Insurer Dropped Sick Patients to Save Money
In the middle of her expensive, months-long chemotherapy regimen, a Los Angeles hairdresser with breast cancer learned her insurer had abruptly decided to cancel her policy. The decision ultimately left the 51-year-old hairdresser, Patsy Bates, with nearly $200,000 in debt, according to the Los Angeles Times today, but it helped win $20,000 in bonuses for the employee who made the call to cut Bates’ coverage. By dropping Bates’ policy and those of roughly 1,600 others, the employee helped the insurance company, Health Net, save more than $35 million from 2000 to 2006, the paper reports. Click Here for Full Blotter Coverage. The company’s own policies awarded cash bonuses to employees who dropped policyholders whose costly medical bills triggered the company’s review of the policyholders’ applications, even if they had serious illnesses — part of what the paper calls an "industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized." Overall, Health Net dropped roughly 1,600 policies from 2000 to 2006, the Times reports, noting that "state law forbids insurance companies from tying any compensation for claims reviewers to their claims decisions." The company said the law did not apply in this case because Fowler was an underwriter, not a claims reviewer, and the goals she was given and which she met were reasonable. It said it cancelled Bates’ policy because she had not disclosed a pre-existing heart condition in her application. Bates said any information left off the application was inadvertent. Bates, whose treatment was partially funded by charities, still cannot afford tests to find out if her cancer has returned, the paper says. She is suing the company, who turned over documents revealing their bonus policy in court proceedings. Do you have a tip for Brian Ross and the Investigative Team?
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Insurance Company = BLOODSUCKER
Posted by: FidoNY | November 9, 2007, 2:28 pm 2:28 pm
Well if the state attorney general allows this behavior from such a pirate then I guess we have no other accord to help defend ourselves from such a rippoff artist as this insurance co. Shall not be long I assume before american people will start taking laws into thier own hands because we cannot depend on oue state governments to protect us from such unsavory pirates in our society.
Posted by: D.Lincoln | November 9, 2007, 2:48 pm 2:48 pm
It’s abuses like this that make one wonder why more people don’t advocate for a nationwide, government run health insurance program. This program could be paid for with the funds companies and individuals are currently dishing out to the big insurance companies.
These heartless, money clutching insurance companies that abandon people in the middle of life saving treatment have got to go.
The problem lies in our govrnment itself and leaders who allow their votes to be influenced by the insurance lobbiests.
However, I must also fault the American consumer, who seems to have an inate fear of government run programs. They worry their taxes will go up, or that the government will dictate their health care decisions.
I guess it will take a few more people being dumped by an insurance company because they abused their health insurance by daring to get sick, to change the public’s mind.
Posted by: Susan | November 9, 2007, 3:07 pm 3:07 pm
And Republicans say that healthcare does not need any governmental oversight.
Posted by: Samantha Stickers | November 9, 2007, 4:36 pm 4:36 pm
Susan, Americans have a right to fear government run health programs. In Great Britain, the wait to see a specialist even for life threatening conditions is months – and that’s just for a consultation. What this company did is wrong and unethical, but the government needs to prosecute the bad guys, not attempt to manage dispensing health care! I for one don’t want to exchange choice and access to good care for free but limited or inaccessible services. Free health care isn’t free! And the government can’t effectively manage programs it already controls – do you want some civil servant bureaucrat dictating life and death decisions? I think that’s a different kind of evil, but just as bad as the unethical underwriter.
Posted by: VA | November 9, 2007, 4:41 pm 4:41 pm
No this is not right but to say this is a good reason to make the goverment do health insurance. Why dont we close the loop hole in the states that this happens. The reason the price of medical coverage is so high is the same reason america loses jobs and billions of dollars a year to another country. Illegal immagriants. If you take them out of the the country you would not have the hospitals closing. the hospitals would not have to write off billions of dollars a year that they cant get back since the illegals move around every couple months. Oh and the argument of they do jobs american won’t. They would if you wouldnt pay them to sit at home on they behinds. If they cant afford to live on those jobs maybe we should to put a minimum annual salary by the federal goverment and if you dont make over a certian amount the federal goverment will give you the rest. oh ya why would we do that it would give them no reason to vote for the democrats and the war on poverty which will never be over.
