U.S. tells insurer: Quit dropping cancer patients

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**sexiest_hero**

http://www.msnbc.msn.com/id/36738112/ns/health-health_care/

Wellpoint had used software to target those with new breast cancer cases

BOSTON - U.S. Department of Health and Human Services Secretary Kathleen Sebelius has called on health insurer WellPoint to stop dropping coverage for patients recently diagnosed with breast cancer, calling the practice "deplorable."

In a letter dated April 22 to Angela Braly, WellPoint's chief executive, Sebelius said she was "surprised and disappointed" to learn from a Reuters report that the company has specifically targeted women with breast cancer for aggressive investigation with intent to cancel their policies.

"As you know, the practice described in this article will soon be illegal," Sebelius wrote. "The Affordable Care Act specifically prohibits insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact."

Reuters reported on Thursday that WellPoint, the largest U.S. health insurer by enrollment, was using a computer algorithm that automatically targeted patients recently diagnosed with breast cancer.

The software triggered an immediate fraud investigation by the company as it searched for excuses to drop coverage, according to government regulators and investigators.

"WellPoint should not wait to end the unconscionable practice of deliberately working to deny health insurance coverage to women diagnosed with breast cancer," Sebelius wrote in her letter. "I urge you to immediately cease these practices and abandon your efforts to rescind health insurance coverage from patients who need it most."

Breast cancer is the second-leading type of cancer among women, has touched millions of families, and will affect one in eight American women during their lifetime, Sebelius wrote.

"I hope you will consider these women and their families as you work to end this harmful practice," she wrote.

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Insurer targeted breast cancer patients to cancel

In a statement responding to the Reuters story, Wellpoint said it uses software to look at a series of diagnostic codes covering conditions that patients would likely have known about when they applied for insurance coverage, but maintained it does not single out breast cancer.

The company said it changed its rescission practices to ensure they are handled appropriately after a 2006 review of its policies prompted by public concern.

The issue of rescission has reemerged in the debate surrounding U.S. healthcare reform, with the new legislation approved last month.

**JohnHwangDD**

Yeah, it's far better to simply deny coverage and refund premiums once cancer has been diagnosed.

**Monster Rain**

The people running some of these insurance companies are some of the worst scum to ever walk the earth. The fact that it is legal, at all, to cancel someone's policy after they are diagnosed with cancer makes me want to retch.

I don't agree with everything that this administration is doing, but trying to put a stop to this garbage is definitely a good thing.

You know what really bothers me though? It's someone's job to do this to people. Someone gets paid to be the one to shut someone's insurance off when they get cancer. Please Jesus, send the Zombies.

/rant.

**JohnHwangDD**

You know, they don't even need to deny coverage in many cases - they just slow things down enough so that they can limit their costs when the claimant dies...

**ShumaGorath**

JohnHwangDD wrote:You know, they don't even need to deny coverage in many cases - they just slow things down enough so that they can limit their costs when the claimant dies...

I say it in essentially every thread, but the simple concept of for profit health care insurance is mind boggling to me. Logically it will become corrupt in virtually every form of implementation. Which it has. It's makes no sense.

**WarOne**

Monster Rain wrote:The people running some of these insurance companies are some of the worst scum to ever walk the earth. The fact that it is legal, at all, to cancel someone's policy after they are diagnosed with cancel makes me want to retch.

/rant.

Cancel is perhaps one of the leading causes of ending things.

What we really need to do is invest more money into cancer prevention and research. I know pre-dispositions occur related to genetics and environment, but that is what the research part of cancer research is there for: to understand the underlying causes of cancer and to reduce them before they get out of hand.

**Monster Rain**

WarOne wrote:
Monster Rain wrote:The people running some of these insurance companies are some of the worst scum to ever walk the earth. The fact that it is legal, at all, to cancel someone's policy after they are diagnosed with cancel makes me want to retch.

/rant.

Cancel is perhaps one of the leading causes of ending things.

I don't get it. I didn't write that...

WarOne wrote:What we really need to do is invest more money into cancer prevention and research. I know pre-dispositions occur related to genetics and environment, but that is what the research part of cancer research is there for: to understand the underlying causes of cancer and to reduce them before they get out of hand.

Yeah, that would be nice. But people need better ED medications, so that's where the R&D money goes!

**Albatross**

ShumaGorath wrote:
JohnHwangDD wrote:You know, they don't even need to deny coverage in many cases - they just slow things down enough so that they can limit their costs when the claimant dies...

I say it in essentially every thread, but the simple concept of for profit health care insurance is mind boggling to me. Logically it will become corrupt in virtually every form of implementation. Which it has. It's makes no sense.

