I'm not surprised. I work at a hospital and deal with health insurance, and I've seen HealthNet weasel out of coverage for patients. It seems the more life-saving it is, the more they try to weasel out.

Looking back, that there are cancellation goals makes a whole lot of sense.

That's pretty disgusting but unfortunately not that surprising. These people are scum.

insurance companies are sick twisted groups, my mom used to work for one... she's pretty twisted as far as consumer rights go...

Hello insurance industry, I'm government regulation. I'll see you soon.

This is why medical insurance as a business is such a wonderful idea- it incentivizes finding ways to drop expensive coverage for really sick people. Not only will it be impossible for them to find another insurer (let alone one that will cover a preexisting condition) but they're too sick and broke from their expensive treatments to sue. The insurer saves money and the underwriter get a $20K bonus. Everyone wines! Except for the sick person, of course. They die.

@Nelsormensch: ''Not only will it be impossible for them to find another insurer (let alone one that will cover a preexisting condition) but they're too sick and broke from their expensive treatments to sue."

Or even better in company's eyes : they are dead from whatever they had.

Cases like this are the reason I strongly believe in universal public coverage and optional private health services on the side.

The fact that this is Hell Net doesn't surprise me. A company that I used to work for had Health Net. I filled a prescription every month, and every month it was $20. One month, I go to have my prescription filled, and the cashier rings up the bill and it's $30. What?? I know, it's only $10 more, but I thought something was odd. I called Health Net, and was bounced around for over an hour between different reps. Finally, they gave me a number to call regarding prescriptions. I called the number, and it was after business hours, so of course no one was there. Well, I kind of need this prescription to survive, so I paid the $30 and went home.
The next day I call back, during business hours, and I am told that I elected to change my plan to a tierred prescription plan. I did? Yes, they said. I was on a 10/30/50 plan. Preferred generic drugs, $10 (meanwhile the cost of that type of medication can be $10 without insurance). $30 non generic preferred, and $50 non generic, non preferred. Well, since there is no generic form of my medication (Novolog insulin), this wouldn't make much sense, would it? Besides, I NEVER CHANGED MY PRESCRIPTION PLAN!!! So after arguing with the rep that I spoke to for an hour or so, defending my claim that I didn't change my plan, I was told that they would look into it.
Fast forward a week, I get a call from Health Net. No, I didn't change my plan, and it was a "clerical error". My plan was changed back to my base co-pay of $20 across the board.
Here is where the surprise comes in. Fast forward another month, and I get a check in the mail, for $10! That I did not expect. I had written off the $10, but there it was.
Anyway, I digress. If I hadn't called to complain and threaten going to my company's HR department, as well as the AG, American's with Disabilites, etc..., I'm sure that they would have happily continued to bill me for my gold level PPO but give me a much lower plan's co-pay.
Sorry for the rant.

And to think I never expected there would ever be a name I could put on my "Wouldn't it be awesome if the people on this list would get some kind of excruciatingly painful and incurable disease requiring medical care but they can't get medical insurance anymore because their policy is canceled?" list.

The percentage of premiums paid out in claims in known as the utilization rate. The lower the utilization rate, the more profit the health insurer makes. So, the incentive is to charge the highest premium the market will bear and deliver as few services as the law (and human decency, if that applies here) allows.

If your utilization rate is still too high to keep the execs and shareholders happy there's still another way to squeeze out a little profit: delay or deny payment on valid claims. After all, the insurer doesn't make money by paying your bills; they make money by keeping your premium in their own investment vehicles for as long as possible.

Health insurance companies are new used-car sales people. Scumbags you should never trust. They are all out to maximize their incomes and pay their executives ever more.

@Nelsormensch: Actually, the hospitals lose out too, since those who are uninsured will end up declaring bankruptcy or simply not paying an impossibly large sum. To match that, the hospital (and other providers) have to increase their rates, which makes the insurance companies cut costs and cancel people more, which leads to more financial misery at the hospital, and then... you get the idea.

I hate big government, but health care is truly out of control for the kind of 'evolved' society we think we have. Of course, ALL these issues (including most every other story on Consumerist) stem from one problem that does not have a cure--unchecked greed.

BTW, if you aren't disgusted enough by Consumerist's synopsis of the article, you should click on the link and read the whole thing.

While I wouldn't wish a debilitating illness on these people, like say flesh-eating bacteria, I think jail and bankruptcy sounds about right.

@StormyBkln:

You complained about a clerical error that the company corrected and subsequently refunded the overcharge?

