Employees at Health Insurance Companies Praised for Dropping Expensive Patients

News reports abound about shady insurance company practices. One woman was refused treatment for cancer because her doc had made a reference to a small aneurysm on her chart. He NEVER said anything to her about it so she did not document it on her insurance application. So based on that she was refused CANCER treatment and dropped. She had actually paid her premiums for several years but when it came time to cover her for cancer they found that excuse to drop her. Oh, it goes on plenty.

How sad...how those employees could live with themselves is beyond me. The guilt would eat me alive.

I think it makes sense that if your job is to look for reasons to cancel a policy, then those activities would be a part of your performance evaluation. Its common sense here folks! No point for them to deny it.

As for whether its ethical or if it was something I could do, definitely not. I could not do that job and sleep at night. The current system kind of sucks that way...

And then these same insurance companies are behind the push against health reform. The next time you see a "scare" ad against health reform, check out the sponsor. Oh, it might not say it's some conglomeration of insurance companies but behind the populist names, there lurk the insurance companies.

I was denied insurance coverage because of a pre-existing condition: I had damage from childbirth: prolapse, cystocele, rectocele and I was denied coverage because I "might" need surgery to get them repaired. It's been over seven years now and, while I could get them repaired and might want to sometime in the future, I haven't needed "immediate" surgery.

I was also denied coverage of a procedure (breast reduction) because, while I met all the criteria: back, neck, shoulder pain, bra straps digging into my shoulders, and rash, the insurance company felt that it was purely for cosmetic reasons and denied payment. I paid for it out of pocket.

Now, what about people who have REAL pre-existing conditions? Like cancer? I've heard of cancer treatment being denied because, even though it wasn't detected before the person got insurance coverage, because of the stage of the cancer when it was discovered, the insurance company figured it was----yup---a pre-existing condition.

Now the insurance companies are the ones whining about "socialized medicine". Had they a SHRED of integrity and cared about people instead of profits, we would not have much of this mess we're dealing with now!

I have Blue Cross insurance. I don't even like to think about the percentage of my income that goes into feeding the greed of that company. I want to be covered "just in case" and for wellness care of course, but I don't even feel secure that I would be totally covered if I really needed help. I often wonder if it's worth it. It's the rotten 'rock-and-a-hard-place' position we are in with health care these days. I would like to see a better option someday...

Perhaps they were just pro-business, pro-shareholder, free-market, conservatives.

Two sides to every story and since a left wing rag like the LA times is in the pocket of left wing causes. Like the NY times both of these newspapers will outright lie and make up stories to promote their agenda.

I was a health insurance agent for over ten years. This is a common practice for insurance companies selling individual health insurance policies. This is nothing specific to the insurance company in this article. However, some health insurance companies rescind much more than others. I had clients' whose policies were rescinded.

With individual health insurance, you don't know what kind of coverage you really have until you get really sick. In some circles, this practice is called "reactive underwriting." It means the the insurance company is quick to issue you a health insurance policy with only cursory underwriting and take your money, and they only check your medical history in depth when/if medical bills start coming in. Then they yank your coverage away when they investigate your medical records and find anything you didn't report on the exhaustive application for coverage. I read a case recently where a woman's policy was rescinded because she forgot to report she had been treated for acne years prior and she had developed breast cancer shortly after taking out her new health insurance.

It's all a chess game with profits and lives at stake. In the long run, it's profitable for insurance companies because they get to collect many, many people's premiums knowing if big bills come in, they can hunt through medical records to get out of paying. However, each policy has an incontestability clause (typically two years) and companies cannot rescind policies after this time very easily. This is why individual health insurance companies tend to raise your premiums sky high before the incontestability clause is up, at two years, so you'll apply for a new plan and start the two-year incontestability period all over again.

See what I mean? Chess game with profits and lives.

In one sense, from a purely business standpoint, I cannot blame health insurance companies for declining a person with a pre-existing condition. (And this includes me, since I cannot obtain individual health insurance due to pre-existing conditions.) Since I worked in the field, I understand it. Honestly, the companies would go out of business if people had the choice of going without coverage and then applying for coverage when they need something paid for. Problem is, this current non-system doesn't allow for people to transition to and from different plans as life changes occur (very well, that is).

When I came off my last COBRA coverage, my only option for guaranteed coverage under existing laws with an individual policy was to pay a premium of $2400 per month. I kid you not. My pre-existing conditions? At that time, asthma requiring daily medications and a history of a couple surgeries that could, hypothetically, require revision.

For health insurance companies selling individual policies, it is akin to someone totaling their car and then calling up State Farm/Farmers, etc, and saying, "Can you cover me? Can you pay to fix this wrecked car?" Insurance and actuarial risk doesn't work that way. You take out the insurance before you wreck the car, before there are expenses or calamities. But this doesn't allow for life changes and changes in coverage. And people aren't cars.

People may not be cars, but the current (non) system sets them up to be treated similarly, regarding underwriting and actuarial practices.

Group health insurance through employers works differently because except for short periods like 6 month waiting periods for pre-existing conditions, group policies are not underwriting individuals for coverage. Instead, employer group health insurance is not really traditional insurance, it's a middle-man managing paying expenses for the emloyees' health care.