Individual Health Policy Cancellations: systematic, routine and unjustified

Every single one.

Blue Cross in California has been routinely cancelling the coverage of women who (horrors!) become pregnant, or people who (heaven forfend!) get sick and need medical care.

Kudos to NCEve and others who have been diarying steadily and conscientiously about the health care scadal that is our current insurance system.  The yo-yo (You're on your own) policies of our government, not limited to republican or democratic leaders, alas, is that if you get sick you are screwed.

More below the appendectomy...

Blue Cross in CA (which is apparently a devision of Wellpoint), has just gotten a hefty fine for routinely cancelling coverage, per an AP story today.  Not surprising is that the fine is a drop in the bucket for them, or that they are appealing the fine, since they probably recognize a huge pending liability.

What was really shocking to me, is that in a random sampling, there was not one single case where the denial of coverage was found to be justified.

The investigation found that Blue Cross used computer programs and a dedicated department to cancel the policies of pregnant women and the chronically ill regardless of whether they lied on their applications about pre-existing medical conditions - a standard required by state law.

Regulators examined 90 randomly selected policy cancellations, out of about 1,000 a year in California, and found violations in each one. Blue Cross already is appealing a $200,000 fine the department imposed in September for rescinding one person's policy, the first in an individual rescission case.

 AP, 2007, emphasis added.

Absolutely f--king incredible.  Not only are they fine-tooth combing policies of anyone who files a claim looking for a basis for dropping your coverage:  Did you "lie" (meaning not mention on your policy application) about athlete's foot?  or a toothache? or a reactive depression 10 years ago sucessfully treated and never recurring?; and not only are they routinely denying almost every claim submitted at least once, and driving you and your physician's office crazy, but they are routinely dropping coverage for pregnant or sick people for no reason other apparently that they are filing claims at all.  And they have a department dedicated to this activity--it's probably called the F--ck the Consumer Profit Center.  Why is this not considered a criminal conspiracy and seriously prosecuted?  Just a f--king coincidance that of 90 randomly selected policy cancellations not a single bloody one was justifiable?  Bullhockey.  

There should be something a lot more serious than a fine happening here.  The cold-blooded illegitimate sons of snakes who have conspired to drop coverage and deny care they were getting paid to provide should spend some time in a federal pen--maybe that would convince them that a contract to cover care is a contract that has teeth on both sides.  Sellers of snake oil individual insurance policies, which elected "leaders" like Romney and Bush want to make the standard for coverage in the US, should be dragged kicking and screaming out into the light like the abortions of compassion, good sense and business ethics that they are.  It is time for the American people to say enough.

•  Astonishing

  Both that Blue Cross would do this systematically, and that California would bother to check.  

  This is the issue that is simmering everywhere and should be front and center in every single election.  One question to the candidates: are you going to support single payer healthcare?  

  by Fungible Chattel on Fri Mar 23, 2007 at 09:48:24 AM PDT

  •  Your'e absolutely correct

    It should be front and center, but isn't.

    I was so incredibly po.'d by the systematic cancellation policy--why isn't this seriously illegal?

    by barbwires on Fri Mar 23, 2007 at 10:35:29 AM PDT

  •  Single payer....

    It amazes me that we have become so conditioned that the high cost of healthcare is somehow our fault.  That the answer is that we simply have to pay more for insurance where we work or simply seek less comprehensive coverage. We've been told the fault is of the uninsured, for they have no coverage and so we end up payin for them, the bastirds!  Added to that we're now told by Bush that the fault lies with those darn gold plated plans, where those folks have all you can eat health care, the bastirds!

    But where is the discussion for comprehensive coverage for all through comprehensive change in our health care insurance delivery?  Not health care delivery, but insurance delivery.  It's smothered by this damn Iraq war!

    My now congressman Sestak shared with me that he firmly believed and intended that health care be a centerpiece of his campaign, but the oxygyn is all taken up by,(and understandbly so )the Iraq war fiasco.

    The country is in social disrepair. We need single payer de-coupled from employment. We need retiree security, we need enforceable labor laws. I pray that by '08 that these and more will be on Americans minds as the Iraq war winds down. If not, we can count on the fear mongering, all time stopped on 9/11 crowd to again drown out the issues leaving the corporatist in charge for four more years.

    by JDPITALIA on Fri Mar 23, 2007 at 11:44:28 AM PDT

•  I hope this diary gets rescued.

