We NEED a Choice, OTHER than, Private “Insurers”

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Rockefeller on Health Insurance Industry Practices

Mar 27 2009


WASHINGTON, DC – Senator John (Jay) Rockefeller, Chairman of the Senate Committee on Commerce, Science, and Transportation, held a full committee hearing this week entitled, “Deceptive Health Insurance Industry Practices – Are Consumers Getting What They Paid For?


A recent investigation conducted by the Attorney General of New York concluded that for a number of years, the insurance industry has systematically under-estimated the out-of-network reimbursement rates it pays its policy holders, costing consumers billions of dollars in excessive out-of-pocket costs. The victims of this deceptive practice – more than 100 million Americans who pay for health insurance coverage that allows them to go outside of their provider network for medical care.

(Emphasis Added)

Press Release

Most people Lucky enough to have Health Insurance, have probably been Unlucky Enough, to have experienced a Denial of Claim notification letter from that Private Insurer. As you have were writing the Check to pay for, that unpaid Doctor Bill — Did you ask yourself:”

“WHY do I even have Insurance — If they’re not even going to pay the Bills?”  

Well it’s not your imagination, Private Insurance routinely look for ways to Deny Claims and even Drop Patients, once you start expecting them to “Hold up their end of the Bargain”

Health Net to reinstate members

By Lisa Girion – LATimes – Sep 12, 2008

One of the state’s largest insurers, Health Net signed a first-of-its-kind agreement with the California Department of Insurance, agreeing to pay $3.6 million in penalties, plus as much as about $14 million in reimbursements for medical charges that the insurer had refused to pay. The company, however, did not admit to any wrongdoing.

In a continuing state crackdown on health insurers, Health Net Inc. of Woodland Hills has agreed to offer new coverage — no questions asked — to 926 people whose policies it canceled after they got sick.

(Emphasis Added)

Cartoon from Physicians for a National Health Program (PNHP)

Guess what — this Practice of last minute “Policy Cancellation” (Rescission) is another cruel form of Claim Denial, AND it is often ILLEGAL! … So WHY do Private Insurers, do it? Well, it’s Profitable for them!  Why else? …(That is, IF they don’t get sued over it, of course.)

Article: Kaiser & Health Net Will Reinstate Over 1,100 Rescinded Health Insurance Policies


The Kaiser Foundation Health Plan and Health Net have settled potential litigation with California’s Department of Managed Care (DMHC) by agreeing to pay fines and reinstate over 1,100 rescinded health insurance policies over the past four years.

Details of the settlement

Under the terms of the settlement, Kaiser and Health Net would each pay a fine of $3,000 and reinstate over 1,100 health care insurance policies (1,092 from Kaiser and 85 from Health Net) that were rescinded over the past four years


The DMHC has said that other California insurers, such as PacifiCare, Blue Shield and Anthem Blue Cross have been approached to settle their outstanding issues with the Department. However, Kaiser and Health Net have been the first to settle their claims.


Illegal policy rescissions amount to bad faith insurance practices. If your insurance company has rescinded your policy or denied your valid benefits, contact an attorney whose practice focuses on bad faith insurance law.

(Emphasis Added)

Sometimes the Practice of “Claim Denial” is just annoying and expensive — Other times this “Insurance” Practice has much more serious Consequences!

(There IS a Reason why People Need Insurance afterall — stuff happens!)

Problems With Medicare Health Insurance Companies

Denied Claims And Deceptive Marketing Biggest Issues

October 7, 2007

A recent federal audit has revealed that private insurance companies have been denying legitimate claims to Medicare recipients and put into practice deceptive marketing. Since March, 11th, health insurance companies have also been fined more than $770,000 for issues involving Medicare recipients.

This revelation comes at a time when health insurance companies are under scrutiny for claim denials in their non-Medicare programs. The New York Times reviewed 91 audit reports and found a huge backlog “of claims and complaints”. The report also describes “improper termination of coverage for people with H.I.V. and AIDS.”

(Emphasis Added)

Insurance Company bureaucrats would never “stand in-between you and the your Doctor” — because they got your “Best Interests” in mind — NOT!

LOL, LOL, Guffaw, Haah!  Good one!

Firm settles suit over health premiums for AIDS patient

By Robert Moran  – Jun. 3, 2009

Texas company, Waco-based Life Partners Inc., did not respond to a request for comment yesterday.

Smith was diagnosed with AIDS and cancer in 1992, and told that her life expectancy was two years.

In 1994, Life Partners purchased the woman’s $150,000 life-insurance policy for $90,000, and signed a contract agreeing to pay her health- and life-insurance premiums for the rest of her life. Had Smith died quickly, Life Partners would have made a profit. Smith is now 53, and the company has lost money on the contract.

In 2005, after the company had twice threatened to stop paying for her health insurance, Smith sued.

