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Yes, big insurance can still use rescission to reject your insurance claims! - Huff Po

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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:49 PM
Original message
Yes, big insurance can still use rescission to reject your insurance claims! - Huff Po
From the Huff Po:

"According to a recent blog post by Ivory, health care companies have found a loophole wherein they can still deny care:

Despite a flurry of news reports that the health care package bans a controversial practice where insurers retroactively cancel the health coverage of patients, the law has not changed. Yes, federal law already outlaws rescission, except in cases where insurers say patients have committed fraud.

But insurers generally are not required to prove that the fraud was committed knowingly, and can revoke coverage retroactively -- saving large sums -- at little risk to themselves. Absent any new disclosure requirements or industry standards governing rescission criteria, insurers will ostensibly continue to be able to exploit the loophole to their advantage.

Have your health insurance claims been denied retroactively? Do you have inside information or insight on about how insurance companies handle rescissions?
Tell us your story or sign up with our Citizen Assignment Desk for updates and volunteer opportunities on this project."

Share your story here: http://huffpostfund.org/stories/pages/help-us-investigate-health-insurance-claims#form


OK, so rescission is still in effect - and they've already started denying that they need to take kids with pre-existing conditions - soon, after the mandate gives them trillions, the reform laws will be rendered meaningless - we must get real reform, expand Medicare, get a public option, kill the mandate, or vote these bums out.
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mdmc Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:49 PM
Response to Original message
1. yeah I know
..
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LiberalLoner Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:50 PM
Response to Original message
2. Sucks. :( Wish we could have single payer. n/t
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Uncle Joe Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:55 PM
Response to Reply #2
5. That would be too perfect and you can't have the good being the enemy of the perfect,
so bad or mediocre must be passed as they are more natural enemies of the "good."
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midnight Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:51 PM
Response to Original message
3. Put teeth into this law, and make it work....
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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:52 PM
Response to Original message
4. Yeah, fraud. You know, claiming you'e insured when you aren't
Fraud. Not lying about pre-existing conditions fraud because that won't exist anymore.

This was argued on a daily basis before the bill passed. Nothing new.
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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 04:57 PM
Response to Reply #4
9. Are you sure they can't ask you about your conditions?
Edited on Wed Mar-31-10 04:57 PM by Oregone
Isn't it that they just cannot deny to cover you anymore because of them?

Don't they still have the right still to collect whatever information they want about your health prior to issuing a policy?
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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 05:11 PM
Response to Reply #9
11. They can't base premiums on health
So I don't know what the purpose of asking about pre-existing conditions would serve. I mean if someone goes to Canada illegally, and signs up for their health plan illegally, is Canada not supposed to deny the coverage due to fraud??
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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 05:24 PM
Response to Reply #11
12. "So I don't know what the purpose of asking about pre-existing conditions would serve"
Edited on Wed Mar-31-10 05:31 PM by Oregone
Um. Duh. Its serves as a record that enables them to investigate whether there was fraudulent misrepresentation.


"I mean if someone goes to Canada illegally, and signs up for their health plan illegally"

I'm not sure how that could happen. When you sign up, you must first prove you are a legal resident or citizen from another province by providing the proper documentation. Of course, if someone defrauded the government with forged docs, that somehow checked out, they would not only be uncovered, but also in jail. The fraud would be blatant and the government would bring forth the very charges, without a motivator of profit driving them.

But this is a bit different of a case. If they claim fraud, I'm not even sure they have to prove it prior to rescission (only inform the policy holder about the termination). Although the burden of proof may ultimately lie on the private corporations in a court of law, who has the resources to see that through to the end? For every case they lose, there could be a slew they save money on by forcing it into a long litigation instead of paying out the claim.
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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 05:39 PM
Response to Reply #12
13. The "fraud" you speak of would be a pre-existing condition
and having a pre-existing condition isn't grounds for refusal of a policy or treatment, so who would commit that particular "fraud"? Nobody. That is not the fraud they're talking about.

They're talking about the kind of fraud that would put someone in jail in Canada, according to you.

This is just another bogus red herring.