  "Death by spreadsheet"--YIKES!

  by Dar Nirron on Fri Mar 23, 2007 at 11:30:01 AM PDT

•  Excellent rant.

  This is no surprise to me. I cancelled my Blue Cross (PA) coverage 5 years ago because I suspected they had no intention of paying up. The main reason I believe that the pursuit of this policy is so totally rampant and unrepentant and they dont even attempt to hide it is because they know they will only have to pay puny slap-on-the-wrist 'fines' (more like paying dues for the privilege of being allowed to get away with murder-by-spreadsheet). This is the result of Republican destruction of the rule of law, and the fascism that now characterizes our government.

  Here's a link to the article.

  by Halcyon on Fri Mar 23, 2007 at 11:40:39 AM PDT

  •  Thanks

    I really started seeing red over this.  

    by barbwires on Fri Mar 23, 2007 at 01:43:22 PM PDT

•  Better punishment

  The cold-blooded illegitimate sons of snakes who have conspired to drop coverage and deny care they were getting paid to provide should spend some time in a federal pen--maybe that would convince them that a contract to cover care is a contract that has teeth on both sides.

  I've got a better idea: put them out of business with a single-payer system.

  by sdgeek on Fri Mar 23, 2007 at 11:58:31 AM PDT

•  Insurance: The biggest scam in history

  It's the only industry where you can take someone's hard earned cash every month, and then actually refuse to provide a service when you're needed.

  by WayneNight on Fri Mar 23, 2007 at 08:50:35 PM PDT

•  Yes, single payer in CA -- and someday the nation

  As mentioned above, the answer to this nightmare is single payer. As  respected Princeton economist Paul Krugman said recently, "Damn the corporate insurers, full speed ahead!" Let that speed take you to this link on California's single payer bill SB 840 which is now cooking in the CA legislature, the same bill passed overwhelmingly by both houses in Sacramento last year that got all the way to the desk of our dumb-as-a-bag-of-hammers governor Schwartzenegger who, being  bought-and-paid-for by the insurance lobby (including Blue Cross and its owner Wellpoint) with slushes of campaign bucks and lots of cigars, vetoed the single payer bill. One stroke of one pen -- think of it!

  Schwartzenegger had his reasons as soon thereafter he came forth with a cockamamie Rube Goldberg plan to offer "universal" insurance to all Californians by forcing everybody in the state to universally buy insurance policies with crappy benefits from fraudulent carriers like Blue Cross with few consumer protections. Now there's a deal for ya!

  Arnold's "universal healthcare" plan has been given credit for "trying" but it doesn't try at all except on behalf of insurance corporations. He not only stole the term "universal" that used to describe single payer (actually Mitt Romney in MA stole it first for the plan Arnold is trying to copy) but, if passed, his boondoggle will be a monumental financial windfall for corporate health insurers. Those cigars went a long way . . .

  If you're not familiar with SP -- or you want to learn more -- here's a link taking you to the grassroots lobbying website for SB 840 where you can learn about single payer and how to get on board the campaign -- whether you live in California or not. Here's a second link that takes you to a series of clearly written short essays by single payer sponsor in CA legislature, Sen. Sheila Kuehl in which she explains every angle of how single payer works and compares it to other plans being offered in CA and around the country.

  There's also a diary series every week or so by California Nurses Shum (here's a sample) -- subscribe to it for the best updates on single payer and discussion of competing plans in CA and elsewhere.

  As California goes, so goes the nation . . .  Let's show 'em how it's done.
  _____________________________________________
  "I mail myself the Constitution every day hoping
  Bush will open it and see what it says." -- Bill Maher

  by wardlow on Fri Mar 23, 2007 at 10:01:42 PM PDT

  •  It's a good idea...

    Not just generally, but in response to the dropping of coverage and cancelling policies because ultimately, the state and the health care providers will be required to pick up the slack. These entities should be FOR single payer for this reason. And the pending legislation in California will - I hope - provide a model for national legislation on this issue.

    by JohnMac on Sat Mar 24, 2007 at 08:20:56 AM PDT

•  When I was in the hospital

  My room-mate's sister said several of her co-workers were notified their insurance had been  cancelled, right in the middle of chemotherapy. So when she had a slight stroke, she didn't tell them. She wanted to be covered for as long as possible.

  by Margot on Fri Mar 23, 2007 at 10:08:31 PM PDT

  •  Its getting to be a real problem

    When peole suspect they have a serious medical problem, but won't tell anyone, for fear their insurance will be canceled, or the next time they have to try to buy a policy they will be deinied.