(Emphasis Added)

Dang those Patients — they just keep wanting to Live!

Dang those Insurance Companies — they just would rather you just Stop expecting things from them! … (Like Payments!)

Ask too much — and they’ll Drop you, for next to “no reason at all” … (NO Compassionate Reasons — anyways!)

Healthcare Rescission

Article: Retroactive Cancellation/Rescission of Individual Health Plans


If the application is for individual health insurance, the insurance company has a laundry list of questions. Typically, it asks and closely scrutinizes your health history as detailed on the medical questionnaire and other information (such as occupation, avocation, etc.) in order to determine the terms of the contract between both of you. But here’s the kicker. It also has the opportunity, after the contract is issued, to re-evaluate that history, if new information is presented to it. If the new information scopes out that you failed to mention treatment or history of arteriosclerosis, epilepsy, alcohol abuse, varicose veins and so forth, and, if your insurance provider concludes it would not have issued you a policy in the first place or it would have been issued under more restrictive terms, your carrier can cancel (rescind, in insurance jargon) your plan. Formally, it will declare it void and return all your premiums paid on the policy. The result: you are on the hook for medical costs.

WATCH OUT! This practice is referred to in the industry as “post claim underwriting”. A recent egregious example of this involved an insurance company that basically offered its underwriters a bounty (they called it a “bonus”) for every claim on which they could find a pre-existing health condition not mentioned on the application that would give them a basis for rescinding the policy and, thereby, avoiding payment on the claim – even when the claim medical records did not provide “probable cause” to further investigate.

(Emphasis Added)

Photo Art by Stephen Hansen

Sometimes those “clinical decisions” made by Corporate pencil-pushers, DO result in some very serious Consequences!

FrontLine: Sick Around America – Video synopsis

Outside of employer-based health care plans, matters are even worse. Americans seeking insurance in the individual market must submit to “medical underwriting,” and if they have a pre-existing condition, they will likely be denied.

For some Americans, life becomes a quest to find and keep health insurance. In 1994, Nikki White, a Bristol, Tenn., native with dreams of becoming a doctor, was diagnosed with lupus, a serious but treatable autoimmune disorder. Too ill to work, she lost her health insurance for several years, but then received coverage from the state’s Medicaid program. Soon, budget cuts made her ineligible for the state program. A few months later, White was rushed to the ER with severe lupus complications and racked up nearly $1 million in medical bills. She finally secured insurance under the government HIPPA law, but her condition was too advanced, and in 2006, at the age of 32, she died. White’s primary care physician, Amylyn Crawford, tells FRONTLINE: “Nikki didn’t die from lupus. Nikki died secondary to the complications of a failing health care system.”

(Emphasis Added)

Nikki White died at 32, from “complications of a failing health care system.”

Some “clinical decisions” ought not to be encouraged, or simply shrugged off as another Statistic — Rather some Insurance Claim Decisions ought to face a their day in Court — of course, that presumes the Wronged Patient actually has the resources to bring the Law Suit. And What are the chances of that?

So in conclusion:

Americans NEED a Choice, OTHER than, Private “Insurers”

OTHER THAN the Bureaucratic Profiteers who seemingly have “No Boundaries” now, in that ever “cut-throat world” of the Private Sector:

We Need a serious and substantial “Public Option”, which will give us a “fighting chance” to actually get the Health Care our Doctors decide we need.

… A “Public Option”, which will finally give the “legacy” Insurance-Claim-Management “Business”a Serious “run for its money” …

People are literally dying, for lack of … such a Choice, now ….

Post Script: the Current Insurance System IS seriously Broken, cost-wise, too:

Protecting Patients

Holding Health Insurers Accountable


Consumer Watchdog research has found that health insurance companies keep 50% of our premium dollars for overhead and profit. As a result, we all pay more for less coverage. Health insurers also refuse to sell policies to those with minor health problems and cancel coverage when people get sick and need coverage the most.

(emphasis added)

That’s your “legacy” Health Care system at work — Not!

Maybe it really is time for a Change?


Skip to comment form

    • jamess on June 23, 2009 at 06:32

    at least we have a choice, here.

  1. I especially appreciate learning that the HICs (health insurance companies):

    …keep 50% of our premium dollars for overhead and profit. As a result, we all pay more for less coverage.

    And a great line…

    Dang those Patients — they just keep wanting to Live!


    • jamess on June 23, 2009 at 15:05


  2. who oppose serious healthCARE reform.

    My favorite is the one about how a government run program will deny you the care that your doctor recommends.

    As a person who had my expensive insurance company deny me the treatment recommended by my physician, I find this propaganda offensive. I am definitely not alone in this as I know numerous cancer patients that have been refused life saving treatments by their insurance companies. What I find particurly abhorrent is how little this propaganda is challenged either by the MSM or by the Democratic Congress members.  

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