I absolutely agree. It blows my mind when people say stuff like 'the government should keep its hands off our healthcare!' - so what, you'd rather have it in the hands of a private company who's only reason for existence is profit?

**FITZZ**

Albatross wrote:
ShumaGorath wrote:
JohnHwangDD wrote:You know, they don't even need to deny coverage in many cases - they just slow things down enough so that they can limit their costs when the claimant dies...

I say it in essentially every thread, but the simple concept of for profit health care insurance is mind boggling to me. Logically it will become corrupt in virtually every form of implementation. Which it has. It's makes no sense.

I absolutely agree. It blows my mind when people say stuff like 'the government should keep its hands off our healthcare!' - so what, you'd rather have it in the hands of a private company who's only reason for existence is profit?

I belive many peoples fear is government mismanagement.
However,I agree that the bottom line should be available health care for everyone.

**MeanGreenStompa**

As someone who works in medical insurance, I can assure you that moving from a nation with a nationalised health service (UK) to a country who's healthcare is provided by profit driven insurance companies (US) it's one of the few things I'm very worried about.

I know what steps companies will take to avoid paying out.

**JohnHwangDD**

FITZZ wrote: I belive many peoples fear is government mismanagement.

Don't be silly. It's not like there's significant fraud or mismanagement tied to any of the other government-provided benefits.

**Albatross**

JohnHwangDD wrote:
FITZZ wrote: I belive many peoples fear is government mismanagement.

Don't be silly. It's not like there's significant fraud or mismanagement tied to any of the other government-provided benefits.

Plus, the private sector is a model of efficiency, effective management, and is totally free from corruption of any sort.

**ShumaGorath**

JohnHwangDD wrote:
FITZZ wrote: I belive many peoples fear is government mismanagement.

Don't be silly. It's not like there's significant fraud or mismanagement tied to any of the other government-provided benefits.

There's not too big a risk of fraud in a straight up government system unless they are working through a subcontracted private company, however there is definitely a big risk of inefficiency. Unfortunately the private industry in this instance is already hilariously inefficient and corrupt meaning that there's little the government could do worse. Insurance isn't something that a national health care system should be based on, it's pointless in a nationalized system and corrupt by design in a private one.

**FITZZ**

Albatross wrote:
JohnHwangDD wrote:
FITZZ wrote: I belive many peoples fear is government mismanagement.

Don't be silly. It's not like there's significant fraud or mismanagement tied to any of the other government-provided benefits.

Plus, the private sector is a model of efficiency, effective management, and is totally free from corruption of any sort.

Now that is funny.

Don't get me wrong, I support the idea of national healthcare fully...I suppose I am just a bit "distrustful" of government in most aspects,meh...I'm old and cynical,it's my cross to bear.

Automatically Appended Next Post:

ShumaGorath wrote:
JohnHwangDD wrote:
FITZZ wrote: I belive many peoples fear is government mismanagement.

Don't be silly. It's not like there's significant fraud or mismanagement tied to any of the other government-provided benefits.

There's not too big a risk of fraud in a straight up government system unless they are working through a subcontracted private company, however there is definitely a big risk of inefficiency. Unfortunately the private industry in this instance is already hilariously inefficient and corrupt meaning that there's little the government could do worse. Insurance isn't something that a national health care system should be based on, it's pointless in a nationalized system and corrupt by design in a private one.

Actually Shuma,you summed that up nicely,"mismanagement",perhaps was not the correct term I was searching for,government inefficeincy suits the point I was getting at better.
However,I fully agree that the system as it has exsited is woefully unaffective.

**Albatross**

FITZZ wrote:
Albatross wrote:
JohnHwangDD wrote:
FITZZ wrote: I belive many peoples fear is government mismanagement.

Don't be silly. It's not like there's significant fraud or mismanagement tied to any of the other government-provided benefits.

Plus, the private sector is a model of efficiency, effective management, and is totally free from corruption of any sort.

Now that is funny.

Don't get me wrong, I support the idea of national healthcare fully...I suppose I am just a bit "distrustful" of government in most aspects,meh...I'm old and cynical,it's my cross to bear.

...and that is fair enough - I don't particularly trust my government either. It's just a question of who you trust less - is it a government which is (in theory) accountable to it's citizens, or a private company who is responsible to it's shareholders. The difference between citizens and shareholders in this instance is that the shareholders measure success in terms of the profits generated.

**Cannerus_The_Unbearable**

At least you actually know what a Private Company is up to. Better the devil you know and all that bollocks. I think we need more regulations. Regulations solve everything. There should probably be committees to make the regulations; but wait, we need other committees to review the regulations made. Once we start to get enough regulations, let's make another committee to regulate previous regulations. It'll all end well enough.

I don't think there's a good answer to any of this.

**Orkeosaurus**

"The Affordable Care Act specifically prohibits insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact."