    It certainly crossed my mind when I heard Bush's big push for electronic medical records is that that was not intended to benefit the patient, but to benefit the insurance companies so they could deny more claims or justify higher premiums.

    by barbwires on Fri Mar 23, 2007 at 10:23:06 PM PDT

    •  Electronic Medical Records Will Improve Quality

      Electronic Medical Records maybe the only thing Bush has right but of course it is all talk with no money to make it happen.  EMRs are a good thing.  All you have to do is look at the Veterans Administration to see their positive impact.  

      Prior to instituting EMRs, the VA was known for being highly bureaucratic and giving mediocre care at best. EMRs have automated many processes to streamline bureaucracy and improve the patient experience.  They have improved quality by allowing better care coordination, reducing duplicate tests and reducing medical errors.  EMRs have played a major role in the VA become a model health organization it is today.

      I understand the privacy concerns but EMRs will be controlled by doctors and other providers not insurers.  Additionally, the paper world is not nearly as secure as people think.

      by mets2005 on Fri Mar 23, 2007 at 10:54:05 PM PDT

      •  Ah

        Yes, but people in the VA are covered. So there's no concern about that.
        I agree that otherwise, electronic medical records help w/ accuracy, reduce med errors, you don't have to decipher the doctor's writing, etc.

        by Margot on Sat Mar 24, 2007 at 12:03:39 AM PDT

      •  Solve privacy first

        I understand the privacy concerns but EMRs will be controlled by doctors and other providers not insurers.

        What the hell does that mean?  Can I tell my doctor not to enter the results of a test or his diagnosis into my EMR until I decide whether it will have an adverse affect my ability to be insured or employed?

        It seems to me that the way things are going people would be well advised to first get medical diagnosis under false names and then decide whether to get a second opinion under their real name.

        If you don't solve the privacy and insurance problems first EMR will become something that people will attempt to circumvent in ways that with be harmful to the whole system.

        by Fred in Vermont on Sat Mar 24, 2007 at 05:29:01 AM PDT

        •  HIPPA

          There are already strict privacy rules on the book through the HIPPA laws.  A doctor cannot share your medical records with anyone without your consent.  It is the form you sign when you first come to the doctor's office and most people sign it without thinking.  However, it can be revoked at any time you choose.

          It always amazes me how skitish people are about electronic transactions in the medical field but they think nothing of it in the banking field, another area where sensitive information is transmitted.  As banking has shown, there are ways to make these transactions and information very safe.  Nothing is foolproof, not even paper transaction, but electronic security is pretty good these days.

          by mets2005 on Sat Mar 24, 2007 at 10:02:34 AM PDT

•  Article Link?

  You say this is an AP article. Could you link to it? Thanks!

  by catfish on Fri Mar 23, 2007 at 10:30:43 PM PDT

  •  I read it here

    ABC News.

    by Rippen Kitten on Fri Mar 23, 2007 at 10:58:29 PM PDT

•  Near Term Solution

  Since single payer is not likely to happen quickly, one solution is to have guaranteed issue, which means no one can be turned away, and community rating, which means no individual underwriting, in the individual market.  NY and NJ both have this in their individual market and while it is not perfect at least no one can be dropped from their policy except for non-payment and no one can be turned down for coverage.  Both states also have mandated benefits packages in the individual market.

  by mets2005 on Fri Mar 23, 2007 at 10:58:01 PM PDT

•  Hefty fine?

  Blue Cross in CA (which is apparently a devision of Wellpoint), has just gotten a hefty fine for routinely cancelling coverage, per an AP story today.

  I hope your snark was on when you said that...

  That's not hefty- that's pocket change. It's pocket change to any major corporation. I'm not the only one who thinks so, either, according to this article from thedesertsun.com:

  Consumer advocates praised the state for its report but questioned whether the fine was substantial enough to affect WellPoint, which earned $3.09 billion in net profit last year on revenues of $56.95 billion.

