There is a new Trend in Health Care Insurance Industry -- it's called "Retroactive Rescission" (aka Cancellation) of your Policy.
Health Net to reinstate members
By Lisa Girion - LATimes - Sep 12, 2008
One of the state's largest insurers, Health Net signed a first-of-its-kind agreement with the California Department of Insurance, agreeing to pay $3.6 million in penalties, plus as much as about $14 million in reimbursements for medical charges that the insurer had refused to pay. The company, however, did not admit to any wrongdoing.
In a continuing state crackdown on health insurers, Health Net Inc. of Woodland Hills has agreed to offer new coverage -- no questions asked -- to 926 people whose policies it canceled after they got sick.
(Emphasis Added)
This practice of Healthcare Rescission saves the Insurance behemoths so much on their bottomline, that they actually offer Adjusters Bonuses, for digging up the dirt, to cancel the Policy -- usually after you make a claim.
Healthcare Rescission
AttorneyPages.com
Article: Retroactive Cancellation/Rescission of Individual Health Plans
If the application is for individual health insurance, the insurance company has a laundry list of questions. Typically, it asks and closely scrutinizes your health history as detailed on the medical questionnaire and other information (such as occupation, avocation, etc.) in order to determine the terms of the contract between both of you. But here’s the kicker. It also has the opportunity, after the contract is issued, to re-evaluate that history, if new information is presented to it. If the new information scopes out that you failed to mention treatment or history of arteriosclerosis, epilepsy, alcohol abuse, varicose veins and so forth, and, if your insurance provider concludes it would not have issued you a policy in the first place or it would have been issued under more restrictive terms, your carrier can cancel (rescind, in insurance jargon) your plan. Formally, it will declare it void and return all your premiums paid on the policy. The result: you are on the hook for medical costs.
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WATCH OUT! This practice is referred to in the industry as "post claim underwriting". A recent egregious example of this involved an insurance company that basically offered its underwriters a bounty (they called it a "bonus") for every claim on which they could find a pre-existing health condition not mentioned on the application that would give them a basis for rescinding the policy and, thereby, avoiding payment on the claim – even when the claim medical records did not provide "probable cause" to further investigate.
(Emphasis Added)
Somehow they really don't seem like, they're "in the Business" of "Providing Care" -- seem more like "Providing Profits" in Job One -- by "Denying Care"!
(Isn't the idea of Insurance is "that it suppose to be there when you need it!?)
FrontLine had an in-depth look at this Profit-based "Health-Squelching" Industry, on PBS last nite.
Here are the relevant clips in case you missed it:
FrontLine: Sick Around America - Web Site
FrontLine: Sick Around America - Video - March 31, 2009
FrontLine: Sick Around America - Video synopsis
Outside of employer-based health care plans, matters are even worse. Americans seeking insurance in the individual market must submit to "medical underwriting," and if they have a pre-existing condition, they will likely be denied.
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For some Americans, life becomes a quest to find and keep health insurance. In 1994, Nikki White, a Bristol, Tenn., native with dreams of becoming a doctor, was diagnosed with lupus, a serious but treatable autoimmune disorder. Too ill to work, she lost her health insurance for several years, but then received coverage from the state's Medicaid program. Soon, budget cuts made her ineligible for the state program. A few months later, White was rushed to the ER with severe lupus complications and racked up nearly $1 million in medical bills. She finally secured insurance under the government HIPPA law, but her condition was too advanced, and in 2006, at the age of 32, she died. White's primary care physician, Amylyn Crawford, tells FRONTLINE: "Nikki didn't die from lupus. Nikki died secondary to the complications of a failing health care system." (Emphasis Added)
How under-65 Americans are insured:
-- 60.9% -- get health insurance through their employer
-- 11.8% -- through Medicaid/SCHIP
-- 5.5% -- buy private health coverage (self-employed; those who retire at 55 and won't be working for the next 10 years until qualifying for Medicare; those between jobs/coverage due to divorce, being widowed, laid off, etc.)
-- 17.2% -- have no insurance
-- 1.3% -- covered through Medicare (65 or older; some disabled people under age 65; or all who have end-stage renal disease)
-- 1.2% -- covered through the military
Profits vs Prevention
So those are the Battlelines for the Health "Denial" Industry -- one Insurance CEO even admitted they "had to Deny Coverage", in order to remain "competitive" (due to apparently a very "cut throat" industry ...)
Profits vs Prevention
Those seem to be 2 big Concepts, in direct Conflict with each other --
something's got to give, somewhere!
All too often, it's individuals who must bear the brunt, of all these "cost savings" measures --
What is the average Life worth anyways?
(I bet your average Insurance Corp CEO, could give you the EXACT number -- Now if only the average Person could actually afford the price.)