There are plenty of positive changes to this bill people could be arguing FOR. But nooooo, once again, the left goes off on a wild goose chase and ends up with a pile of death panels of their own. It's so predictable.

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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 05:47 PM
Response to Reply #13
14. Fraud is fraud
Edited on Wed Mar-31-10 05:51 PM by Oregone
The grounds for refusal wouldn't be the condition, but their misrepresentation regarding it. There is a clear distinction.


"They're talking about the kind of fraud that would put someone in jail in Canada, according to you."

You mean forging your birth certificates or immigration papers? No, thats not what's being talked about here. In fact, they are quite ambiguous about exactly what they mean by "fraud" in the bill; just that it can be used as an excuse for rescission. Do you not think they will exercise that language to the full extent and act in any case that can thinly constitute a case of fraud?

As far as Ive been aware, "fraud" is the main excuse behind rescission as has been. They investigate to find inconsistencies with applications and claim fraud. The bill removes people's motivations to be inconsistent on applications (and be fully truthful aboput pre-existing conditions), but mistakes can still be made about illnesses someone may of had 20 years earlier.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:16 PM
Response to Reply #13
21. Having a preexisting condition would not allow them to refuse to cover you
But we are talking about rescission here which is cancelling your policy when you get sick. And if you neglected to mention some condition or other on your application that would suffice. They need to close this loophole and I was saying they needed to close it before they passed the bill. The bill passed and it still needs to be closed.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:19 PM
Response to Reply #12
22. They can rescind the policy and force the patient to go through their 'internal review' process
If you fail to get relief that way then there's an external review process. The patient may prevail in the end but will they still be alive?
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:13 PM
Response to Reply #4
19. That doesn't make a bit of sense
Edited on Wed Mar-31-10 06:36 PM by laughingliberal
If you're not insured there's no policy to rescind. How would lying about being covered lose you an insurance policy you don't have? There's nothing in the bill which defines, "fraud." It will still be the insurance companies defining it. And it will still be up to the insured to try to prove a negative-that they didn't intentionally leave out any information.
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DireStrike Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Apr-01-10 10:16 AM
Response to Reply #4
62. Are you saying that the industry will only use this in cases of fraud?
They will use it wherever it will save them money. The small percentage of cases where the "fraudulent" insured person has the time and money to pursue a lawsuit to its conclusion would only amount to a handful of millions in settlements. Which would probably be less than they can save by claiming fraud wherever the hell they feel like it, and stalling and continuing to screw people over as the government looks on, smiling and nodding.
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:57 PM
Response to Original message
6. The legal definition of fraud requires that it be committed knowingly.
If it's not done knowingly, it's not fraud, it's error.

http://legal-dictionary.thefreedictionary.com/fraud

"Second, the defendant must know that the statement is untrue. A statement of fact that is simply mistaken is not fraudulent. To be fraudulent, a false statement must be made with intent to deceive the victim. This is perhaps the easiest element to prove, once falsity and materiality are proved, because most material false statements are designed to mislead."

I have a feeling that no court in the country would uphold a rescission based on "fraud" if their was no knowledge by the insured that they made a statement the insurance company deems false, it just wouldn't meet the legal criteria for "fraud".
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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 04:59 PM
Response to Reply #6
10. Isn't negligent misrepresentation classified as fraud?
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Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 05:49 PM
Response to Reply #10
15. No, and the gist of fraudulent misrepresentation
is (1) knowing misrepresentation (2) intended to induce the other party to take an action it would not otherwise have done (intent to induce) (3) that the other party actually relied on in taking that actio (detrimental reliance).

Once the bill is fully implemented, the insurance company has to issue you a policy and cannot base the cost of the policy on your health.

You could be 24 hours from a open heart surgery and they would have to give you a policy, and the price for that policy would have to be the same as if you were perfectly healthy. That means they have no choice - so whatever you say about your health status is irrelevant to whether they give you a policy or what it costs (knocking out the both the second element). No intent to induce, no detrimental reliance.

The details of fraudulent misrepresent vary from state to state, but you can't have fraudulent misrepresentation without at least those 3 elements - so no fraudulent misrepresentation.