  (Note that Blue Cross of California and WellPoint have merged- they are essentially the same company.)

  by EsnRedshirt on Fri Mar 23, 2007 at 11:15:52 PM PDT

  •  I should also mention...

    ... Blue Cross considers itself a non-profit organization. I kid you not.

    by EsnRedshirt on Fri Mar 23, 2007 at 11:20:17 PM PDT

    •  Not Correct

      Blue Cross plans are both for profit and not for profit depending on which states they operate in.  Blue Cross of California, which became Wellpoint, has been a for profit entity for over a decade.  On the other hand, Blue Cross and Blue Shield of Oregon is a not for profit plan.

      by mets2005 on Sat Mar 24, 2007 at 10:06:12 AM PDT

•  Bush Pushed for Electronic Medical Databases

  I was afraid this would happen. A few years ago, President Bush began pushing for electronic medical databases that ultimately will contain information about every doctor visit, eye exam and dental cleaning. Bush claimed it would improve health care for Americans. But, I was skeptical.  With doctors these days taking orders from insurance companies, it seemed more likely the insurance industry hoped to use the databases to screen out pre-existing conditions. The average person will not have the same depth of medical information in their files, and so can easily be accused of "lying" when they simply don't have all of the evidence in their possession; and, even if they did, often would not know how it might be interpreted.

  by Deep Harm on Sat Mar 24, 2007 at 05:45:22 AM PDT

•  John Grisham

  This reminds me of that John Grisham book...I think it was "The Rainmaker."  The bad guy in the story was the insurance company that systematically denied coverage to a certain number of customers every year.  A small number.  Apparently the bad guy in Grisham's book was a real piker compared to BCBS.  

  I haven't had health insurance for years.  I can't imagine a scenario where I would be able to get health insurance.  I'm not even 40 (yet).  I can't imagine what my kids are going to do, or my grandkids.  

  But then again, who cares about them?  They're not rich and they're not republicans, so they're apparently expendable.  At least as far as the Bushies and BigCorps are concerned.  Sigh.

  by Peacemongermom on Sat Mar 24, 2007 at 06:28:52 AM PDT

  •  what's even worse

    is that in this case people aren't being denied coverage up front.  their coverage is getting cancelled when they get sick.

    by barbwires on Sat Mar 24, 2007 at 12:33:50 PM PDT

•  the CA legislature must pass

  a bill that would stop this. If you are in a group plan, the carrier cannot cancel you or refuse coverage due to pre-existing conditions. But if you buy your own plan, no such protection exists.

  The very least the CA legislature should do is to change this law.....

  I believe the Governor said he would veto single payer here, but he might sign this type of legislation.

  more on this here: http://www.latimes.com/...

  by kimoconnor on Sat Mar 24, 2007 at 12:59:37 PM PDT

•  They did it to me too

  Actually, they just denied me coverage - because of a genetic condition that is well managed and having no bearing on my overall health.

  As far as I can see, the health insurance companies are skimming the cream off the market and leaving the rest of us to twist in the wind.  

  Screw 'em.  Put them out of business with a national plan.  Do not support national plans that work through the existing insurance companies.  Shut them down and outlaw their racket.

  by Angry Blue Man on Sat Mar 24, 2007 at 10:26:08 PM PDT

•  Barbwires

  Hello, and thank you for this diary, as much as one can welcome bad news.

  I was rereading your eloquent and touching comment on my diary about my mother of a year ago, and have now subscribed.  And I apologize for just dropping out of sight on DKos after such caring responses as I got on that diary.  Scantily pertinent to the topic here, my mother went through healthcare hell (I found out they were drugging her behind my back), then not long afterwards she died.  Follow that with six weeks of homelessness, and (pertinent to your diary here) finally moving to Mexico to be able to deal with my own healthcare... nine moves as of this weekend in under two years (this one seems permanent).  If I seem unpredictable as water, that may be why.  Anyway thank you again for the understanding.

  Yes, our response to the healthcare nightmare falsely known as a system, we had to leave the country.  No kidding.  No other way to go.  I am just so sorry that my Mom didn't survive to come with us.  I brought her and Dad's ashes, and we will eventually have a service here - the wretched cousins I mentioned in the diary insisted on having a "funeral" for Mom when I could not be present. End here this testimony to the evil of health care in the US...

  by stonemason on Wed Mar 28, 2007 at 08:09:36 AM PDT