U.S. tells insurer (Wellpoint): Quit dropping cancer patients

[sabra]

Source: MSNBC/Reuters

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.

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

[HughBeaumont]

1. This cannot get enough recs from me.

Parasite bastards. It's called life and health; they're not items for risk/return or P & L.

[dotymed]

59. How could this surprise Sebelius?

Check out this link from fellow DU'er "political heretic." America has the overall worst record against its citizens of the "top 20 countries." Please, if you haven't already, look at these statistics. I am sure that Sebelius is very aware of them.




http://journals.democraticunderground.com/Political%20Heretic/78

[happygoluckytoyou]

70. the BANKS rip off the TIRED & POOR, wellpoint wants the HUDDLED MASSES please

[Mark D.]

75. Now

Where's that wet noodle? If Sibelius, and the President, want to help them, telling them to stop is a start. Humiliation may hurt getting new customers. But not really. There are entire markets dominated by Wellpoint, where there is almost no choice, but 'equal evils' like United Healthcare or Aetna, who do the same kind of cruelty. There are no-doubt executive orders that can be signed. By all means, raise awareness. This sort of thing is hated by all on the left, most in the middle, and a surprising number on the right, except the totally heartless corporate apologists.

You can't defend this unless you're Wellpoint, a stockholder, or Hannity-esque. Once folks are mad enough, an executive order sighting this as intentional harm to patients (and it is) could work. It's not just denial, or 'defense' of profits. It's 'offense', 'assault' if you will, on patients. They'll skip treatment they can't afford or go into bankruptcy to pay for it. Only in America can we have this effing 'miracle' of bake-sales and fundraisers to help folks WITH INSURANCE pay medical bills. That last sentence would almost work as an SNL skit, except it's not funny.

[rocktivity]

2. Well, maybe Sibelious should DO HER JOB

and "aggressively investigate" THEM, not wait until it's no longer legal!


rocktivity

[tabatha]

18. Well maybe she was spending time on the law to

make it illegal. She looks like a hard working person, and you are doing a no-facts (ala rwers) criticism.

[liberation]

20. Funny you chastise others for lack of facts by using your own perception as a counterargument

... "looks like" and "maybe" are in no way shape or form factual statements.


Talk about the pot calling the kettle black.

[tabatha]

37. That is why I said "maybe".

I did not say definitely. I was offering up possible alternatives - unproven, hence maybe, - for what she was doing.

[liberation]

43. Yeah, that would be the case if you hadn't thrown the ad hominem at the end...

Which is what I was pointing out... but if you think the red herring tastes better. By all means...

[saigon68]

57. Lol

Looks like that comment didn't last long

I just love the ad hominem attacks and the strawman arguments of the rustics around here !!!

Those idiots need to take a debate and a logic course before inserting their foot into their mouth

[Name removed]

53. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Uncle Joe]

3. A system relying on for profit "health" insurance is immoral at best and evil at worst,

mandating the purchase of or not can't change that fundamental trait.

Thanks for the thread, sabra.

[truedelphi]

12. + 45,000,000 One point for each of those

Uninsured who were used to bring us the Mess that is now considered our big Health Care "Reform" success.

[liberation]

26. It is worse than that...

... a government mandating its citizens to purchase services only provided by private for profit corporations displays, in no uncertain terms, a collusion between the state and corporations. That is called corporatism, and we all know what that is Italian for.

[Dappleganger]

27. That's the fundamental flaw with what we have.

The minimum we should do is be like Switzerland.

[IndianaGreen]

31. Obama promised to preserve our 'unique American' system

which is the crappy for-profit system we are stuck with, now more than ever thanks to HCR.

[jgraz]

60. Status Quo You Can Believe In

:banghead:

[Name removed]

54. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Enthusiast]

51. Same as the financial services

industry. We are victims of a new kind of extra/hyper predatory corporation. What a country!

[Demeter]

67. 100% Agreement, Uncle Joe

Why can't Obama see that?

[lark]

84. Obama is very smart, so obviously does see this

He just doesn't care, wanting tiny little incremental changes, nothing that will really rock the boat or hurt the uber rich companies like banks, insurance co's. Wall St., big pharma. He is part of the problem, holding back real progress by never letting it be part of the conversation. He's being well paid or well threatened, maybe both?

[deminwi]

4. I had to recommend this

What a horrible, souless company!!

[Lerkfish]

5. did they ALSO drop men with testicular cancer?

that's the question I would ask.

[dmr]

6. That's not only a good question, it is a valid one. n/t

[liberation]

23. Probably

These people are about making money, not about following some sexist agenda.