(Negligent misrepresentation would include at least #3 and a less strong version of #1 - and again, under the new rules, #3 cannot exist - so no negligent misrepresentation, either.)
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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 05:56 PM
Response to Reply #15
16. But they can claim intent and leave it to a court to sort out the details
Or settle for a bit under the claim.


But I don't think they are required by law to keep the policy active until its sorta out legally.
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Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:09 PM
Response to Reply #16
18. Nope. You have to have specifically allege all three elements
(and any other details are required under the applicable law) and there is nothing to allege on the latter two elements. There is no possible inducement, and no possible detrimental reliance. Any first year law student would be able to get that claim dismissed with a one page motion.

It would be similar to someone claiming that you injured them by driving your car into the horse they were riding on Wacka-Wacka street, when they don't own a horse, and there is no Wacka-Wacka street. It doesn't make a bit of difference that you own a car, if you could not possibly have driven it into a horse that doesn't exist on a street that doesn't exist.
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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:14 PM
Response to Reply #18
20. "Any first year law student would be able to get that claim dismissed with a one page motion"
Edited on Wed Mar-31-10 06:14 PM by Oregone
Get what claim dismissed? The only claim the insurer has to make is to the private individual (not to a court of law).

Look at the bill...it says before rescission due to fraud all they must due is issue a notice of termination (paraphrased from the last time I read it).

It is the private individual that has to take it to court and hire a lawyer to combat the rescission, by proving there was no case of fraud.

Correct me if I'm wrong here, but the insurers are allowed to act without legally establishing the incidence of fraud. Its up to the individual to take the matter to the courts. There is nothing to simply dismiss, as you suggest
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:34 PM
Response to Reply #20
25. The first recourse the patient has, before they can pursue any other course,
is an 'internal review process.' Essentially, the insurance company will 'review' their own decision. If the patient does not prevail in that, then there is access to an external review process, presumably the same one they have now which is to appeal to the state's insurance commission to review it. All this is just the same tricks as ever. Drag out the process until the patient dies or, barring that, is much closer to death and won't be around long enough to take too many expensive treatments.
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Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:41 PM
Response to Reply #20
26. You'll have to wait for the regs to see how it will be implemented
Those haven't been written yet. All that we know at this point is how the existing law is implemented.

If you want input as to better protection regarding the recission practices, watch the Federal Register for the regs and comment on them when they come out. If you haven't tried that before, you have a far better chance to influence the regs than any statute. Typically, hardly anyone comments (at least compared to the number of comments on statutes) so any comments made carry far more weight.
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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:54 PM
Response to Reply #26
39. I beg to differ - here is how the insurers operate (link)
"But rescission victims testified that their policies were canceled for inadvertent omissions or honest mistakes about medical history on their applications. Rescission, they said, was about improving corporate profits rather than rooting out fraud.

"It's about the money," said Jennifer Wittney Horton, a Los Angeles woman whose policy was rescinded after failure to report a weight-loss medication she was no longer taking and irregular menstruation.

"Insurers ignore the law, and when they find a discrepancy or omission, they rescind the policy and refuse to pay any of your medical bills -- even for routine treatment or treatment they previously authorized," Horton said.

She and others from around the country accused insurers in testimony of gaming anti-fraud laws to take policyholders' premiums, only to drop people who developed serious illnesses. They testified that they or a deceased loved one had had policies canceled over innocent mistakes and inadvertent omissions on their applications.

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

The committee's investigation found that WellPoint's Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure. And the committee obtained documents that showed Blue Cross supervisors praised employees in performance reviews for rescinding policies.

One employee, for instance, received a perfect 5 for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care."

http://www.consumerwatchdog.org/patients/articles/?storyId=27994
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Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:27 PM
Response to Reply #39
51. That is how they operate now - when they are permitted to pick and choose
their clients.

Although only the first element is spelled out in the article, what the insurance companies were saying was:

1. You lied about your health
2. You lied because you wanted us to give you insurance
3. We gave you insurance only because we believed your lie

That means you got the policy by fraud, and we are entitled to cancel the policy.

#3 can never be true under the new law. The insurance company has no choice - it is required to give everyone a policy. If all three statements aren't true, the insurance company doesn't have fraud, and it can't rescind - even if you get sick, and even if it is directly related to what you lied about.

