Wednesday, June 27, 2007

You Want Answers?

Remember the movie "A Few Good Men"? Remember the exchange between Jack Nicholson & Tom Cruise. "You want answers?" as Jack challenged Tom.

Now it seems ABC's Good Morning America is looking for answers.

Well, today we are announcing a GMA commitment to take a hard look at the health insurance industry, to get some answers about those policies we keep hearing about, about what happens to sick people in a time of need. Today, you're going to hear about something called rescission. It is a controversial practice where insurance companies retroactively cancel the policy, often after you're trying to make a claim. Chris Cuomo here again with the story of a young woman who faced a real crisis. Her sight was at risk."

No doubt, rescission is a controversial topic.

But so is insurance fraud.

According to the industry's, the insurance industry's own estimates, thousands of similar rescission investigations into policy holders occur every year. And most of them lose their coverage as a result. It's a frightening practices you might miss in the fine print of your health insurance policy. Shannon Dagher, a 22-year-old college student, says she was at the eye doctor for a check-up last November, one month after her new insurance policy kicked in when she received terrible news."

Shannon Dagher (Denied Insurance): "I was diagnosed with a very rare disorder It's called pseudo tumor cerebri. It basically looks and acts like a brain tumor."

Cuomo: "Now, Shannon's doctors say she needs surgery or she may go blind."

Dagher: "I'm petrified of the thought of going blind. I've never been sick before in my life. And now, in the past six months, I've started to lose my peripheral vision and I'll never get that back."

Cuomo: "But instead of authorizing the surgery, here insurer, Blue Cross of California stopped processing her bills

I would not suggest fraud in this case, but the carrier is obligated to investigate.

The vast majority of claims are paid on a timely basis with little or no investigation. But when a new policyholder submits an illness related claim within the first few months, the carrier investigates to see if there is a tie in to a pre-existing condition that was not reported on the application.

In other words, is the insured trying to pull a fast one on the carrier by deliberately withholding relevant information about their health that could affect the outcome of the underwriting decision.

"Isn't it a little fishy though that this rescission review process only begins after someone files a claim? Isn't that suspicious? You know, why don't you just do it when I'm applying in the first place, figure out whether I'm telling you the truth, like most industries.

One can also ask, isn't it fishy that someone visits a doctor in the first 30 days after the policy is issued only to be diagnosed with a serious medical condition?

I can't tell you the number of people I talk with during any given week that ask about how to get coverage for an existing condition.

And that is just the conditions they are willing to admit to . . .

Carriers do investigate up front. They rely not just on the application, but independent sources where your medical records and pharmacy records are stored. In many cases they also will request specific doctor records depending on what they find through other sources.

GMA went back to Blue Cross for clarification on Shannon Dagher's case. What really surprised us was that shortly after we asked about Shannon's policy, she learned that her investigation was complete and her policy would not be canceled.

Why is this a surprise?

The carrier did the investigation. Determined there was no fraud. Paid the claim.

Isn't this what carriers are SUPPOSED to do?

Seems like GMA can't handle the truth.
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