The Cheerful Oncologist

“You’re a Liar! Do You Hear Me? A Liar!”

Posted by Craig Hildreth on November 12, 2007
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From ABC News comes this story of a woman who had her health insurance policy cancelled after being diagnosed with cancer and starting on chemotherapy.

[She] is a self-employed hairdresser who was in the middle of cancer treatment when Health Net, one of California’s biggest health care companies, canceled her coverage.

[She] told ABC News, “I have two chemotherapy sessions, then we find out the surgeon hasn’t been paid. The anaesthesiologist hasn’t been paid, and the cancer doctor has not been paid.”

The patient sued her insurance provider, and in the discovery phase it was revealed that the insurance company paid $20,000 in bonuses to its “senior cancellation specialist,” whose job is to remove customers from their coverage plans in order to save money.

Court documents show that over six years Health Net canceled 1,600 policies, avoiding at least $35.5 million in medical expenses. In 2002, the goal was set at 180 cancellations and was exceeded by its cancellation specialist, who dropped 275 policies that year.

Hmm…let me try to digest that last statement. The boss wants at least 180 customers dumped from coverage, but actually gets 275 lives off the rolls. Gee, I wonder how many of these folks were healthy, happy, no-medical-bills-here-boss campers. Can you say “none”?

In case you’re also wondering how an insurance company gets away with not paying the medical bills of its customers, here is their answer:

Health Net says the information on [her] application was either inaccurate or incomplete, and its policy is to eliminate customers who don’t tell the truth.

I have seen this many times in my career, where someone buys a new health insurance policy, usually individual coverage, then gets sick and the company accuses the patient of lying on their application. What came first – the illness or the application filing? In my experience no matter what medical support I muster for a patient’s claim of innocence, if the insurance company says they’ve been misled, then that’s that. The game is over, and the patient lost.

One of the morals of the story here: tell the truth when you fill out an application for health insurance. If you’ve had a mass in your neck for three months prior to enrolling, the company will likely find this out.

The other moral, though, is this: if you develop an illness that, according to your doctors, was not present prior to joining your insurance plan, you have a legitimate right to fight back. Hey, you might even uncover a curious philosophy of “selection” that, although championed as an efficient way to save money, does remind us of a time when selections (to use meiosis) were an even more unpleasant reality of “health care.”

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Comments

  1. #1 RoseColoredGlasses
    November 12, 2007

    Health insurance is not an insurance business, it’s a racket.

    The only real insurance is life insurance. Pay your premiums on a $1 million policy, die, and your heirs expect to collect a cool $1 million. They can count on it, in a lump sum, and reasonably soon, not years later.

    All other kinds of insurance are all rackets: the company either doesn’t pay at all, or it pays a piddling amount very late, daring you to take on a years-long expensive court battle for the rest of the money they owe you, a battle they are almost sure to win.

    And they buy judges. They got out of over $1 billion in Katrina claims by getting a judge to free them of liability because paying those claims would make their business unprofitable.

    The fix is ready to go, all it takes is finding a judge who isn’t wholly corrupted. If the company doesn’t pay up in full, prosecute them for fraud, and put the people in prison.

    Insurance is supposed to be a business, yet no insurance company insures itself against catastrophic loss — like Katrina or the California fires — because they know their own carrier would never be so stupid as to pay the claim.

    The fix I think isn’t possible. I don’t know of any judge who isn’t a professional criminal.

  2. #2 forHealth
    November 12, 2007

    If the insurance companies don’t do their homework during underwriting, it should be their own fault. They have every opportunity to research a potential client. Once they accept someone as a customer, then they have to assume some risk too. That is the very nature of insurance. One person bets they will get sick, the other they won’t.

    What is more fraudulent, a company that doesn’t live up to their promises or a potential customer who fills out an application to the best of their knowledge?

  3. #3 AnnR
    November 13, 2007

    Without getting all political I’d like to say that I’d like to see reform in the market for people buying non-group insurance.

  4. #4 Kevin R.C. 'Hognose' O'Brien
    November 22, 2007

    HealthNet provides management for the military’s TriCare program, and they do a lousy job. They customarily stiff the troops (and, perhaps more to the point on a doc’s blog, their medical providers) also.

    For example, three members of my unit were injured in 2004 during annual training. We were taken to an ER in Anniston, Alabama (the military hospital at former Ft. McClellan was long ago closed), and treated there and referred for other treatment — in my case, for surgery.

    Then after we returned to our New England and New York homes, HealthNet started playing games with the “line of duty” paperwork. First they made me get a string of local docs to validate my need for surgery. Then they approved a visit to a surgeon. Twice I went in for surgery, and twice, on the morning of the operation when I was already on the schedule, they withdrew previous confirmations. They demanded a surgical plan from the surgeon. He asked them what they wanted. They wouldn’t reply to him. This went back and forth. They never did approve the surgery, and they never paid the surgeon a dime despite making him put as many as 100 hours into doing their repeatitive paperwork.

    To this day they haven’t paid the Alabama hospital or ER doctor. I finally wrote a stack of checks to get my surgery done this year, after suffering for three years. The other soldiers did similar things. Our state’s National Guard does have one part-time manager who fights with HealthNet to try to get these bills paid, but they won’t do it. Again, he has problems even with the simple matter of getting a call returned.

    The providers have kicked the bills over to collection agencies, causing most of us to pay them.

    This year, I got a notice that I can now buy health insurance through the Guard in place of the $7,500 a year an individual policy costs me in Massachusetts. For a mere $81 a month. Wow, what a good deal — till I saw it was delivered by Tricare and therefore, HealthNet. The reason you pay insurance premiums is in the expectation that your claims will be paid and experience tells me that HealthNet will not do so.

    Yes, HealthNet does systematically cheat their insureds, and systematically cheats their providers as well. In our case, since we’re captives of the dreadful TriCare group program and they have full access to our medical records, they don’t even have the “liar” dodge.