The details of implementing the law - whether they will even be able to ask about health, for example - will be sorted out in regs. Since they haven't been written yet, speculation about how insurance companies will try to get around the details of implementation is pretty much a waste of time at this point.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:49 PM
Response to Reply #51
55. I see no reason to leave anything to chance or give them any wiggle room
We were told that once HCR passed your insurance company would never be able to cancel your policy as long as you paid your premium. The only committee that passed a bill with this exception in it was Baucus' Senate Finance Committee. I see no good reason to leave this door open for them. Close it up before the mandate goes into effect in 2014 and there won't be any need to argue about it.
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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Apr-01-10 10:09 AM
Response to Reply #51
61. What they say is "you are sick, it will cost us too much money, is there anything we
Can find in your history that you did not disclose. Like the time you used that acne cream. You're failure to disclose that constitutes fraud, your policy is cancelled. Don't like it? See you in court without team of high prced lawyers."
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Foo Fighter Donating Member (621 posts) Send PM | Profile | Ignore Thu Apr-01-10 12:02 AM
Response to Reply #39
59. Exactly.
Nice post, as painful as it was to read.

"A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne."

Good gawd, how despicable. And we can expect more of the same. Without SP or a PO, we are SOL.
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:49 PM
Response to Reply #18
28. Bingo. The burden of proof lies with the one alleging fraud, not the one accused of fraud.
Previously, an insurance company could simply claim, for example, that you didn't disclose a pre-existing condition. Now that they no longer have that avenue, they must claim that you intentionally defrauded them. That claim is easily met with a lawsuit which ends up being cheaper for them to pay the claim than to defend the lawsuit(punitive damages can be a bitch, and juries don't like insurance companies that act in bad faith).

An insurance company with a good legal department will not allege fraud unless they can prove it in a court of law, it's too costly.

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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:57 PM
Response to Reply #28
29. "ends up being cheaper for them to pay the claim than to defend the lawsuit"
We will see how that plays out actually. Its tough to figure out which is cheaper from the outset. Not everyone will have the resources to see their case all the way through. The insurers probably don't even know yet which option is cheaper
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 07:21 PM
Response to Reply #29
30. A case like that would be handled on contingency basis by any lawfirm
You wouldn't pay any fees unless you won.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 07:38 PM
Response to Reply #30
31. Uh huh. Except the law only provides for an internal review process followed by an external review
I'm assuming you would be free to sue, but I'm not sure of that, once you get through both of those.
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:31 PM
Response to Reply #31
35. Not exactly true. The insurance company says they only provide that
A lawsuit for bad faith is entirely separate. A suit for breech of contract, bad faith, etc. can be filed at any time. I spent many years as a paralegal handling cases like that (among other types of cases). Hell, I even worked for the dark side for a time and defended cases like that before I woke the hell up.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 09:22 PM
Response to Reply #35
43. Perhaps people are free to sue before they get through the review processes
Good luck with this 1) finding an attorney to take the case 2) Getting it to court while your condition is still treatable.

Yes, insurance companies have often lost in these cases but it takes time and THAT is the real purpose of the practice. If they can't get completely out of covering something the next best is delay as long as possible. What we are talking about here is something that generally is done to people when they are diagnosed with something very serious and very expensive. If they can delay a cancer patient starting treatment for several months, they save a bundle. The patient will either die before it's settled or will be very much more advanced in their disease process and will not live long enough to take as many treatments. That's the game they've always played. We have time to fix this before we have to worry about leaving people to have to find legal help for it.

Where in the hell are all those people who were screaming we needed to pass the bill so we could start fixing it?
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 09:44 PM
Response to Reply #43
46. Get back to me when you've spent a decade or so in courtrooms on both sides
Edited on Wed Mar-31-10 09:45 PM by ET Awful
of cases involving insurance companies.

Once you've done that, get back to me.

For instance, when you know what fraud is and what it entails then we'll talk.

