Time for Kathleen Sibelius to step in again. This time Wellpoint leads the way by targeting key groups of insureds for fraud investigations. Their first experiment appears to be women diagnosed with breast cancer.
Via Reuters:
The women all paid their premiums on time. Before they fell ill, none had any problems with their insurance. Initially, they believed their policies had been canceled by mistake.
They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.
Once the women were singled out, they say, the insurer then canceled their policies based on either erroneous or flimsy information. WellPoint declined to comment on the women's specific cases without a signed waiver from them, citing privacy laws.
h/t Wonk Room
This type of behavior has been smacked down before and now has the force of the new health care reform law to do it again. You'd think insurers would get the message, right?
Not so much. This morning I received a report of an employer conducting a "dependent eligibility audit." This isn't the first time I've heard of these, but this one is particularly ugly. For obvious reasons, I've removed names and the identity of their employer.
...I am pretty sure my family is currently being targeted by [my spouse's employer] and Aetna because of my child's recent [redacted for privacy] diagnosis. Just a month after his Dx we received a notice in the mail letting us know that we were being "audited" by the health insurance co to make sure that [my child and I] were actually legally related to [my spouse] and eligible for health benefits. We were asked to fax in copies of our marriage certificate and IDs and our child's birth certificate...We did. HR confirmed it.
...Today I got a call saying that we still haven't sent in the requested paperwork and are in immediate danger of being dropped from the health plan. And they claim to have no record of the paperwork we sent in.
This press release from HRAdvance is pretty clear about why these "dependent eligibility audits" are taking place:
[Section 2712] of the PPACA prohibits the rescinding of health insurance for any reason other than ‘fraud' and ‘intentional misrepresentation of material'. Proving that an employee has committed fraud can be extremely difficult, and will only become more challenging in the future. "A dependent eligibility audit provider who can assist in those efforts will be key to success," states Brennan Clipp, Senior Vice President of Sales at HRAdvance.
Simply stated, these audits are intended to build a database of people they can target for fraud or misrepresentation if they should be diagnosed with anything from acne to hives to breast cancer later on. This person's report of the supposed non-receipt of sensitive documents bothers me, too. It makes me wonder why documents faxed from the same machine wouldn't always reach their intended recipient, particularly in light of the specific circumstances.
The good news? They're pushing the limits and the edges early, giving Sec. Sibelius a great foundation to slap them back like she did when they started rumbling about not covering children with pre-existing conditions.
The bad news? We're all going to have to watch out for each other every step of the way, because they're doing this to people through their employers, causing them to fear for their jobs if they get caught in one of the insurance company's "algorithms".
FireDogLake re-posted this on YouTube today.
Texan Robin Beaton, victim of rescission by Wellpoint, testifies before US House in June '09
Note: WellPoint, Inc. is the largest health plan company in the Blue Cross and Blue Shield Association.
When will government of the people, by the politicians, for the corporations perish from this Earth?
Not soon enough!
to put themselves out of business. The whole 'looking for loopholes' practice is not laughed at anymore, and serves only to piss off the targets.
These bastards were up in arms over being made redundant by the govt, and now they're proving it should have been done.
As long as they do this shit and people find out, it will be harder and harder for these entities to exist on their own selfish, greedy terms. They invite severe regulation by govt when they fail to self regulate, that empty promise they always make to get outside regulation dismissed.
Talk about fraud. I hope they've put themselves in their own fraud database, as they practice it on a daily basis.
WellPoint. Pretending to be health insurers.
me-oww!
"WellPoint.
PretendingProving to behealthinsurers.“Why would anyone with a functioning brain believe this guy?”
Some guy with an eating disorder
they have proven they don't get messages.
America's health insurance industry, dedicated to proving you married a mistake.
“Why would anyone with a functioning brain believe this guy?”
Some guy with an eating disorder
"Damn the regulations, more profits ahead!"
.
more $$$
Why buy when they cancel when you need it?
Medicare for all NOW!
Republicans are liars and simply cannot be trusted.
It makes me wonder why documents faxed from the same machine wouldn't always reach their intended recipient, particularly in light of the specific circumstances.
Loan modification departments routinely "never receive" documents and lie about what's going on.
almost. Mail a certified letter, return receipt requested, with the requested documents enclosed. If they accept it, they have to sign for it, and you get the signature card back. If they do not accept it, you get the whole package back proving that you tried to send it to them and they refused to accept it. Do NOT open the letter, because if you do, you cannot prove what you tried to send to them. Most courts will see this as proof of your compliance with their request. Let the judge or whatever authority you're in front of or appealing to open the letter. Costs less than $5.00.