Ahh HealthNet. About 2 years ago, HealthNet came into Arizona. They offered some amazing insurance. Low co-pays, very low premiums, and excellent coverage across the board.

Needless to say, my employer switched to them post haste. Fast forward exactly 1 year to the day our coverage was issued. The premiums sky rocket, the prescription coverage went to the dogs, and the co-pays oh god the co-pays. At the time I was taking 2 daily doses of Alegra-D 24 Hour. Which at the time cost me $20 dollars a month. This medication was make or break for me. It is the only allergy medication that worked for my sever allergies. After the 1 year mark, Alegra-D 24. Was dropped from the prescription formula. I tried everything, getting my allergist to contact them, begged and pleaded with them, everything I could think of. In the end, my employer decided to drop HealthNet and go back to UnitedHealth.

The woman doing chemo that lost her insurance still has the drug catheter in her chest and nobody will remove it because she has no insurance. Uh, leaving something like that in too long runs the risk of a nasty infection, in her chest cavity. This was the first thing I heard this morning when I flipped on CNN getting ready this morning. Maybe that explains my sour outlook today.

There is no freaking excuse for this.

Insurance companies are NOT your friend.

@warf0x0r: Indeed, I think government regulation is being given more of a reason to come out. I don't know what's worse, an inept government regulation or corporate corruption and greed, but hopefully the government will feel that it's in its best interests to not kill off everyone with health problems.

individual coverage is issued to only the healthiest applicants, who must disclose preexisting conditions.

Does this not seem backward to any of you? To the United States? Aren't the least healthy people with the highest medical bills the ones who need help with it the most?

Yes, I understand and appreciate the capitalist system, but you will never make me admit that profit has any place in the health care a person receives.

Bah. I'd very much like to have a small, streamlined government that didn't poke its big stupid nose into every industry, but clearly we're not ready to handle that kind of responsibility without acting like total jackasses. THIS IS WHY WE CAN'T HAVE NICE THINGS.

There is a special place in hell reserved for people like her and those who run her company.

Semi-similar situation with Great West medical. I've seen documents from my previous company on how they sell their services, spinning up the fact they auto-deny XX% of first run, X% of second run and a small percentage of third run claims as a savings benefit for the company purchasing the plan.

From the sounds of it, the idea is to get the patient to 'give up' on smaller claims and just pay it (thinking by the time its approved, it would have cost less to just pay) out of pocket instead of appealing the denials.

I'm sure this is illegal, but the documents didn't spin it this way, sounds like they used various methods to avoid payment such as minor clerical errors, smudges on claims and the like. Probably filed under the 'shouldn't be but is barely legal' pile.

luckily I'm back with UHC, while they haven't been the best, they certainly are a few tiers higher than great west. That, and I don't have them denying nurses, food and other things that are 'accidentally' classified as out of network while the hospital itself is in-network.

OMG. I have HealthNet.

*shivers*

viva kucinich

Looks like they broke the law, a good fine wold be 71 million. 2 times what they saved.

For everyone who said "insurance people are scum" do you have insurance? if so why? with a few exceptions insurance is not required. As far as I know, health insurance is never required. So if you hate them so much, why do you pay them?

@XTC

Yes, health insurance people are scum, and yes, people still pay for it. They do so because it's one of those things that you shouldn't live without, and insurance companies seem to be all too happy to take advantage of that fact.

Also @ XTC

Health insurance is required by law in the state of Massachusetts. And as an added little "F-You" to the residents of MA, the people who passed this legislation decided to make the penalties for not having health insurance FAR greater than the penalties a business would recieve for not offering their employees a coverage plan.

@xtc46: Why? Because think of the alternatives to not having insurance, and then having something awful and costly happen to you.

@mgyqmb: It is indeed backward. And no, ideally, money shouldn't come into play when it comes to someone's healthcare. But here is the reality: medical practices cost money to run; hospitals cost money to run; insurance companies cost money to run. It's all a business, because everything costs money. It's not just a capitalist thing -- if things cost money, then money will always be an issue, in one way or another. For example, under Federal law a patient cannot be turned away from an emergency room if he is uninsured or cannot pay. But he will still be billed anyway. But an uninsured patient with not a lot of money may think twice before going to an ER, or may decide to not take an ambulance, which might get him there faster, because he can't afford it. The money issue leaks into everything.

One could say that socialized health care is the answer, but someone is footing the bill for all these services. Someone is going to have to decide that certain things won't be covered, because there just isn't enough funding. It's a never-ending cycle. Unfortunately, we're not dealing with that cycle even remotely appropriately. And Cumaeansybil has a point: entire industries can't be left alone because, left to their own devices, they will ruin everything for everyone.