Your sensationalist rhetoric serves no purpose other than to get people hyperactive over something that is much more easily addressed than you seem to think.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 10:24 PM
Response to Reply #46
47. How about if we just close the fucking loophole before we put people in the position of
spending a decade of their life in a courtroom dealing with this crap? Is there some problem with that? I mean, what purpose does it serve to leave it there open to abuse by an industry we already know will seize on any opportunity they can find to screw their customers? Do we just leave the loophole and wait for them to abuse it and then spend a year or more fighting to get the legislation fixed? Why? Who benefits from leaving it there?

I read this loophole in the bill before it passed. I also know bills passed out of 4 committees without the loophole. It was Baucus' gang of industry whores who put it there which tells me all I need to know about who it is meant to protect. The article posted here is by someone who sees the same thing I saw in it. Why don't we just get it tightened up? If I'm wrong then closing the loophole will just be something we do to reassure people. If I'm right, we'll be saving a lot of people a lot of misery.

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Foo Fighter Donating Member (621 posts) Send PM | Profile | Ignore Wed Mar-31-10 11:56 PM
Response to Reply #47
58. +1000000000000. n/t
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:24 PM
Response to Reply #6
23. How do you prove a negative?
Edited on Wed Mar-31-10 06:24 PM by laughingliberal
As always, it will be up to the patient to prove they didn't know about it or did not intentionally withhold the information. The remedy if your policy is rescinded is to first go through an internal review process (with the insurance company). If the insurance company finds against you in their own favor (ya think?) then you can request an external review process. If you are still alive at the end of this you might prevail. But you might also now have a stage IV breast cancer which was a stage I when you started the process.


edited punctuation
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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:41 PM
Response to Reply #23
38. This is exactly it!
Edited on Wed Mar-31-10 08:42 PM by grahamhgreen
They rescind based on the accusation that you committed fraud - it's up to you to disprove it.
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eleny Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 03:59 PM
Response to Original message
7. We'll be fighting these battles for some time since the right thing wasn't done in the first place
The apologists around here will be a busy bunch.

K&R
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ixion Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 04:35 PM
Response to Original message
8. ah yes... I said they would find loopholes
and sure enough...
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Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:00 PM
Response to Original message
17. Recission is not permited now, or under HCR, absent fraud
and once the ban on selective issue and coverage is fully in effect, fraud should not be an issue in the way it is now (if companies are even permitted to ask about health, it cannot be used to decide to issue a policy or to price it, so fraud cannot arise from misstatement of your health status).

The (current) concern is that restating the current law in the bill that was just passed is not strong enough to fix a problem that is occurring despite the existing law.

Nothing from HCR has gone into effect yet. The earliest provisions go into effect in 90 days. Any recission happening now is still under the old law.

Give the regulators a chance to write the implementing regs - the intent of the law is clear, the regs may tighten it up even more. If you want input as to how to make sure there are no loopholes, watch the Federal Register, read the regs when they are published, and comment on them.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 06:28 PM
Response to Reply #17
24. This isn't about being able to refuse to sell you a policy or charge you more for it based on prior
conditions. This is about rescission where they cancel your policy when you get sick because you neglected to mention this or that condition.

This loophole is quite plain and I wrote about it many times before we passed the bill trying to get people to raise a little heck and demand they fix this before passing the bill.
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Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 07:49 PM
Response to Reply #24
32. It is about issuance and price.
Rescission is ONLY permitted if there is fraud. Fraud is far more than just lying (or neglecting to mention a health condition).

You have to be lying for a purpose (to get insurance - or a better price - or pre-existing conditions covered, for example) AND the insurance company has to do something only because it believed your lie (issue a policy, or give you a particular price for the policy or cover pre-existing conditions when they are not required to). In other words, in order to cry fraud the insurance company has to look at why you lied, and whether you actually tricked them into acting - and that gets you (in most instances) to getting coverage or getting a better price.

If they are legally required to give you the policy, even if you tell them the truth (which they will be when HCR is fully implemented), it is impossible for them to have acted in reliance on your "lie" Meaning no fraud, and no legal grounds for rescission.

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:18 PM
Response to Reply #32
33. Please explain how your post jives with the wording of the bill
which says they may not rescind or cancel your policy except in cases of fraud? Rescission is not refusing to sell the policy to you. It is cancelling it at a later time (generally when a patient gets sick). There was no reason to include that 'exception' there except to allow the insurance company a loophole so this practice could continue.