As always, keep a copy of everything for your files.
The thing to note, especially in an election year, is that this is the kind of behavior the GOP was fighting with everything in their arsenal to protect. This is the kind of thing they were so desperate to keep in place they funded the Tea Party "movement" as a means to help in that goal. Even now, they want to repeal health care reform so that what little protection we have gets removed.
So next time thinking "vote GOP", think "uh what if I get sick?" instead. Because the GOP's belief is sick people deserved it and don't work hard enough.
..for dropping the public option, why are Republicans getting a pass for forcing it to be dropped? Had two Republicans stepped up and said they'd stand in Blanche and Ben's shoes, the public option would be reality.
Great to see Reuters acting like a real news service again and running NEWS!
I understand this is made possible by the wonderful piece of legislation Obama and Congress passed that they called "health care reform".
*
write the legislation. Any one who thinks insurance companies are upset over this is naive. I am sure that the insurance industry had many, many lawyers help write this mess, too. This is the second attempt to further screw real people (or as the Founding Fathers called us, "The Great Beast"). That they didn't get too far the first time ups the odds they are getting closer to winning one.
Were it not for health care reform, no one would have any basis to a)protest; or b)request action.
problems too seriously before, as you point out, so I am attempting to resuscitate them now. I am not one of the people who think we won anything of any consequence.
Someone gets away with murder by legally poisoning their victims. Gov't puts a stop to that right quick, but didn't see death by starvation through denying people the ability to buy food. Oh gosh, let's all blame gov't. Let's not blame the murderers.
A hospital where I used to go for blood work now requires a photo ID before they give you any treatment. The first time that was required of me is when it sank into my head how desperate some people must be for help. That, to me, is very sad and just wrong. People have to die just because they cannot afford health insurance? Even if you have it, it may not do you any good.
My last job was with a health insurance company. It's not a major national insurer but it is big in the state where I live. I would hear daily from customers who sent in all kinds of paperwork and we just never received it. It happened a lot, too much for occasional loss in the mail. I could never prove it but I believe there were people, who would intentionally lose this information within our company. What was really suspect was when the doctor's office or the customer were right in the same city and would send the paperwork in 3 times and still it would not show we received it. I would have to have them fax it directly to me so I could note in our computer system that I had received it. I could tell you all kinds of stories of shady stuff going on all the time. I finally left because I couldn't work for such a dishonest and unethical employer.
I see people dealing with tragedy and I make sure everyday that the insurance is in they system correctly. I do this so that I know they can concentrate on their lives and not on paperwork. I don't want them to ever believe, for one moment, they have to pay for something they don't. To know that the company you worked for did the opposite is terrible. There is a lack of conscience here. This is criminal.
Jeanne
Last November I and my wife were required to provide info for a "dependent eligibility audit" at the hospital where my wife works (she is FT and I being an independent contractor am fortunate enough to be her spousal co-enrollee). The project was contracted out by the hopital. The paperwork was very vague. The printed deadlines for submission were buried on page 5. The hospital did not inform the employees of the importance of the forms, or the consequenses of turning the forms in after the deadline. Many employees dragged their feet returning the paperwork and lost their eligibility until the next open enrollment period in November. I'm quite sure this was an attempt by the hospital and the insurance carriers that provided coverage for the employess to weed out as many enrollees as possible. They wanted birth certificates for kids, and marriage certificates for spouses, SS numbers and names of family physicians. I've never seen anything like that before.
"Someday somebody related to some of these sufferers, these victims, these collaterally damaged souls, may try to kill you. And I have to tell you, I think you’ll have it coming." - Christopher Cooper
... from the "your papers, please" stuff going on in Arizona at the moment.
However, if somebody's in the country illegally, or someone is on the rolls of the insurance company when they really shouldn't be, they really have no right to complain when somebody finds out that they're someplace that they have no business being.
We do agree that people who have illegally penetrated a country's border or who have lied or committed some measure of fraud in order to gain insurance coverage they don't qualify for have done something wrong, right?
It's a crime now?
in case you missed this part:
me-oww!
The women all paid their premiums on time. Before they fell ill, none had any problems with their insurance.