Posted by: Damien | November 9, 2007, 4:50 pm 4:50 pm
This is an OUTRAGE. Dropping the policies of sick people ! Lord have mercy !
Posted by: John | November 9, 2007, 7:03 pm 7:03 pm
I feel bad for anyone that has to face cancer. However, I would like to know more about this pre-existing heart condition. If she knowingly did not disclose a condition, then who is the “rip off” artist? What company wouldn’t check to see if they were they victims of fraud. I can tell you that the government does not have the best track record in this department. Is it possible to imagine fake clinics treating dead patients and collecting huge somes of money from the government for it? I can see it happening – always a “rip off artist” somewhere. A government controlled health care would be a disaster. What have they done to prove to you that they efficiently manage money. Is it our bankrupt Social Security or our trillion dollar war? I do not work for an insurance company, I believe in our court system to punish wrong doers – on either side of the fence.
Posted by: Scott | November 9, 2007, 7:06 pm 7:06 pm
We don’t elect for national care because we wouldn’t get any care you idiot! Why are democrats so stupid? Have you ever been on Medicaid? It’s the crappiest medical care in the world!
Posted by: Tina | November 9, 2007, 10:56 pm 10:56 pm
Well you can besure of one thing…If Congress try’s to fix the problem BUSH and the REPUBLICAN THUGS will VETO any action Congress takes..Take this to the bank..
Posted by: Joe Murphy | November 10, 2007, 2:10 pm 2:10 pm
Even in England where the government has national healthcare, many people pay for private health care. People come from other countries to England in order to take advantage of the free health care. Demand is going up which puts a strain on the government funds available to pay for the services. I’d think it foolish to believe that a national healthcare system would solve all the problems. It might solve some, but it would create others. Use your brain.
Posted by: Sean | November 10, 2007, 2:24 pm 2:24 pm
For those who use the ‘pre-existing condition’ to justify the acts of this insurance company, here’s a heads-up. If you have a policy for a time and a condition is discovered for the FIRST time which had taken LONGER than the policy was in effect to develop, the Insurance companies often claim it was a pre-existing condition and deny benefits. Insurance companies are in the business of making PROFITS. So are most hospitals and doctors and other health-care providers. Until the profit motive is removed, we’ll see cases like this more and more often as costs continue to climb.
Posted by: fatesrider | November 10, 2007, 6:16 pm 6:16 pm
what does the heart condition have to do with the cancer, seems like a really bad excuse to me for them to cancel the insurance. If there was a history of cancer or a prior condition related to cancer then they might have a reasonable cause for termination of the policy but it does not sound to me like there is any link to the treatment being offered. Or if she was being treated for a heart condition maybe
Posted by: Aaron | November 10, 2007, 8:29 pm 8:29 pm
This is a prime example of the consequences of selfish thinking. When one starts to think of how to get themselves ahead, such events are bound to happen.
Posted by: Samantha | November 10, 2007, 10:13 pm 10:13 pm
If you think cutting off medical care to save the company money, just wait until these companies have access to your DNA sequences. There must be federal protection from this type of business ethics and companies will certainly fight it with all the resources they have. It borders on criminal to deny coverage while a patient is undergoing chemotherapy, surgeries and the like. There should be a very wide risk pool and not the ability to hand pick policyholders. Your DNA will predict things like high blood pressure risk, diabetes, cancer, genetic diseases and a whole litany of diseases and disorders. Best thing to do is to be well-informed and in contact with representatives and senators on this extremely important issue. Your life could very well depend on it.