We were told an insurance company would no longer be able to cancel your policy when you get sick (which is what rescission means). I wrote extensively on the presence of this loophole before the bill passed. It's there. It means exactly what it always meant and it needs to be closed. They may be required to sell you the policy but this loophole still allows them to cancel it for 'fraud.' Nothing, not one thing, in this bill changes the way the insurance companies define fraud. Why are they even allowed to question you on your health history in light of the guaranteed issue? Why? It is for the express purpose of continuing to do this to people. This loophole was not in several of the bills which passed out of committee. It was included and made it to the final bill by Baucus' gang of criminally compliant industry prostitutes.

People need to quit piling on the posters here who are pointing out the gaps in this bill and start raising the roof with lawmakers to change it. There was enough shouting down of any criticism here during the debate by those who were desperate to see anything pass. Now, it's passed. The time for denying the criticism is over! It is time to start looking at at getting these loopholes closed up. This is just one of them. We have til 2014 to fix this. Let's get busy.
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:41 PM
Response to Reply #33
37. First, your definition of the word "rescission" is faulty.
Rescission is NOT canceling your policy because you get sick. Rescission is retroactively canceling your policy for ANY reason. For instance, your auto insurer can rescind your policy if you lose your license. Your home owners insurance can rescind your policy if you (for the sake of argument) are found to be engaging in illegal activities on the property. A health insurer could rescind your policy through your employer if your employer royally f'ed up the paperwork, etc. involved with your policy. Hell, they could rescind the entire group policy if they found fraud on the part of the employer which was used to gain discounts on the group policy.

If you don't know what rescission actually is, your entire argument kind of falls on its face.
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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:57 PM
Response to Reply #37
40. This is what they do and will continue to do
"...rescission victims testified that their policies were canceled for inadvertent omissions or honest mistakes about medical history on their applications. Rescission, they said, was about improving corporate profits rather than rooting out fraud.

"It's about the money," said Jennifer Wittney Horton, a Los Angeles woman whose policy was rescinded after failure to report a weight-loss medication she was no longer taking and irregular menstruation.

"Insurers ignore the law, and when they find a discrepancy or omission, they rescind the policy and refuse to pay any of your medical bills -- even for routine treatment or treatment they previously authorized," Horton said.

She and others from around the country accused insurers in testimony of gaming anti-fraud laws to take policyholders' premiums, only to drop people who developed serious illnesses. They testified that they or a deceased loved one had had policies canceled over innocent mistakes and inadvertent omissions on their applications.

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

The committee's investigation found that WellPoint's Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure. And the committee obtained documents that showed Blue Cross supervisors praised employees in performance reviews for rescinding policies.

One employee, for instance, received a perfect 5 for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care."

http://www.consumerwatchdog.org/patients/articles/?storyId=27994
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 09:40 PM
Response to Reply #40
45. And those type of rescissions are not permitted under the bill because they DO NOT
Edited on Wed Mar-31-10 09:42 PM by ET Awful
constitute fraud by any legal definition.

Once again, fraud requires a willful intent to deceive for personal gain or to deprive the defrauded entity of property. None of the cases you cited constitute fraud under any legal definition.

The ability of people here to misread, misinterpret and misunderstand the law is comical.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:33 PM
Response to Reply #45
53. Let's just close the loophole
See? Simple.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 09:00 PM
Response to Reply #37
42. Yes. Rescission is canceling your policy for any reason
It most often is done when people get sick.

I've been an RN for 27 effing years. I damned well do know what rescission is. And I know most people find the insurance company does it when they get sick.

And this part of the law is addressing more of the individual market than the employer based market.

But, please, just keep arguing with the messengers. Don't, by any means, consider contacting any lawmakers to let them know we want this fixed.
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ET Awful Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 09:38 PM
Response to Reply #42
44. Little tip: Being an RN does not equate to knowing how the law works
Edited on Wed Mar-31-10 09:38 PM by ET Awful
Tell you what, you stick to taking care of sick people. Let the people who understand the legal system handle the legal questions.

