Former Members Sue Blue Cross
By Lisa Girion
Los Angeles Times
March 28, 2006
The state’s largest health insurer systematically – and illegally – cancels coverage retroactively for people who need expensive care, 10 former Blue Cross members claimed in lawsuits filed Monday.
The suits, filed simultaneously in Los Angeles, Orange, Riverside and San Bernardino counties, allege that Blue Cross of California and Blue Cross Life & Health operate a “retroactive review department” devoted to finding ways the company can escape its obligations to members who become seriously sick.
“Blue Cross’ conduct is particularly reprehensible because it was part of a repeated corporate practice and not an isolated occurrence,” according to the suits.
Blue Cross, which is owned by Indianapolis-based insurance giant WellPoint Inc., declined to comment on the suits.
The suits involve health policies purchased by individuals, not group or employer-sponsored coverage. To obtain such policies, applicants must fill out a health-history questionnaire.
According to the suits, each patient filled out the application honestly, was accepted for coverage and paid premiums for months before being diagnosed with a serious condition of which the patient was previously unaware.
In each case, the suits allege, Blue Cross didn’t look into the member’s medical history until an expensive claim came in. Then, the plaintiffs contend, Blue Cross extensively scrutinized their records looking for something that had not been disclosed and seized on whatever discrepancies they found to justify revocation of the policy, even if the inconsistencies were inadvertent or irrelevant to the claim.
Yenny Shu of Los Angeles, for instance, says her coverage was canceled after she was diagnosed with breast cancer at 46. In its letter rescinding her coverage, Blue Cross allegedly told her that she failed to disclose her exposure to the hepatitis B virus when she was a child.
http://www.latimes.com/business/la-fi-bluecross28mar28,1,3086059.story
Comment: By Don McCanne, M.D.
If we had universal national health insurance, prior medical history would never be an issue as to whether an individual would be eligible for health care benefits. Everyone would always have coverage, throughout life.
Instead, our politicians continue to support policies designed to promote and protect the private insurance industry. Does this industry warrant that kind of support? They have failed in delivering crucial, fundamental insurance goals: universal risk pooling and adequate protection against financial loss when faced with medical needs. Tens of millions are left with no health insurance, and many more face major debt in spite of their coverage.
As if failure weren’t enough, today’s message shows us that the administrators of the private insurance plans manifest one more characteristic that should make us decide to dismiss them as stewards of our health care dollars. They are evil people!
(evil… 2. Causing ruin, injury, or pain; harmful…
The American Heritage® Dictionary of the English Language: Fourth Edition)