And I assume that none of those women were being covered fraudulently. If that is true, then the insurance companies had no business in taking away their coverage.
The company where I work recently conducted a insurance coverage fraud audit. My wife is a breast cancer survivor, coming up on 5 years real soon. We came up with the required proof that we were eligible to continue to be covered under our current policy by the required deadline, and we remain so covered as of today.
and
The topic here isn't about the companies actually being defrauded. The topic is WellPoint classifying breast cancer survivors as cons. Then dumping them because they decided they were a con. And classifying it as fraud.
I think I understood perfectly.
me-oww!
probably cost them money, and the only way they can get rid of them is to classify them as frauds now. So, if coverage is mandated, and these people have been classified as frauds, and the insurance companies can refuse to sell them coverage, what happens then? Are the insurance companies mandated to sell coverage if they don't want you as a customer for whatever reason they cook up? Exchanges? Is that an answer? Not really.
have coverage? Is that an acceptable number of people to be in jeopardy? With all the financial billion and trillion dollar machinations, 12 million of anything has apparently become chicken feed.
Enrollment: College-age child is full-time student, parent certifies that. Six months later, college-age child enrolls in 11 units instead of 12 because that last Econ class was full, or kid fails a class, or whatever. That's not fraud, nor did parent mislead. Yet, their kid is on the rolls as a dependent when they're technically not.
Under Wellpoint's model, an audit would serve up an informal indictment for fraud, despite the fact that there was no fraud.
How does one get on the rolls of an insurance company when one shouldn't be???? I must know how this can be. Is it like hooking up your own Cable for "free TV" or are you just a moron?
Would put them out of business.
...and evidently, also FDR, who scrapped plans for a national health insurance program based upon private/public insurance partnerships because of concerns that it would kill Social Security.
http://www.chomsky.info/articles/20041217.htm
Disturbing, but informative. It's from 2004, and that makes it even more disturbing to me.
There is a long, storied history of efforts to try and get a national health insurance program passed. This most recent health insurance reform effort was only about breaking the long-standing, time-honored pre-existing conditions barrier. They did that, and as you can see, the insurers aren't accepting the verdict.
In this country, it's always been ok to take care of the elderly and occasionally, the poor. The rest of us can more or less go to hell. The hcr package is the first battle won in a far longer war.
.
...that this is the same firm whose female CEO (according to the reports) received a whopping 51% increase in her compensation last year while Wellpoint eliminated 1500 jobs and instituted rate increases. (If that doesn't make you sick, maybe this will -- a few other executives at the company received even higher raises, up to 75%!) Bet she wouldn't have any trouble getting treatment if she contracted breast cancer, even if she didn't have coverage (and there's no question that she does).
Never trust anyone who insists that patriotism requires you to blindfold yourself with the flag.
These heartless devils are rapidly getting to a place that even corrupt Rahm Emmanual style democrats will back away from taking their blood money. It may take a few more election cycles but better days are coming.
A colleague has a 23 year old son who still has a year of college. She was told that kicking him off the program at 23 was 'grandfathered in' which is specifically forbidden in the law. She pointed it out to the insurance company - no response yet.
all I can feel is sorrow. This is so heartless. Breast cancer is a terrifying reality. I remember hearing the words and thinking...'I'm mortal.' My husband, now ex, was laid off and we were on Cobra and when I asked the insurance company if I could go with them after the Cobra was finished the woman told me no. I had a pre-existing. Do you have any clue how...how devastating that is to hear? Without insurance I had to choose no treatment or bankruptcy for my family. Thankfully in Minnesota, a non profit insurance state, the insurance companies must put money into a pool that will cover those they won't insure. But what about other states? What happens to the the families in this case? The choice this company is giving it's members is ungodly. How do you do that to human beings?
Jeanne
You have mixed up a few different topics here. Dependent eligibility audits are used to protect and maintain benefit levels for employees and their eligible dependents. An employer sponsored health plan is still one of the best tools to recruit and maintain good employees. When an employer has 10%+ ineligible participants, such as neighbors kids, nieces, nephews, boyfriends, girlfriends, etc. everyone, including employees, pay for that type of fraud and it can cost a company millions. Just because someone is ineligible to participate on an employer’s plan doesn’t mean they can’t be covered. They just need assistance and direction to find the right plan, whether it’s their own employer, individual insurance or a government sponsored plan. Get your facts straight and keep the topics separate. You should do a cheaters and liars article using real data and stats on how many people fraudulently enroll on employer plans because the benefits are rich.