It is that dropping breast cancer patients is a pretty low place to sink. But I am sure, they are not the only cancer patients being dropped left and right. Breast cancer orgs have far higher visibility, and I hope they use it to drive these assholes back into the stable they escaped from.

[Lerkfish]

40. I'll bet a neck massage they DIDN"T drop testicular cancer patients.

no probably about it.

[liberation]

45. Men are evil, got it.

[snake in the grass]

47. As a man, I can assure you that men are...

...not evil. However, the patriarchy, in which we live, is.

[ronnie624]

50. I think he was being sarcastic. n/t

[Lerkfish]

61. I'm a man, in fact a survivor of testicular cancer, so what I'm saying

is that men-run insurance companies, who refuse to cover pap smears but cover viagra, have a tendency to do these sorts of things.

[lark]

83. Good man

eyes open and recognizes truth.

[elehhhhna]

7. CLASS. ACTION. LAWSUIT.

[Divine Discontent]

16. DING DING DING!!! They'd win, BIGGGGGG! These women have INSURANCE for a reason, and to drop them &

cause them emotional trauma in a time when their emotions need to be running as high as possible, and instead place worries over bills on their mind - IS A SOULLESS ACTION!


And of course it's soulless - because corporations AREN'T people - regardless of what the Supreme idiots say!




MATTHEW 25:40 And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my children, you did it to me.’

[aquart]

36. Soulless? More like depraved indifference to human life.

[panzerfaust]

66. Nope: Just "Good Business"

Nothing in life being more important than The Bottom Line.

So great that our health-care "reform" simply assures such businesses of continued profits.

What was that, oh yeah, the Public Option. Who promised it? No. Not REALLY promised-promised ... so its OK.

Now beyond hope for change.

[thereismore]

32. Frivolous! We need tort something or other!

:hide:

[jgraz]

62. Thank God we elected a president who unconditionally supports our constitutional right to sue

Oh wait...

[IndianaGreen]

8. According to HCR, the fine to Wellpoint is $100 a day--a lot cheaper than paying coverage!

This is a point made by Michael Moore last night on the Olbermann show, being hosted by Lawrence O'Donnell.

[grasswire]

9. yep -- the penalty was less than the cost of treatments

And it was Lawrence O'Donnell who dotted the "i" by saying that the capitalists and profiteers need to be OUT of the business of health care.

Michael Moore says it is the job of insurance companies to make money for shareholders. It's their fiduciary responsibility.

O'Donnell says that's why the insurers need to be out of business.

[elehhhhna]

17. So if your treatment costs more than 36.5K/year they jsut take the fine instead?!!!

That's horseshit. WTF kind of shit law is that?

[IndianaGreen]

21. That's what Moore and O'Donnell said last night on MSNBC

It is cheaper to pay the fine than to pay for treatments. Blame the law!

[elehhhhna]

34. Who wrotte that clause? Massey Mining Company? W. T. F.

[liberation]

35. Nope, it was written by some of our friendly Dem representatives...

... make sure to thank them by voting early and voting often.

[ooglymoogly]

82. And MM also said that that clause was so well hidden in kabuki

script and enigmatic legalese, (paraphrased). He challenged any viewer to pull the HC"R" bill up on the net; And if they could find that clause, he would come and wash their car; And that my friends is pure and simple and fraudulent, full blown deceit in flagrante delicto; A clause that makes the entire bill a charade; To appear something it is not. A government that rules by deceit is not even close to democracy or the concepts of a republic. Where we stand, is on the precipice of despotism by Oligarchy, with a shrill wind at our backs. Health care and capitalism are oil and water, they cannot be mixed and they will never play well together.

[donco6]

64. That's not even an annoying fly.

Sheesh.

[perdita9]

10. I Hope there really is a Hell ...

...just so Wellpoint executives can burn there.

[change_notfinetuning]

11. Per the OP, "Sebelius said she was 'surprised and disappointed'." I could have

sworn she said, "SHOCKED! SIMPLY SHOCKED!"

[emmadoggy]

13. Yeah, "surprised and disappointed". Gee, I hope

she didn't get her blood pressure up too much there!! :sarcasm:

How about a little stronger wording like, "appalled and disgusted" or "furious and sickened"?

I mean, geez, we wouldn't want them to feel like they had done anything reprehensible, now would we? I'm sure this weakly worded letter is really going to put the fear in them, eh? :grr:

[liberation]

24. How about some f*cking actions already?

This administration, and the Dems, are playing the whole "shocked, shocked I tell you" coy game for long enough already.

