I don't want to live in U$A part eleventy billion

[lapsedmodernist]

http://www.cbsnews.com/stories/2008/02/22/health/main3867618.shtml

A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer has been awarded more than $9 million in a case against one of California's largest health insurers.

Patsy Bates, 52, a hairdresser from Gardena, had been left with more than $129,000 in unpaid medical bills when Health Net Inc. canceled her policy in 2004.

Arbitration judge Sam Cianchetti ordered Health Net to repay that amount while providing $8.4 million in punitive damages and $750,000 for emotional distress.

"It's hard to imagine a situation more trying than the one Bates has had to endure," Cianchetti wrote in his findings. "The rug was pulled out from underneath, and that occurred at a time when she is diagnosed with breast cancer, one of the leading causes of death for women."

"I had cancer, my life was on the line, and these guys did not care, did not care at all," Bates told the CBS Evening News last November.

In fact, she was in the hospital getting prepped for surgery when she first learned Health Net was dropping her.

Some of the documents Health Net was forced to hand over revealed that senior analyst, Barbara Fowler, single-handedly dropped hundreds of policy holders like Bates from the rolls every year.

The shocker: the company awarded her bonuses based on how many policy holders she dropped.

The company called 2003 - the year Fowler dropped Patsy Bates - "a banner year" for her, for saving the company $6 million in what they call "unnecessary health care expenses."

Comments

[lapsedmodernist.livejournal.com]

do you mean the one who was featured in "Sicko"? if so, then no, her name was Linda Peeno.

[mcfnord.livejournal.com]

the incident occured in america, but so did the judgement.
my state tracks complaints about insurers, and this is the best way i've found to avoid the worst of them.

[lapsedmodernist.livejournal.com]

I feel like it's perverted to applaud a "humane" judgment when it is completely obscene that this happens in the first place, and the government gives to these companies with one hand while occasionally slapping them on the wrist with the other. My long-term plan for avoiding them is moving somewhere where the health care system is not run for profit.

where can you get information about insurers? Is it a website? I would love to see it, and see if there is something analogous in various states.

[birds-hum.livejournal.com]

I agree with your anger, but I do have this response in addition: What was the reason Health Net claimed to have canceled her policy? I don't know if that can be public information, but I would be curious to know - normally companies have to prove a reasonable cause... I think... ?

[theophile.livejournal.com]

why ask that question? I suppose it's useful if you want to understand the operations of the company from a procedural standpoint, but ultimately: they cancel coverage to a client with high medical bills at a time when acute medical care is unambiguously indicated, and they do so as part of an observed pattern of cost-cutting by dropping expensive clients. why would it matter one jot or tittle what reason the company provided?

that being said, the company dropped her "contending she had lied about her weight and a heart problem on her application." source.

[birds-hum.livejournal.com]

Thanks for the source.

I ask the question because it is relevant to legal matters. Besides lapsed's post, I didn't know anything else about this case, so I think that is relevant information to have.

Don't get me wrong - the company seems like a bad guy to me. But I am interested in the facts, not just the feelings the story evokes in me.

[nightspore.livejournal.com]

Iirc part of this scam is that they keep taking premiums once they find an inaccuracy, so that only if a person starts needing health care do they call them on it. So if she'd been fine, she'd still be paying, and many people who are paying are liable to being dropped if they get sick. So what are they paying for?

[birds-hum.livejournal.com]

bonuses, it sounds like...

[theophile.livejournal.com]

and, of course, that such cases the fault for the inaccuracies can be traced to people working on the provider side of the equation (in this case, the broker). the ideal configuration of the industry, from the insurance companies' standpoint, would be a plan that enrolled everyone in the world, but for which no one was technically eligible. money would keep rolling in, and the company would just drop each subscriber the first moment they would otherwise have to pay out on a claim. just think of the billions an enterprising young capitalist could make. excuse me, I mean, "think of the billions they have made."

more U.S. healthcare fun

[neverdreamofme.livejournal.com]

I read recently that WalMart is going to start opening walk-in medical clinics in its stores... Creepy.