Forgive my ignorance of insurance company policy, but what rationale is currently being given when the company denies treatment?

Albatross wrote:
ShumaGorath wrote:I say it in essentially every thread, but the simple concept of for profit health care insurance is mind boggling to me. Logically it will become corrupt in virtually every form of implementation. Which it has. It's makes no sense.

I absolutely agree. It blows my mind when people say stuff like 'the government should keep its hands off our healthcare!' - so what, you'd rather have it in the hands of a private company who's only reason for existence is profit?

What about a private, non-profit organization?

**dogma**

Orkeosaurus wrote:Forgive my ignorance of insurance company policy, but what rationale is currently being given when the company denies treatment?

Currently most companies are able to cancel policies for any misrepresentation of fact. Intention doesn't come into it.

**Orkeosaurus**

Ah, I see. It sounds like the revised burden of proof is better, then.

**Albatross**

Orkeosaurus wrote:

Albatross wrote:
ShumaGorath wrote:I say it in essentially every thread, but the simple concept of for profit health care insurance is mind boggling to me. Logically it will become corrupt in virtually every form of implementation. Which it has. It's makes no sense.

I absolutely agree. It blows my mind when people say stuff like 'the government should keep its hands off our healthcare!' - so what, you'd rather have it in the hands of a private company who's only reason for existence is profit?
What about a private, non-profit organization?

Such as what? A charity?

**KingCracker**

Pft, cmon Albatross, you didnt know that if you have cancer of the....well anything, BigBrothers BigSisters will totally take you in and take care of it......wait a second, I just WIKIed them.....they dont do that at all.... Im going to the local soup kitchen tomorrow for a dentist appt. I should make sure they still cover that

**Fateweaver**

I went to a pancake feed one time expecting to get a gunshot wound treated. Some help they were. Most screamed, some ran and some called 911 all at the same time but nobody actually helped me out themselves.

How odd.

**Soladrin**

Fateweaver wrote:I went to a pancake feed one time expecting to get a gunshot wound treated. Some help they were. Most screamed, some ran and some called 911 all at the same time but nobody actually helped me out themselves.

How odd.

.............................................................Really?

**ShumaGorath**

Fateweaver wrote:I went to a pancake feed one time expecting to get a gunshot wound treated. Some help they were. Most screamed, some ran and some called 911 all at the same time but nobody actually helped me out themselves.

How odd.

This post doesn't really make any sense. What's pancake feed?

**Fateweaver**

It's where a local church group will sponsor a pancake breakfast complete with coffee and OJ for a minimal fee (usually a goodwill donation of sorts).

Like a soup kitchen but it's not all the time, 7 days a week.

I was going along with the game that KingCracker appears to be starting. LOL.

**ShumaGorath**

I confus.

**Fateweaver**

No surprise.

Alba enquired about charities offering healthcare vs a private organisation, KC made the joke about going to a soup kitchen (a non profit organisation) for a dental appointment so I continued with the comment about going to a pancake feed for a gunshot wound.

For being "the enlightened one" between us two that sure went past you. LOL.

Also, what's wrong with private ensurers making money off selling insurance. That's what capitalism is all about.....err wait, I forgot the attitude toward capitalism most of you have. Silly me.

**Soladrin**

Fateweaver wrote:
Also, what's wrong with private ensurers making money off selling insurance. That's what capitalism is all about.....err wait, I forgot the attitude toward capitalism most of you have. Silly me.

Oh just the part where thousands of people suffer daily because they can't pay for it.

But I guess that makes you happy.

**Fateweaver**

Paying for insurance is normally cheaper than footing the bill yourself.

I paid around $1400/12 months for insurance through work with a $1,000 deductable. Great if I ever broke my arm but seeing as how I never did I didn't need the insurance, just took it because it was affordable and there is always the rare occasion when my homeowners insurance or car insurance or workmens comp wouldn't cover a broken bone.

Well, thanks to me in 4 years everyone will be able to afford it and if I refuse it I pay a fine come tax day. Yes, the government really does have my best interests at heart.......errr wait.

**Soladrin**

Fateweaver wrote:Paying for insurance is normally cheaper than footing the bill yourself.

I paid around $1400/12 months for insurance through work with a $1,000 deductable. Great if I ever broke my arm but seeing as how I never did I didn't need the insurance, just took it because it was affordable and there is always the rare occasion when my homeowners insurance or car insurance or workmens comp wouldn't cover a broken bone.

Well, thanks to me in 4 years everyone will be able to afford it and if I refuse it I pay a fine come tax day. Yes, the government really does have my best interests at heart.......errr wait.

Wow... just... wow. A government has to think of the general populace, not the individual.

I can't believe how egoistical you are.