A person in charge of the health services dept who is "shocked" about private insurers behaving this way should be run out of DC with plenty of feathers and tar.

But who knows... maybe in a couple more years, she may move from the initial shock to write strong worded letters. That will show them!

[IndianaGreen]

15. She was as shocked as Captain Renault at Rick's Cafe in the film Casablanca

It is not like we didn't warn people that HCR was a love give to the blood sucking health industry. The chickens are coming home to roost.

[laughingliberal]

48. Heh! Is that anything like, "No one could have predicted....:" nt

[lolly]

14. Did she say "pretty please?"

Jeez, when will this administration figure out that this is what they do, it's what they are.

Asking them to stop is like asking a tiger to stop eating meat.

That's why we need universal health care.

[grahamhgreen]

19. OR WHAT? It's not illegal if the patient has committed fraud. They can investigate fraud.

The fact is she's wrong - we told them this was a mjor issue and her response is BS PR.

We need to get rid of the mandate, or get a public option or single-payer.

The bill is a crap - wait til Welpoint gets the trillions we have mandated them.

[Divine Discontent]

22. can we get 500 recs for this? This story is DAMNING... they need stopped by our govt!

[Bette Noir]

25. How is this not illegal now?

If they have a computer algorithm set up to exclude them from having to pay for the care of people who have paid them premiums for exactly that purpose, how is that not evidence of intention on the part of the insurance company to commit fraud against the insured? How about a nice RICO investigation?

[liberation]

29. It is legal. A lot of people supporting the HCR PoS Bill made a lot of assumptions without bothering

to read the law.

They can still drop people via "internal" investigations for fraud and whatnot. They are the judge, jury, and enforcer.


Actions like these are going to multiply, as insurers want to dump as many patients as they can into the system before the law goes in effect. Then they can double dip: the dropped patients will then get back into their policies via state subsidies. I.e. they cut patients as soon as they become not cost effective, and then the government picks up the tab when it comes to get the actual care the patients paid for. That is if the patients survive long enough, or they can get some public assistance to get back in the fold.


A reform which did not tackle the main source of problems: the fact that for profit insurance carriers offer absolutely no value added in the delivery of health care. Was never much of a reform to begin with. But at least both parties got to play posturing, and score some cheap political points with their bases. It is a win win all around, except for the patients... they are still shit out of luck.

[postulater]

28. I've seen three people this week who could recover

from their health problem but can't afford the care and Medicaid won't pay for some of it. Now they are applying for disability.

What sense does it make for us to pay for permanent disability forever when they could recover at about a tenth the cost?

[subterranean]

30. How will the new health care law stop them from doing this?

Everyone knows insurance companies don't drop customers because they got cancer. They drop them for "fraud" and "misrepresentation" (which is conveniently discovered only after the cancer or other serious disease is diagnosed). Unless I'm missing something, there is nothing in the new law that will prevent them from continuing this practice.

Well, at least after 2014, when we get dropped by one company, we'll be able to get insurance from another one. Unless there's a loophole for that too.

[katandmoon]

33. It won't. But Obama got a bill to sign!

[lark]

85. You absolutey hit the nail on the head

This was all about political victory, nothing about really helping people. He pulled single payer and even public option off the table because it would have hurt his masters, the people really calling the shots. The absolute worst part of this is, other than the cost in health and aggravation, people will hate the results of this bill and it could keep Dems out of power for a very long time. His refusal to do the right thing is the mechanism that will probably limit him to 1 term. He turned victory for working folks into a possible loss by them, but a huge win for big insurance and big pharma.

His only chance now is to really put in some good tight financial regulations, but of course that won't happen either.

Is he a Repug plant? I listen to him and he sounds good, but then turns around and does bad things like letting all the Bushco folks off for their traitorous acts, ruining HCR, etc. etc.

[laughingliberal]

49. I think the loophole put in by the Senate allows this very thing to continue

and I find the White House's response of 'shock' about this wholly without credibility. If I knew they left this loophole for 'fraud' in the bill, and I did know it, I'm am quite certain it did not escape their notice.

[IndianaGreen]

71. The Left supported the House version, while Obama supported the Senate version

In the end, Congress passed the bill that Obama wanted all along: a love gift to the evil health insurance industry!

It was interesting to see how the GOP and the corporate Democrats play the good cop-bad cop game. Corporate Dems use the GOP and their tea bagging storm troopers to get the rest of us to support bills that are just as bad to us as if the GOP had written them. We should have opposed the corporate Dems with the same vigour we did the GOP and their tea baggers. None of them have our class interests at heart!