Posted by: curtis41 | November 11, 2007, 6:00 pm 6:00 pm
Four years ago I had surgery on my upper spine, neck area, for ruptured disks. Around three months later I received a letter from my insurance company informing me they wanted me to reimburse them for the actual surgery, but did not mention the medical care before or after. I wrote back to say basically hell no. That was the last I heard from them on the subject. They did start to pay my medical bills very slowly from then on. As soon as I was eligible for Medicare I dropped this over priced coverage. I don’t know why I should pay nearly $600 a month for insurance and then they request repayment for anything. It struck me as rather ridiculous. Maybe some feel they are obligated and pay them. Of course they made no mention of saying no, in any form, in their request letter.
Posted by: Connie | November 12, 2007, 3:12 am 3:12 am
Like I say over and over again, do away with the health care system. Minimize the prize of every thing. You know whats going to happen now… people will go to other parts of the world or other countries (for medication) to get medical help. It will cost then a fraction of what they pay here. Don’t complain then that health care system is loosing money!
Posted by: kilroy was here | November 12, 2007, 9:38 am 9:38 am
This insurer should be prosecuted; insurance companies want exorbitant fees for their services yet try anyway they can to not pay out. God have mercy on the soul of the employee who dropped this woman for a few bucks. It is disgusting how people treat each other!
Posted by: Marsha | November 12, 2007, 10:02 am 10:02 am
She acknowledged that she left out her pre-existing heart condition claiming it was an oversight. An oversight? She deliberately attempted to deceive. The tricker got tricked. How about her accountability? Kilroy said its disgusting how people treat each other. I say its disgusting how we defraud and then expect others to do right by us.
Posted by: desertrat | November 12, 2007, 12:02 pm 12:02 pm
“Grand theft” by HMOs is not reported by the U.S. media; that’s where media’s big profits come. Just take note of health insurance and drug company ads on radio and TV, in newspapers and magazines, including AARPs publications. The greatest transfer of wealth from the middle class to the wealthiest 2%–not only in the history of the U.S., but of the world–began when Reagan/Bush slashed the 15 tax brackets to the present number. The “grand for a few take” has exploded since. In 1996,the former CEO of OxfordHealthPlans,Stephen Wiggins,took as “compensation” $111,900,000.00,OneHundredElevenMillion
NineHundredThousandDollars.Then Wiggins resigned. In that same year,Oxford’s David Snow took $34.3 million;William Sullivan took $28.3 million; Robert Smoler took $24.1 million.
Posted by: Ena | November 12, 2007, 12:29 pm 12:29 pm
Failure to disclose a pre-existing heart condition, inadvertant or not, would get any of us dropped from any insurance company, once they found out. It’s considered fraud. The fact that she’s undergoing chemo allows the story to be spun in an inflamatory manner, but truth is, she would’ve gotten dropped even if healthy.
Posted by: Otis | November 12, 2007, 1:10 pm 1:10 pm
A maze of uniformed, Fox couch educated citizens running their mouth on a subject they know absolutely nothing about. Abominable, provincial ignorance.
Go live in any developed western society, use the gov’t controlled medical system there and then make the claim of the ‘superiority’ of the great rip called the American Health Care System.
Posted by: Wolf | November 12, 2007, 2:06 pm 2:06 pm
From Samatha (above) “Susan, Americans have a right to fear government run health programs. In Great Britain, the wait to see a specialist even for life threatening conditions is months – and that’s just for a consultation.”
Lies, Lies, Lies…I have relatives in Great Britain…They would not immegrate to the US specifically because of our health care system. They all go to the doctor when they want. If they call that morning, they get in that day. My neice was brought to the emergency room for stitches…drive down, procedure, get home – 1 hour 15 minutes…try that here in the states.
Posted by: Kathi | November 13, 2007, 8:36 am 8:36 am
I’m sorry, I credited the above statement to the wrong person. Samatha did not make that statement, VA did, and I apologize to Samatha.
