Skip to main content

So does the House/Senate bill actually protect us from rescission?


‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).

The House Health Care Bill and Senate Amendment from

Apparently not. Keep reading...

As insurers use 'fraud' as their excuse to rescind policies already, and as this bill places the burden on individual states to investigate rescinded policies (with their understaffed and underfunded resources), how does this change anything at all?

California already finds it impossible to investigate and resolve illegal rescission cases, let alone enforce fines against the largest insurers. (That's right: Anthem Blue Cross is too big to be sued!)

The truth is that no one, regardless of the level of 'fraud' they've perpetrated, should be denied health CARE, because that is the point of all of this insanity, right? Health CARE, rather than simply health insurance coverage. If you have cancer and you failed to disclose that you had been treated for cancer ten years ago, does that mean you no longer need treatment? Does it magically cure you? No. Since we are a moral, upstanding nation (we are, right?), then we should not let anyone be denied care regardless of what they did or did not disclose on their insurance application.

But of course we are not a nation driven by morals, but rather by greed. To have a for-profit health insurance industry is already immoral, but to also encourage that industry to be unjust and cruel is, frankly, outrageously heartless. As it is, with no anti-trust regulations, we have in our future less and less options and more and more large, too-big-to-be-sued corporations in charge of the administrative end of our health care. Where does that leave us? In a Banana Rescission Republic, where the rights of the corporations trump the rights of the people. Rescission banana, anyone?

Originally posted to nolakai on Sun Dec 20, 2009 at 04:13 PM PST.

Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags


More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

    •  They ALWAYS say its fraud (2+ / 0-)
      Recommended by:
      nolakai, ranger995

      or as I have read, and they also win 98% of the arbitration hearings. Also, the new law only applies to new plans. Given the cost increases most would see, I don't think people are going to be able to switch plans once the new ones come online. You can't switch plans when there is a risk they would dump you.

      The grandfathering of existing plans with their huge problems is a serious loophole right there.

      Those forms are intentionally complicated and almost everybody makes mistakes on them. How could people possibly remember every doctor they had gone to for ten or twenty years, for example,

      Also, one only needs to read ERISA section 514 to see how much in bed the government and the health insurance industry are.

      If they wanted Americans to have good health care it wouldn't be hard, just do what the rest of the world does.

      Obviously they don't want that. 101,000 Americans dying each year of lack of access to healthcare - that huge amount of preventable mortality is not a bug, its a feature.

      •  Exactly. (0+ / 0-)

        Did you read the link about California? Apparently Anthem Blue Cross is too big to sue. Imagine how many more insurers will join their ranks now that the antitrust language has been removed from the bill.

  •  Oh well, you go to the hospital with the (2+ / 0-)
    Recommended by:
    nolakai, trueblueliberal

    healthcare you have, not the health care you want.

    "Sir, you look like the piss boy."

    by ranger995 on Sun Dec 20, 2009 at 04:48:01 PM PST

    •  The governator of California claims (2+ / 0-)
      Recommended by:
      nolakai, ranger995

      that the concept of rescission is implicit with any contract and that for that reason, rescission cannot be made illegal.

      Rescission attempts to make the plaintiff whole by making it as if the contract never was. The state I think tried to make it so people couldn't be made responsible for some arbitrary number of years bills retroactively but I don't know how successful they were. And of course, they lost their insurance.

      And in some instances, suddenly found themselves being kicked out of hospitals in the middle of treatments.

      Its the way this system works. They keep trying to pretend it's not that way but they can't hide the fact that its really in its last stages and this is the death grip around the neck of Americans unfortunate enough to be caught in it.

      Its like a vampire that needs to have a silver stake nailed through its heart, without that stake, and extreme attention to detail in insuring the new laws are simple and leave no wiggle room.. (like single payer, that simply says everyone and everything necessary is covered) , the lifeblood sucker WILL come back to life and kill another million or two.

  •  Sooo... (1+ / 0-)
    Recommended by:
    Angela Quattrano

    if preexisting conditions are outlawed, there can be no legitimate reasons for denying coverage... so what possible grounds for a fraud claim can there be?

    The question is not whether the chickens needed replacing, the question is whether the fox should be guarding them in the first place.

    by happymisanthropy on Sun Dec 20, 2009 at 04:57:45 PM PST

  •  A fraud claim could be made (3+ / 0-)
    Recommended by:
    nolakai, ranger995, Halcyon

    for not disclosing "pre existing conditions" even though they would not be used to deny coverage.   Here's how it can work.  A person may have several inconsequential diagnosis codes put on an exam, and they may not even know about it, or if they do, do not think anything about it, so when they apply for insurance coverage they don't list them.  So, they get insurance, and later they are diagnosed with something serious, say, leukemia.  Now the insurance company goes prospecting for "fraud", those diagnosis codes the person didn't mention.  (For example a benign skin condition).  Even if companies couldn't and  wouldn't deny coverage based on these codes, they now can claim fraud because you didn't disclose something "material."  

