Rescissions, Rescissions

[Welcome Kaiser Network readers!]

Out on the left coast it seems the attorney's favorite sport is challenging policy rescission's.

So far the major players in this game (from the carrier side) are Kaiser, HealthNet, Wellpoint (Blue Cross) and United Healthcare.

Aetna has not been a player.

But in a pro-active move, the Hartford based carrier is taking a stance on rescission's.

According to the Hartford Courant, Aetna will now let members appeal rescission decisions to an independent panel of doctors either before or after contesting them via its own internal-review process.

I applaud this effort.

Anything that can stave off a nasty legal fight is good for all parties.

the company says it’s revoked only 165 of the 570,000 individual-insurance policies it’s issued since 2005. Most of those policy cancellations involved fraud,

That is a very small number. Apparently they are doing something right.

But there is this bit of information that I find most curious.

Consumer Watchdog also argues that the legal standard for rescissions needs to be tightened to cases where policyholders intentionally misrepresented application information, not simply made inadvertent mistakes.)

Sounds great, but how does one prove it was an inadvertent mistake?

In a case involving HeatlhNet that was reported here, it seems the applicant "inadvertently forgot" their true weight and failed to disclose she had serious heart damage as a result of taking Phen-Fen.

In the case of Phen-Fen, she had filed a claim, and collected a judgment from the drug manufacturer based on medical records substantiating her heart damage.

Fraud or inadvertent mistake?

Either way the carrier lost.