The
Los Angeles Times is reporting this morning brazen abuses, dare I say possible criminal activity, by
Blue Cross of California
I think after you read this, when you stop shaking with rage, you will understand perfectly well why we must demand single payer healthcare in the United States of America.
There is a deadly inherent conflict between for-profit insurance companies, and the health needs of the American people.
Our system is broken beyond repair.
Read it and weep.
A California Blue Cross employee testified in secret last year that the state's largest health-plan company routinely canceled policies of sick members after looking for inconsistencies -- not fraud -- in their applications.
Experts say, however, that state law allows only deliberate omissions or misstatements as grounds for canceling health coverage.
There is no longer any doubt. If you had the misfortune to be a Blue Cross of California client, if you received a particular medical diagnosis, if you then filed a claim, you triggered an internal Blue Cross investigation. It's all here.
The testimony, given in a lawsuit against Blue Cross, also indicated that those reviews were triggered by claims for treatment of certain illnesses.
If we're privileged to have insurance (remember in America, health care and health insurance is a privilege not a basic human right) we hope . . .expect that if we get sick, our insurance company will honor its obligation. Right? Wrong.
The suit is one of many filed recently by a Claremont lawyer representing policyholders who say the company seized on inadvertent errors and omissions in applications to justify dumping them after receiving claims, leaving them with big medical bills and no health coverage.
Blue Cross is being investigated. Catherine Seipp is fortunate indeed that Blue Cross only raised her deductible. They might have cancelled her for having the bad luck to get cancer!
Two state regulatory agencies also are investigating the allegations, which involve individual policies, not those issued through employers or other groups.
Blue Cross parent WellPoint Inc. of Indianapolis, the nation's largest health benefits company, denies any wrongdoing.
Of course, Blue Cross was able to persude a sympathetic judge to seal much of the most damning testimony. Some of it however made its way into the clear light of day.
The company persuaded a Los Angeles County judge to seal several documents, including the depositions, arguing that they included proprietary information about the way it conducts business.
Portions of the employees' testimony, however, are included in the public court file. Along with other documents, they offer a glimpse into the work of a four-person unit that, employees testified, reviews as many as 1,500 policies a week and cancels those whose holders misstated or omitted facts found in medical records -- inadvertently or otherwise.
The testimony revealed certain illnesses triggered an investigation.
A second employee, Sheila Millan, testified that the reviews were triggered by claims made for treatment for certain illnesses, such as hypertension, diabetes and cardiovascular disease.
"When a claim comes in and there is a certain diagnosis, that would pretty much [consign] them to be reviewed for a possible preexisting condition," Millan testified. "There is a list."
Women and their unique health problems were also under intense Blue Cross scrutiny.
The complete list of diagnoses was sealed and the company declined to make a copy available. But according to portions included in the public file, the list includes diseases of the jaw, disorders of the breast, endometriosis and disorders of the female genital tract.
It should come as no surprise that Blue Cross wants to keep as much under seal as possible.
I'm not a lawyer but, one has to wonder if the actions of this company amount to criminal activity.
A legal expert said the practices portrayed in the testimony were troubling.
"That just strikes me as so unfair and inequitable," said Bryan Liang, a physician and lawyer who teaches at UC San Diego's medical school and California Western School of Law in San Diego.
"If I were the attorney general, I'd want to look closely into this to find out what they are doing," he said.
Once a policy is issued, Liang said, insurers by law "have to show actually willful acts of omission on the part of the applicant" to cancel coverage.
Systemic and widespread.
Plaintiffs' attorney Shernoff has filed policyholder suits for years. But he said he had no proof that the cancellations were anything more than isolated problems until the employees deposed last summer described how the reviews worked and revealed that the company kept monthly reports of its cancellation activity.
"That's when it became clear that this was systematic and widespread," Shernoff said.
My simple suggestion. We must ask our congressional representatives to reveal whether the Rolls Royce insurance benefits they give themselves include a retroactive review department. We must ask, if any of them are investigated and terminated for filing a claim?
We must also ask our congressional representative whether they would subscribe to Blue Cross of California and suffer the indignities of their fellow citizens.
We must demand the same health care that our elected officals bestow on themselves.
We're not greedy-- we just want what they have.
[Update] Here's a link to LA Times:http://www.latimes.com/business/la-fi-bluecross26apr26,1,2168554.story