Sorry, but you're spreading misinformation with little basis in actual fact.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:26 PM
Response to Reply #44
50. No, but It's given ample opportunities to watch how insurance companies screw their customers
Edited on Wed Mar-31-10 11:38 PM by laughingliberal
What's the problem with closing the loophole? Who benefits from leaving it in? I believed this loophole allowed the insurance companies to continue this practice when I read the bill. Apparently, the writer of the article posted in the OP saw the same thing.

5 committees passed an HCR bill. Only allowed 1 this loophole through. All the others outright banned rescission except for failure to pay the premium. It was Baucus' gang of industry whores who put it in. It's obvious who benefits from it and it just needs to be closed. We have until 2014 to work on that. What's the problem?
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Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:12 PM
Response to Reply #33
48. They cannot cancel your policy when you get sick
EXCEPT for fraud. So if they are cancelling your policy when you get sick they are accusing you of having committed fraud. Usually (under the current law) they are accusing you of having lied in order to get the insurance.

They don't get to legally yank your insurance (now or in the future) just because of a lie. Your lie had to hurt them. Because they are required to give you a policy regardless of your health status (under the new law), telling them you are healthy when you are not can't possibly hurt them - so no fraud. If you didn't commit fraud, they can't rescind your policy when you get sick.

I am not shouting down criticism - I am trying to explain what fraud is - and how the two parts of the statute work together to mean that after the law is fully implemented your policy cannot be rescinded for fraud even if you blatantly lied about your health on an application, because your lie could never (under the new mandatory issue provisions) hurt them.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:29 PM
Response to Reply #48
52. Let's just close the loophole
Why is that a problem? 4 out of 5 committees that passed a health care reform bill outright banned rescission for any reason except failure to pay your premium. Why would anyone defend a loophole that Baucus and his gang of six industry prostitutes wrote into the bill? Who would you guess it was put in to protect? We have until 2014 to fix this. Let's focus on that.
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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:48 PM
Response to Reply #48
54. They can stop paying your bills. They can cancel and you have to make the
Multi billion dollar company pay.

It's you vs a team of industry lawyers.

You still arguing your case?

In the meantime, they are not pauing your medical bills and your trying to get them into court. Good luck.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:53 PM
Response to Reply #54
57. Right. If the insurance companies believe they are being defrauded make them prove it before they
can cut off coverage. If they prove the fraud they can go after the customer to recoup their losses like anyone else. It is not okay to leave the burden of proof on the accused while life saving treatments are delayed. We were told that HCR would mean your insurance could never be cancelled for any reason as long as you paid your premiums. I believe we need to hold them to that promise.
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greencharlie Donating Member (827 posts) Send PM | Profile | Ignore Wed Mar-31-10 06:43 PM
Response to Original message
27. time for more regulation... nt
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amborin Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:21 PM
Response to Original message
34. as if we didn't know. state of California has had to drop its suits against Anthem for recission
anthem can out-spend the state
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:34 PM
Response to Reply #34
36. Yep! And, despite what some here have said, the enforcement of the regulations will still be left to
the states. The states already can't keep up with enforcing their own regulations and after 2014 they get to deal with tons more customers in the system. And, AFAICS, there was no money allocated for the states to help with the additional resources this will take.
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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 08:58 PM
Response to Reply #36
41. And when the insurers are mandated trillions, there will be no stopping the abuses.
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defendandprotect Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:15 PM
Response to Original message
49. Seems they were also trying to renege on the NO pre-emptive for children deal . . .
Evidently, Obama had to WARN them two days ago cause they were trying

to get around it -- !!!

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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-31-10 11:51 PM
Response to Reply #49
56. And they will try and try again for the next 50 years until they win. The mandate gives them
Unlimited financial resources to skirt the laws.
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defendandprotect Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Apr-01-10 12:15 AM
Response to Reply #56
60. We are strengthening our enemies with our own tax dollars -- !!!
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defendandprotect Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Apr-01-10 10:18 AM
Response to Original message
63. And, seemingly, they're not the slightest bit concerned about
having their "gaming" of the system met with the addition of a Public Option

to the new health care reforms!

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