of discussion.

Now that we are each stakeholders in AIG, we should insist it review those rejections and insure some number of people in each state who are without insurance. Better yet, why not force AIG to open up a month-long window in which people who have been turned down by other health insurers can re-apply to its agents?

Noble idea I suppose but how does the federal government, who has no stake in regulating insurance carriers, single out a carrier for punishment and presume to tell them to change their business model? Why not force WaMu and Wachovia to offer no interest loans to anyone who applies, regardless of their credit history?

Makes about as much sense.

Second, now that AIG is akin to a quasi-federal agency, the unions should demand collective bargaining rights, as they do with other government entities.

The company employs 117,000 individuals, most of them unorganized. There are thousands of clerical workers, for example, at AIG's main offices who have seen the company shares in their 401(k)'s shrink by 95 percent.

Great.

Kick them while they are down and force them to increase their costs by taking on union employees.

That's like offering a drowning man a drink of water.

You really can't make up this stuff.

Read More

I am Going to Wreck My Car This Month . . .

and the month after that, and the month after that.

I don't have auto insurance. Will you insure my car?

How silly is that?

Yet for some illogical reason, people think they can pull this with health insurance carriers and get away with it.

Yara Pereira has chronic allergic rhinitis but she has never had health insurance and spends about a third of her income on medical bills.

allergic rhinitis, or hay fever, could require two or three visits to a doctor each year plus a supply of over-the-counter antihistamine medication, which can cost about $1,000 yearly, according to a report from the American College of Allergy, Asthma and Immunology.

Pereira's situation is different as she is utilizing immunotherapy, a long term and more expensive regimen that does not always work.

Free clinics can be an excellent resource for people without health insurance to seek treatment and advice for their allergies. According to data from the U.S. Census Bureau, 45.7 million Americans went uninsured in 2007. But free clinics can be underutilized.

Free clinics can be underutilized.

So even when free care is available not everyone avails themselves of these resources.

Most states apply underwriting standards when applying for coverage. An applicant can be denied coverage if their medical condition(s) are too costly or they can have those conditions excluded from the plan.

But Pereira lives in New York, a guaranteed issue state. If she were to apply for individual coverage, she could not be denied no matter how expensive her treatment would be.

Or she could look for a job that provided health care benefits.

So why is she the topic of this ABC news report?

Read More

I am Going to Wreck My Car This Month . . .

and the month after that, and the month after that.

I don't have auto insurance. Will you insure my car?

How silly is that?

Yet for some illogical reason, people think they can pull this with health insurance carriers and get away with it.

Yara Pereira has chronic allergic rhinitis but she has never had health insurance and spends about a third of her income on medical bills.

allergic rhinitis, or hay fever, could require two or three visits to a doctor each year plus a supply of over-the-counter antihistamine medication, which can cost about $1,000 yearly, according to a report from the American College of Allergy, Asthma and Immunology.

Pereira's situation is different as she is utilizing immunotherapy, a long term and more expensive regimen that does not always work.

Free clinics can be an excellent resource for people without health insurance to seek treatment and advice for their allergies. According to data from the U.S. Census Bureau, 45.7 million Americans went uninsured in 2007. But free clinics can be underutilized.

Free clinics can be underutilized.

So even when free care is available not everyone avails themselves of these resources.

Most states apply underwriting standards when applying for coverage. An applicant can be denied coverage if their medical condition(s) are too costly or they can have those conditions excluded from the plan.

But Pereira lives in New York, a guaranteed issue state. If she were to apply for individual coverage, she could not be denied no matter how expensive her treatment would be.

Or she could look for a job that provided health care benefits.

So why is she the topic of this ABC news report?

Read More