[andym]

76. Most of the "fraud"-based recission is because insurers claim unreported pre-existing conditions

That will not be allowed, because pre-existing conditions will not be accepted as a way to deny insurance. So what other kind of fraud could they come up with: person not really having the disease?
I don't think that will work.

They'll still be able to rescind on bureaucratic errors-- perhaps they'll not send a bill, and then when it isn't paid they can rescind someone. But if that is intentional, they would be committing fraud and subject to legal action.

[subterranean]

77. I thought about that, but

if they can no longer weed out people who have pre-existing conditions or charge them more, why have this clause in the bill? What other kinds of "fraud" or "misrepresentation" could there be? Maybe if someone lies about their age to get lower premiums? A misspelled word on the application?

The only reason they should be able to cancel a policy is non-payment of premiums. Period.

[andym]

79. lying about their age--> that could do it, misspelled words

probably not. Unfortunately, lying about one's age would be fraud. Only good thing is that greedy companies will try to catch people at this as early as possible to rake in more money sooner, so it is unlikely to cause disease rescissions.

[Bluebear]

38. Wellpoint: OK, in 2016, when your bill says we have to stop.

[SocialistLez]

39. Draft a strong consumer protection law

when it comes to health insurance and fine these fu**ers retroactively! Two can play that game!

Of course I know it's like wishing for a pony....

[Jefferson23]

41. Wellpoint, doing a great job making the case for single payer or

at the least a public option.

[IndianaGreen]

72. Last year was the historic opportunity for single payer, Medicare option for all!

Obama surrendered that on the altar of political expediency and corporatism!

Thanks a lot!

[Jefferson23]

87. Oh I know, but Obama also has to deal with the continued case the

health insurance companies will make for single payer, being the contemptuous bastards that they are.

[WillYourVoteBCounted]

42. sure and UN-Wellpoint will just raise their rates and deductibles

so that they won't be able to afford the premiums any more.

Insurance isn't sustainable.

[dflprincess]

44. If the deductibles are high enough

and what's covered is restricted enough they'll still be able to collect premiums and never pay a dime in claims.

But hey! The Insurance Company Profit Protection Act does require that annual mammograms are covered as a preventative test. But good luck to any of us if that routine mammogram shows something needs follow up. It can cost several thousand to find out the odd spot is benign.

[gleaner]

46. I gave this a "Rec" ....

Something everyone needs to understand is that existing health insurance companies are for profit businesses. Like all for profit businesses they emphasize the profit and put everything else second. I can't think of anything more calculated and cruel than what they are doing to the women who bought their insurance, paid for it and then when they needed it the most had it yanked away from them. These deliberate actions by Wellpoint left them both uninsured and now with a pre existing condition that no other for profit insurance company is going to cover. Even if the HCR bill that was passed was everything it should be they would have to wait four years. With cancer that can be a death sentence.

That is why I do not favor for profit health care. I favor single payer government run programs like Medicare that are regulated, affordable and transparent. The for profit companies are doing exactly what I knew they would do. Regardless of what was passed or its intentions there is no meaningful regulation. The insurance companies are exploiting every loophole they can find or make up. They will file lawsuits for years to keep from coming into compliance, because for them it is cheaper to pay lawyers than treat diseases like cancer or other conditions which are life threatening, chronic and expensive. They would rather pay for the lawsuits. It costs less and their bottom line looks better, and that is their only criteria.

Years ago I worked for a car insurance company which was used by lenders to force place on auto loans to protect their collateral. It did nothing for the individual who was buying the car except maybe pay off a loan balance if that was a condition of the policy. They gave us seminars and taught us every way they knew to get around dealing fairly with the people buying the cars. They were not our customers. The loan companies were and they paid the bills. The bottom line for us was to work to their advantage so the company could increase its profit and the Hell with everything else.

When California finally passed proposition 103 to give consumers a fair shake with all kinds of auto insurance the insurance companies took it to court and litigated it for years, even though it was a ballot initiative which had been written with that type of litigation in mind. Eventually our Department of Insurance was set up, our commissioner was duly elected and a law which provided a huge amount of punitive damages against the insurance companies for acting with bad faith toward consumers put a stop to the most abusive practices. But part of Prop 103 was rebates for consumers who had been overcharged and abused for years by the insurance industry. The insurance companies fought that tooth and nail and it was years after the other provisions had been litigated and enforced because they kept the rebates in court for as long as they could. Finally we did get our rebates.