Read that last paragraph carefully. The idea is to identify potential fraudsters. Yet, I can think of ten scenarios where there is no fraud, there is no effort to mislead or keep dependents on a policy longer than they should be, but they will be stigmatized going forward.
The assumption is simple: If dependents are included wrongly, the person who did so is committing fraud or at best, intentionally misleading. In fact, there are lots of ways it could happen with no affirmative act on the part of the employee.
if there is one thing I think should have happened and didn't with this health bill, it's unbundling health insurance from employment, for reasons like this.
I do agree with you and it is unfortunate that there are many vendors who do these dependent audits in a poor manner. We're in agreement, fraud is fraud, but let's help people find the right solution, help employers maintain their current plans and find coverage for the one's who need it most. Employers should not be paying for people that do not belong on their plans.
and granted, I work with small, not mega-large employers, I have never come across a situation where people were enrolled on plans that didn't belong there OTHER than the dependent status issue. In divorce situations, the spouses couldn't wait to dump their ex (and sometimes even their kids!).
Typically, it was the full-time student status that was the problem, and usually not intentional.
You are correct, in our experience 1% to 3% of the ineligibles simply misunderstand the eligibility requirements and we spend a great deal of time and effort trying to educate and help those employees find other coverage for that ineligible dependent. However, there are also many that do it intentially and we have hundreds of thousands of those examples. It's a misconception that student age children are the problem and they're typically lower utilizers of a plan. With healthcare reform, the student factor goes away and will not be an issue; however, they still have to be an eligible dependent, not the neighbor's kid. Divorce, another issue. The divorce decree may state that an individual (ex-husband or ex-wife) provide health coverage, but that does not make it the responsibility of the employer, it then becomes an individual issue. Kids, different story and usually a qualified medical child support order involved. Those people are the first to call and say, drop the kids. A good eligibility vendor has already addressed that situation and will intercept and not let the employee drop the kids. I'll stop now, out of room to respond further. I've enjoyed our communication.
healthy. If they are such a problem, why was the insurance industry so against a public option? Oh, right. Because the way it is now, the taxpayers will have to pay private companies to cover those who are mandated to buy from you, but cannot afford it. Where the money comes from is not important. Just that insurance companies get it.
Your take on divorce law is somewhat simple. What parent in their right mind would choose to pay cash for court ordered coverage for their children, as that would be the result of telling the insurance companies to "drop them." Never mind.
When any such Audit is being used against you; ALWAYS send all correspondence by Registered Mail. It's a little more expensive but you receive a card stating the Mail was received at it's destination. A lot less expensive than having your medical bills denied.
With that Card you have proof they are Lying by claiming you have not responded.
Donaldd
We need a public option; period.
It's all out war , the corporations / right wing against "we the people", it's been going on for a long time but now they've all but come out in the open and made a declaration , only the dumbest and most ignorant can't see it , but there are a lot of dumb and ignorant people in this "wonderful" country .We have to defend the ignorant and dumb too , they are totally defenseless .
Insanity , it is what it is , there is no understanding it .
right there. Liberals will protect and defend even the ignorant and those too lazy to learn things, and the right-wing not only doesn't care about them, but are annoyed by the existence of those who cannot pay their own way, even if the reason they can't pay their own way is caused by the right-wing. Poor education, poor health care, poor nutrition. The selfish bigots rule, whether or not they pretend to be the ones "holding" power.
Michael Moore said on Countdown the penalty insurers would have to pay if caught denying coverage for pre-existing conditions is ONLY $100.00 a day.
How many times does 100 go into a billion?
...this is why private for-profit insurance companies have to go.
American corporations are simply too corrupt to ever be the basis for a fair, sustainable health care system. We're going to waste an incredible amount of time and money, and patients are going to experience horrendous suffering before we have the wisdom and courage to embrace a workable system.
I'd be so happy to see these health insurance companies and their "products" go down the tubes fast. They are as worthless as Wall Street "transactions", in fact, those two industries are mirrors of each other. They produce nothing, except wealth for their greedy, criminal executives.
they can rescind anybody they want, if they claim fraud. The recission rate is barely going to be slowed. It's one of those loopholes that made sure the insurance companies get to do as they please.
Anybody still think it was a good idea to allow these gangsters to continue to exist and do business?
Comments are closed on this entry