I love the smell of lawsuits in the evening. It smells like ... like victory!

@StevieD: I think it's a valid complaint when your health insurance costs go up for a totally BS reason. I'm sure they would have been happy to keep the $10.

@Dr_awesome: So don't live there. I don't agree with every law in the state I live in, either, but your end of the social contract you make with your ELECTED government is to follow the laws your elected reps enact.

"claims reviewer" = "one who reviews claims"

This woman reviewed claims, clearly, to see if the company should weasel out of its responsibility.

Thus, they're breaking the law.

Isn't it amazing ... for far less than we will spend on the "war" in Afghanistan and Iraq, every man, woman and child could be covered with Universal Health Care access. PLEASE ... pray for a candidate who will fight for Universal Health Care access to get into office. As a health care worker, I am consistently exposed to the waste, excesses, and inequities of the current health care system. This is the BIGGEST issue facing the American public. We are the ONLY industrialized country in the world without universal health care access, and we must have it to compete and prosper in a world economy. And the added benefit ... the scum-bag, greedy, immoral, insensitive insurance companies will effectively be put OUT OF BUSINESS of deciding YOUR BUSINESS when it comes to healthcare.

I'm just wondering why aren't people targeting the woman who made these decisions for profit? I'm not saying to do anything other than call her out for the pariah that she is.

What she did was disgusting and everyone in her church, her community, and her alma maters should be let in on Barbara Fowler's source of income. I'm sure they would not be proud of her.

@parnote: What I don't understand is how USA spends more $$$ per person for healthcare than Canada and still unable to offer universal care access.

Where this money goes?

@xtc46: Decisions, decisions ...
Where do you live? (I mean country)

Most peoples have a choice : pay for insurance or lose everything they possess if they get sick, an accident, etc. (Few people are affected : Bill Gates, Paris Hilton...)

Bankruptcy due to medical expenses is very common.

And if you are paying for a service (aka health insurance), the contract should be respected by the insurer. Dropping customers, while they get sick (hoping they won't be able to fight back false pretenses) is very ''lowlife''.

Similar to buying a airplane ticket and being pushed off the plane over Atlantic ocean.

So all of the responses to my question were along the lines of "they suck...but its better than nothing"

I live in the US (Hawaii to be exact) and I have had no trouble with my insurance companies (health or auto) I have no trouble with the company who handles my Flex Spending account for medical either. What this leads me to believe, is that either I am incredibly lucky (I've had no major injuries, but have been to the emergency room a few times, torn a tendons in my hand, pulled several muscles got, stitches several times, a concision of 2 etc.) or there are both good and bad companies (like every other industry). So why do people give money to the bad ones.

I have 2 jobs, both offer medical (one even offers 3 separate plans to chose from). In addition to that, I can pick a number of private medical insurance plans. If I had no job, I could get state provided medical. So with all these options, why use a crappy one? If you can only afford a crappy one, then work towards affording a better one. otherwise it's like people saying "because I can't afford a BMW, Kia should make their cars just as good" it doesn't work that way, you get what you pay for. For those who say its "required by law" then pay the stupid minimum fee, and pretend you don't have it. Car insurance is required here, I think the minimum just covers if you hit somone, it doesn't cover your injuries, or any damage to your car. That will cost all of 30-40 bucks a month on a cheap car. You want better coverage, you pay more. I pay 110/mo because I drive a SUV and have been in a few accidents. But I also have full coverage, and in every one of those accidents my car came back as good as new. You get what you pay for.

Now I understand that what this company did sucked. But that is there business. They look and see if the payout is bigger than the risk, in this persons case is wasn't so they dumped the person. If you decided that the premium you were paying your insurance company was more than the risk of you needing it, you would stop paying them, and no one would blame you. It's business.

@parnote: Universal Health Care only helps those who are irresponsible enough to not get their own insurance. So unless my jobs decide to dump our insurance, and give me a significant raise to cover the tax increase, I wont support it. Why should I have to pay for insurance for those who dont want to help them selves?

The only exception to this is for kids. If you are <18, then sure give them health care, its not their fault they have irresponsible parents.

And please don't give me this crap about not everyone being able to afford insurance. I have held a full time job since I was 15, every one of them offered health care. And for the last 4 years I have held 2 full time jobs because life is expensive, so we need to work to deal with it. If you can't afford health insurance for a kid, don't have a kid, its that simple. Any adult (with the exception of those who are disabled) can easily hold 2 full time jobs. And I cant think of a single place where 2 full time jobs even at minimum wage, is too expensive to live on your own. Those who are disabled already have the benefit of welfare and medical. Everyone else is just lazy or irresponsible.

