Shortly after being diagnosed with an aggressive form of breast cancer, Robin Beaton received a phone call from Blue Cross Blue Shield telling her that her health care coverage was being terminated.
The call came just before she was scheduled to undergo surgery.
The 59-year-old retired nurse said she was stripped of her coverage after her insurance company scoured her medical history for an excuse to do so. They managed to find a reason, claiming she had misinformed them of her medical history.
Beaton had written her weight incorrectly and she failed to tell them of a medication she began taking after she first applied for coverage. “I didn’t know what to do,” she said, adding that “Blue Cross Blue Shield have control over life and over death.”
“I live in fear every day of my insurance company,” Beaton said.
Beaton was one of three who testified before the House Energy and Commerce Committee at a June 16 hearing on the issue of health insurance companies terminating individual health policies.
The hearing took place following a congressional investigation on the issue that has lasted nearly a year.
After searching through every possible option, Beaton was only able to get her insurance reinstated after her congressman, Joe Barton, got involved in the case. Since her surgery came much later than it should have, her cancer spread further and all the lymph nodes in her arm had to be removed.
Another witness, Wittney Horton, is leading a class-action lawsuit against Blue Cross. Her health care coverage was rescinded after it was found she failed to mention a medication her doctor said was for weight loss.
Peggy Raditz, the third witness, said her brother’s coverage was rescinded just before he was scheduled to undergo surgery for a stem cell transplant, which was needed to save his life.
Fortis Health Insurance ended his coverage because a doctor once stated that a CT scan showed a small aneurysm and gallstones in Raditz. The doctor, however, never informed him.
As an attorney, Raditz contacted her attorney general’s office who then contacted her brother’s former doctor. After the doctor testified that he never alerted her brother of his health issue, he was able to get his coverage back and have his surgery.
Raditz said that in denying a dying patient coverage, "What the Fortis Insurance Company did was unethical.”
<headline>A Last Resort<headline>
Insurance companies claim that rescission is to root out fraud. When asked what their impressions of the practice were, all three women answered that it was solely about money.
Insurance companies saved more than $300 million over the past five years through rescissions according to testimony.
After the three women gave their statements, representatives from insurance companies were asked to come forward.
One of the biggest concerns for Horton is that her rescission means that she is unable to get insurance by herself from anywhere. Don Hamm, president and CEO of Assurant Health admitted that his company does not issue insurance under these circumstances.
The other two, Richard Collins, CEO of Golden Rule Insurance Company, and Brian Sassi, President and CEO of Consumer Business for WellPoint claimed that they were unaware of their companies’ policies.
Hamm added that his company does not review rescissions by other companies for mistakes before denying coverage.
Insurance company representatives stipulated that although rescission is a last resort, it is important in order to provide affordable health care for everyone.
“Rescission is rare. It affects less than one-half of one percent of people we cover,” Hamm said. “Yet, it is one of many protections supporting the affordability and viability of individual health insurance in the United States under our current system.”
According to insurance companies, it is often the case that the individual patient fails to report a condition undisclosed by the physician.
This information often leads to an investigation and a rescission of the coverage when problems arise. To ensure these individual’s rights, two out of the three companies said that their companies have independent review panels.
Many patients are still unsatisfied with this process though, as delays in coverage could cost them their lives.
|
|
|