    The fraud claims are useful for getting rid of seriously ill people, whether they were already ill when they became insured, or they just became ill later.  In the language quoted above, I don't see how people are protected from this in the future.  People have lost their insurance in the past based on this kind of "fraud."  It looks like more of the same to me.

    •  Well that's great news... (1+ / 0-)
      Recommended by:

      not that I expected anything less from our stellar corporatist system.

      •  The overall trend is overwhelmingly towards (0+ / 0-)

        the people having to pay a larger and larger share of the costs, even if they don't have the money.

        If they can't afford to keep paying more and more, tough luck.

        The government wants to spend less on things like healthcare and have less responsibility for bad healthcare when it occurs..This is clear, they are going to do that. That was the main stakeholders main goal from the beginning. Cutting their costs.

        Thats why they didn't want the people at the table. They wouldn't like hearing the specifics. These changes will impact a lot of sick people.

        To get an idea of how much they care, look at the high risk pool for those with pre-existing conditions. The funding is under $4/year per American until the pre-existing conditions ban kicks in in 2014 and they (of course most wont be able to afford) "might be offered" a chance to buy overpriced individual insurance. How many people can afford individual insurance now but can't get it only because of it not being offered to them.. a lot but nowhere near the number who simply can't afford it at all.. Even so, there are at least several millions who would be willing to spend their last penny so theoretically could afford individual insurance now but who can't get it now. Those - the ones who CAN afford individual insurance but were turned down, are the ones who were promised help, and they were promised access to that subsidized high risk pool. A hell of a lot of people. Well, its clear that there isn't enough money to do anything for them. Its a cruel joke.

        Also, many people don't realize how risk pools work. They are not for the poor or for people who can't afford individual insurance. That means most people.

  •  What to the referenced (1+ / 0-)
    Recommended by:

    sections indicate?  

    and only as permitted under section 2702(c) or 2742(b).

    Perhaps the clauses in those sections strictly regulate what is and isn't fraud...

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White

    by zenbassoon on Sun Dec 20, 2009 at 06:09:56 PM PST

    •  The first is about Medicare and Medicaid (1+ / 0-)
      Recommended by:


      (c) Medicare Provisions- In carrying out this section, the Secretary shall apply to State plans (or waivers) under title XIX of the Social Security Act the regulations promulgated pursuant to section 1886(d)(4)(D) of such Act (42 U.S.C. 1395ww(d)(4)(D)) relating to the prohibition of payments based on the presence of a secondary diagnosis code specified by the Secretary in such regulations, as appropriate for the Medicaid program. The Secretary may exclude certain conditions identified under title XVIII of the Social Security Act for non-payment under title XIX of such Act when the Secretary finds the inclusion of such conditions to be inapplicable to beneficiaries under title XIX.

      I'm still looking for the second.

    •  Okay, I've searched (1+ / 0-)
      Recommended by:

      every version of the bill and I haven't found "2742(b)". Let's just assume it exists. But where? It must be embedded in another number, because it ain't here or here even with just "2742" searched.

    •  I've found this on Wiki (1+ / 0-)
      Recommended by:

      but it still doesn't explain what Sec. 2742 says.

      I've also found it amended here, in the House Report 110-868 - Part 1 - BREAST CANCER PATIENT PROTECTION ACT OF 2008:

      (a) Clarification regarding application of guaranteed renewability of individual health coverage

      Subsection (a) amends section 2742(a) of the Public Health Service Act to provide that, except as provided in section 2742, a health insurance issuer that provides individual health insurance coverage to an individual shall renew or continue in force, including without rescission, such coverage at the option of the individual.

      In addition, subsection (a) amends section 2742(b) to provide that if the individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage, including the intentional concealment of material facts regarding a health condition related to the condition for which coverage is being claimed, coverage may be non-renewed or not continued in force, including rescinded.

      I'm still not seeing anything other than protection for the insurers to cancel policies for 'fraud'. This business of 'no rescission' but 'yes rescission' in the last two paragraphs is impressive. It takes a serious effort at doublethink to make sense of that.

    •  Trying to find 2742 (1+ / 0-)
      Recommended by:

      in the Public Health Service Act of 1944 and its amendments led me to this. Cornell has the links, but the Library of Congress doesn't have the text online. So much for transparency!!

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site