If these people burned in their houses while they slept, I would mark it on my calendar and be sure to celebrate it annually for years to come. For as much as I hate government bureaucracy, I hate health insurance companies even more.

BCBS of NC dropped my mom when she had a claim saying she didn't specifically report that she's had migraines before, and not constant or chronic migraines, but has just had a migraine before. Who hasn't? Anyways, after she complained they reinstated her, but raised her premiums and since it was after that claim they dropped her for, added it to the pre-existing condition list. So moral of the story is, unless you list every head ache, stomach ache, flu bug, cold bug, itch, gas, or cough you've ever had, they will drop you for any little arbitrary thing if they can save themselves a buck or extract an extra ten out of you.

@XTC46, if you think having to work two full-time jobs in order to afford the basics is a sustainable an acceptable way for everyone to live, then I'd hope everybody takes your opinions on the health care industry with a grain of salt. Also, it is quite clear you have never been self-employed or worked with small mostly family owned businesses.

@xtc46: That's complete BS. Many people are not insured not because they are "irresponsible" but because nobody will insure them. For example, if you have a chronic disease (E.g., cancer survivor, rheumatoid arthritis, etc.), you can't get insurance.

The problem with private health insurance is that they're out to make money (legitimate), and therefore won't be able to insure people with those disaeses.

And what about the person who got dropped? Can they get insurance?

Tell me something, people: Would you object if telephone companies said, "You can only get a phone in your home if your employer pays premiums and sponsors you"? And the employer's choice of phone company means you are stuck with a lousy company with excessive fees and rates? Or the phone company demands you pay for long distance calls *before* you make them yet won't connect you (or disconnects you) when you try to make long distance calls?

Of course you would. It would be idiotic to expect people to live without a phone while they are between jobs (or without a usuable phone, period) while paying for it, and yet that is the exact same situation the US has with health care.

The universal health care in countries like Canada, England and other places may be flawed systems, but flawed is better than (apologies to the siteowner) completely fucked up systems. At least the other countries have medical systems that work instead of constantly breaking down.

Well, at least their stock went down a little. Might have been more, but I suspect there were some people who thought "hmm, that's pretty shrewd! BUYBUYBUY!"

@supra606: Disagree, its the fucked up system we have in this country. What do you expect them to do? Embrace less profit?

@xtc46: Its already been called out that you are full of it. Two minimum wage jobs will pay to live in NYC? Right. The fact is we pay almost twice as much for health care as the #2 country (France) for far lesser results. That is the fact. Our GDP, our taxes, our salaries, is being pissed away to feed an administration nightmare so that we have the privilege of less health. Address some facts instead your nonsense opinions about who is what. The greatest country in the world requires you to have two full time jobs to barely live? That is so messed up. Is this what we want government for? And yes, doesn't it piss you off that Iraq' costs could pay for the whole thing and leave money left over with to invest in education? oh well.

Wanna fix health care? Get insurance companies and their sky-high profit margins out of the picture.

Healthcare 1
Consumers 0

@xtc46:
You're funny. All those deadbeat douchebags out there wanting a free ride for basic medical care! The nerve of some people! The government shouldn't do anything to help anyone (fire, police, etc) because that would be "giving" away services for free. Meh, the "pull yourself up by the bootstraps" people really annoy me. We pay an insurance company for many things, as you mentioned, but the payment for that insurance constitutes a contract, which is supposed to be legally binding (and the defintion of "legal" has undergone a sea change over the last 6+ years). As health insurance companies continue to operate in this manner, it is just a matter of time until you "become" one of the unfortunate rabble who is either denied service (even Medicaid will deny coverage on certain types of treatments) or outright dropped (regardless of the "cafeteria" of health plans you have to choose from). At the rate were going, life insurance claims will be denied because the insured DIED. At that point you can't fight the insurance company....or pull yourself by the bootstraps...as it were.

I suggest a compromise between government-managed healthcare and the current for-profit system: a system of independent, non-profit health care organizations that are funded through taxes on businesses, but are independently managed. NC has Blue Cross/Blue Shield; it's a nonprofit and the state has been able to keep it that way, despite BCBS's desire to switch to a for-profit company. With no profit incentive, there's no incentive to be draconian with benefits, and there is much more money available for providing services.

@xtc46:

This isn't the 50s son. Not all people are irresponsible and lazy. And if you are happy with working two jobs, that's great that it works for you, but not for everyone. Open your eyes to what's really going on...