Posted by: Kathi | November 13, 2007, 9:24 am 9:24 am
IF THEN STATEMENTS can clarify things rather well: If…Donald Rumsfeld brought private corporation health care persons into the government in order to reduce the costs of health care for our military…THEN it follows that private insurers would do this or have done this rather well and even reward their employees to do it better. So much for whistleblower protections…
Posted by: daddy | November 13, 2007, 11:28 am 11:28 am
Yup, although Great Britain and other countries have a few issues with over stretched national health care and waiting lists, I would still choose this over private insurance any day of the week. You have to understand that when people go on wait lists it’s because they don’t have something that’s critical. Everyone is prioritized and guess what, if you really want it done quickly why not pay to go private with all the health insurance money you haven’t had to pay?!
Americans have long been hoodwinked into believing that they get better care for their money.
Posted by: Oli | November 13, 2007, 12:16 pm 12:16 pm
What is Medicare if not government run healthcare? As one person said, most of the statements against government run healthcare are based on fear. The fact remains, we spend more money on killing people than helping people–and in the process, the CEO’s of healthcare insurances are taking home $40M bonuses–that’s bonuses! And look at publicly reported outcomes & shorter life expectancy–then come back and say the European system doesn’t work.
Posted by: Tim | November 15, 2007, 3:18 pm 3:18 pm
After talking to several conservatives who think national health insurance would be nothing less than evil, I finally figured out why they think this way. They are proud to be paying their monthly health insurance premium. It is a symbol of their rugged individualism, that they’ve pulled themselves up by the bootstraps and take care of and are responsible for only themselves. And they’re petrified that the taxes that would go toward national health insurance would help pay for someone who didn’t deserve it or work hard enough for it. They can’t stand the idea of any of their money going toward someone who may have less than they do or might not have worked as hard as they do, but who would get the same benefits. All having access to the same health care flies in the face of their world view that we all reside at different levels depending on our resourcefulness, and money is the equivalent of virtue. To the most deserving and virtuous goes the better health care. It is to them a priviledge, not a right.
Posted by: mlk | November 17, 2007, 2:54 am 2:54 am
Those who fear government running the medical system don’t seem to use the same argument for government run military…they don’t balk at that but when it comes to poor people getting anything that the hypocritical right-wing judgmentalists fear they should not get, then all of a sudden, potential government abuse, inefficiency and waste becomes a huge issue. I don’t see these same ‘efficiency watchdogs’ being such watchdogs over government involvement with fat cat socialism: corporate tax write offs as part of the government run IRS system, or government involvement in military defense, police,
agriculture, and a host of other programs involving government subsidy and administration of services…that doesn’t bother the conservatives…but they’re afraid of some poor person (remember: to them, ‘poor’ equates with ‘lazy’) might get some care that they didn’t ‘work hard enough for’. I don’t see the same work and efficiency standards applied to Bush and his many fat cat cronies that benefit from government subsidy, administration and oversight. Just no ‘universal medical care’ because that smacks of ‘welfare’ and we all know ‘welfare’ is for bums and lazy and unwanted ethnic minorities we don’t approve of.
Posted by: JL | November 18, 2007, 9:54 pm 9:54 pm
quality health care should be a right
not a priviledge. and i mean birth
right. for the working class the
employer must have employee health
care insurance.before he can hire
anybody and there is no deductibles
it should cover a family of four.
i think every business should pay
a health care tax into a national
pool.that would be managed by private
interprise.
and if the company outsouce fine them
and put that money into health care -
pool. and there should be a pay-
scale for health specialist. they
can’t get no more then what the scale
pay. a merit board make the decisions
no unions. and there will be a bonus
for quality work. and the pool will
be self insured.
Posted by: pete | November 21, 2007, 1:46 am 1:46 am
Why doesn’t Congress hold hearing about this topic? Is Congress so “sold-out” to the health care lobby that they are afraid they will lose their payola? Is the pay-off money that good? Where is the leadership in Congress to hold these health care insurers accountable? Where are our the heros we sent to Congress? Where can we find a member in Congress that is not on the take? I regret to say, there are none! Congress is completely sold-out to the lobbies and the American people can go to hell!
Posted by: Tony | February 24, 2008, 6:56 am 6:56 am