It was not even that much of their net worth, but oh that holy bottom line. They were going to protect it at all costs just like the health insurance industry is trying to do now. We are not going to get any kind of meaningful and affordable health care until we take the profit out of it and let it be handled and regulated as it needs to be. Until then you might want to think of what you would do if you were one of the women that Wellpoint is fully prepared to murder. Because that is what they are doing. And they are doing it with premeditation in cold blood with specially designed software to choose the victims. So how much are those lives worth? How much is your life worth? How much is anyone's life worth as long as it is more profitable to let people die and you are operating a for profit company?

[Skittles]

52. disgusting

[FunMe]

55. May these FREAKING pieces of trash go to hell!

They will get their KARMA and will live their own HELL for doing this.

May they all rot in hell, their "lliving" one!

[Shining Jack]

56. What a bunch of greedy bastards !

That's a real nightmare !

[Vinca]

58. There was an article in the local paper about Anthem yesterday.

The state of Maine told them they couldn't raise rates 30 some odd per cent, so Anthem took the state to court. The judge ruled in favor of the state being allowed to limit the increase to 10% and noted that a guaranteed profit margin cannot be built into rates. Maybe the worm is turning in favor of consumers (formerly known as "patients").

[Christa]

63. K & Highly rec'd nt

[Dont_Bogart_the_Pretzel]

65. BS! How dare the U.S. tell a business how to do its job?

WE WANT LESS GOVERNMENT!







:sarcasm: from me but I'm sure some on the other side think it all the time.

[Phoebe Loosinhouse]

68. My own opinion is that the one guilty of fraud is Wellpoint

For targeting certain specific individuals with specific illnesses or conditions that they wanted to cleanse from their rolls under any pretext - I think it is a criminal conspiracy for the sake of profit. People who bought those policies were not told "if you get breast cancer or become pregnant we will do everything in our power to end your coverage".

I still wonder if the targeted people were those from small business or individual policies, further evidence of how well thought out it was, if that turns out to be the case. Those people would be the least likely to have large Human Resource departments to assist them.

Unless a fine reaches the point where it becomes more than the cost of the behavior it prohibits, it is meaningless. I hope a huge class action suit devolves from this. I think like Enron and Goldman, it could be another case where corporate misconduct actually warrants criminal charges. I also wonder if the victims themselves couldn't sue under the Americans with Disability Act - they have been discriminated against with extraordinary actions to deny them their benefits due to their specific illness/conditions that were not equally applied to other policy holders.

These are the companies that President Obama entrenched into our healthcare system for the foreseeable future without competition from a public option even though these horror stories have been around forever. Always remember that the insurance companies ADD NO VALUE and add cost. The profits are paid out disproportionately to their upper tier (United Health paid out over 1 BILLION in salary, bonus and stck options in one year to their CEO - google it if you don't believe me) I also personally believe that the healthcare reform will do little to alleviate medical bankruptcies because the costs of prescriptions,deductables and co-pays will still be more than enough to put American families under.

[freebrew]

73. It is discrimination, no doubt of it..

If it were not, the companies would have refused to accept the premiums for all these years.
If the policies were canceled only when there was a claim, they(the ins. cos.) committed fraud by accepting payment.
It is positive proof, by using this algorithm, that there was never any intention of honoring the contract with the consumer.
They accepted payment for a policy, attempting to find fraud now, when that should have been done prior to accepting the policy...

That's fraud on their part. The victims should have a very good case in court.

[hunter]

69. Wellpoint IS a cancer.

Other nations have developed remarkably effective cures and treatments for this sort of disease.

[IndianaGreen]

74. The for-profit health insurance industry is the cancer, not just WellPoint!

Obama's HCR forever enshrined into law the monopoly of the for-profit health care industry.

Another of those Obama BOHICAs we have come to expect from this Administration!

[change_notfinetuning]

80. Under Obama's health care deform, for-profit insurance is the only

pre-existing condition that will be safe from fraud investigations.

How come people are denied insurance for "fraud" discovered by insurance companies, but when an insurance company or pharmaceutical company commits real fraud, they are fined a usually insignificant amount as a percentage of profits (no one goes to jail, of course), and they are allowed to continue in business and to raise their rates or drug prices to compensate for the amount of the fine?

[Odin2005]

78. K&R

[salguine]

81. Wellpoint tells U.S.: "Fuck off. We own you. Now go get me some coffee." U.S." Yes sir."

[bamacrat]

86. More evidence of a need for a public option.

What if everyone with terminal illness or cancer or anyone denied from their private health lords were allowed to buy into medicare. How amazing that would be.