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Health Insurance Companies Fight to Keep Rescission Alive

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Imagine that you have been diagnosed with a life-threatening illness, one that will require lengthy and expensive medical treatment. The concerns and worries you might have are obvious and likely endless: Will I fully recover? Will I be able to continue working? Will I be able to support my family?

The one question no one in this situation should have to ask is, Will my health insurance company suddenly decide that I am not entitled to coverage, and leave me without the resources to seek the medical treatment I desperately need?

Unfortunately, due to a practice known as “rescission,” tens of thousands of Americans have been faced with that very situation at the time when they were most vulnerable. The practice – denying coverage for certain medical conditions or entirely cancelling a policy after an insured has been diagnosed with a particular medical condition – has been well documented by law enforcement agencies, state regulators and a congressional committee. Many times, the basis for the denial or the cancellation is flimsy at best, and erroneous at worst.

A recent Reuters article described the tragic circumstances that occur when an insurance company places profits above the interests of the consumers it has promised to insure. The article describes the plight of three women – successful, active adults – who were diagnosed with breast cancer. Although the three women were from different from one another in many ways – they lived in different states and worked in different professions – in addition to sharing this frightening and life-changing diagnosis, they also shared another unfortunate trait: each of them had purchased health insurance from WellPoint, one of the largest insurers in the United States.

As the article describes, shortly after receiving the diagnosis of breast cancer, each of the women profiled received notification from WellPoint that her health insurance coverage had been canceled. The ramifications of the cancellation were swift and devastating. One of the women was required to delay undergoing a much-needed double mastectomy, drastically reducing her chances for survival. Another woman was financially devastated by the cost of obtaining the treatment she needed for a staph infection caused by her stay in the hospital.

Recently, federal investigators determined that WellPoint was specifically targeting women with breast cancer for aggressive investigation with intent to cancel their coverage. A computer algorithm used by the company identified women with that diagnosis, and immediately triggered a fraud investigation intended to uncover some pretext for dropping their policies. The federal investigation revealed that, at the time when these successful, responsible women needed their health insurance coverage the most, WellPoint was expending considerable effort to find a reason to abandon them.

The most frightening thing about the women profiled in the article is that they are not alone. Other insurance companies – the article mentions Anthem Blue Cross in particular – are known to have wrongfully rescinded the coverage of their insureds. Some individual insurers, including WellPoint, note that they have made internal efforts at preventing wrongful rescissions and denials of coverage. During the recent debate over the health care reform bill, however, WellPoint lobbyists actively campaigned against the creation of a Federal Office of Health Insurance Oversight that would have monitored and regulated insurance practices like rescission. They also sought to quash proposed provisions that would have required third-party review of decisions to cancel customers’ policies. Neither the new Office nor the proposed provisions made it into the final version of the health care reform law.

Issues like this one remind us of the important role played by attorneys who represent the rights of injured people. It is easy to imagine how someone faced with a tragic, life-altering situation like the ones described in the article might feel: scared and alone in a fight against a large corporation. Already overwhelmed by a profoundly terrifying medical diagnosis, a person who has fallen victim to the bad faith practices of her health insurer might feel like she doesn’t have the energy or the wherewithal to seek justice. What she needs is someone who is willing to help her fight for the coverage she deserves: the coverage she paid for and has every right to expect.

Attorneys at Spangenberg Shibley & Liber are working to protect the rights of individuals who were denied coverage or were subject to higher premiums because of a health insurance company’s misconduct. If you or a loved one were denied health insurance coverage, were subject to higher premiums, or had health insurance coverage cancelled, contact us for a consultation.

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    I can’t imagine having to face a diagnosis like cancer and having an insurance company tell me, “by the way, you’re not actually covered under that policy you’ve had for years.” The idea that the people who do have insurance are much less safe than they realize is frightening.