Home

REPUBLICANS DEFENDING MEDICARE: DUPLICITY BEYOND BELIEF

Posted by John Geyman MD PNHP on September 14, 2009 - 12:44pm

Medicare has long been a flashpoint generating intense disagreement across party lines over the role of private markets versus that of government. Republicans have fought against Medicare from the very beginning. They bitterly opposed it in various committees in both houses of Congress in 1964 -1965. But they relented, at least for a while, in the face of strong public support for the program, and it passed with bipartisan support.



Almost overnight, tens of millions of American seniors gained access to affordable health care. Medicare was also a boon to the medical profession, hospitals, and the insurance industry, since Blue Cross became the main fiscal intermediary between government, physicians and hospitals.

But that honeymoon was not to last. Republicans have been trying to rein in “entitlement programs” and chip away at Medicare since the start of the Reagan years in 1980. As Speaker of the House in 1994, with a new Republican majority in Congress, Newt Gingrich introduced a bill to privatize and convert Medicare to a smaller program with defined contributions instead of one for all seniors with benefits defined by law. His statement at the time clarified the conservative agenda: (This kind of ‘reform’ might result in “solving the Medicare problem” and lead it to “wither on the vine.” Later pronouncements have followed along the same line, as illustrated by Grover Norquist’s desire to “shrink the government down to the size that it could be drowned in a bathtub.”

With the Balanced Budget Act of 1997, the conservatives’ goal to privatize Medicare was advanced with the new Medicare + Choice (M + C) program. These private plans, mostly HMOs and PPOs, were promoted as offering more choice and value than traditional Medicare. But their subsequent track record belied those claims. Instead, these programs proved themselves unstable in the marketplace, seeking out favorable markets, leaving others when profits were not sufficient, cherry picking the market by avoiding sicker enrollees, and costing the government an average of 13 percent more per enrollee than in traditional Medicare. About one-third of Medicare beneficiaries enrolled in M + C plans between 1999 and 2002 were dropped when their plans abandoned the market, often forcing patients to change physicians and return to regular Medicare.

As M + C programs became discredited, Republicans renewed their attack on Medicare with the passage in 2003 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), another bonanza for the insurance and drug industries. The MMA established private Medicare Advantage plans (MA) as successors to M + C plans and turned over the drug benefit to the private sector, even prohibiting the government from negotiating drug prices as the Veterans Administration does so effectively. As expected, MA plans have many of the same problems as M + C plans. They are still subsidized by government overpayments averaging 14 percent more than Medicare, while providing less efficiency, choice, value and reliability than traditional Medicare.

Today, as health care reform proposals take shape amid a highly polarized debate in Congress and across the country, conservatives (including Republicans, Blue Dog Democrats and some Independents) have mobilized once again to expand private markets for the insurance industry and other corporate stakeholders in the medical industrial complex. While overlooking their role in fueling health care inflation in both private and public programs, conservatives are intent on handing the party in power a defeat over health care reform, but at the same time maneuvering to expand future health care markets.

In their strategy to kill ObamaCare (whatever that may turn out to be), they are all of a sudden sounding like defenders of Medicare beneficiaries against the presumed evils of big government. Consider these examples of their new-found protector role of seniors:

• Senator Mike Enzi (R-WY) and member of the Gang of Six charting policy in the Senate Finance Committee, warns that “Democrats are cutting hundreds of billions from the elderly and planning to limit or deny care based on age or disability of patients.”
• House Minority Leader John Boehner (R-OH) claims that projected reductions in the growth of Medicare spending means “fewer choices and lower health care quality for our nation’s seniors.”
• In order to “assure that our greatest generation will receive access to quality health care”, Michael Steele, chairman of the Republican National Committee, recently proposed a ‘Seniors’ Health Care Bill of Rights’ with these provisions:

“(1) We need to protect Medicare and not cut it in the name of ‘health insurance reform’;
(2) We need to prohibit the government from getting between seniors and their doctors;
(3) We need to outlaw any effort to ration health care based on age;
(4) We need to prevent government from dictating the terms of end-of-life care; and (5) We need to protect our veterans by preserving Tricare and other benefit programs for military families.”

The cynicism of these statements almost defies belief, given the long Republican track record of trying to undermine Medicare at every turn. These would-be defenders of Medicare pretend to be protecting seniors from an uncaring government, while raising such scare words as rationing and loss of choice, coverage and benefits. Their real goal is to advance their narrow agenda of undermining public programs by privatizing them to their best advantage.

The Republican machine, based on long experience, is expert at scare tactics. One of many examples is the threat of “death panels”, raised by former vice-presidential candidate Sarah Palin and others in reaction to a provision (Section 1233) in the House bill (H.R. 3200) which would provide funding for voluntary end-of-life counseling by physicians on such matters as living wills. Ironically, this provision was suggested by Johnny Isakson, Republican pro-life senator from Georgia, who has been advocating such counseling for years. But as the Medicare Rights Center, AARP and many experts have confirmed, none of these scare claims have any substance in fact.

So what we are seeing is blatant distortion, disinformation and deception by conservative forces bent on defeating any health care reform advanced by the party in power. Fanning concerns and worries among seniors is intended to weaken seniors’ support for reform and perpetuate the hold of private markets on the system. Meanwhile, of course, Republicans keep trying to exploit private Medicare markets to their own advantage as long as the program is alive.

Adapted in part from Shredding the Social Contract: The Privatization of Medicare, 2006, with permission of the publisher Common Courage Press.

Buy John Geyman's Books at: http://www.commoncouragepress.com

»

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.

Bias

Submitted by Squibcakes on September 14, 2009 - 5:58pm.

This has got to be the most misleading, distorted summary of the history of private administration of Medicare I have ever read.

In truth, private carriers started off being reiumbursed what Medicare cost (equal)... which of course attracted particpation because private insureres knew they could do it more efficiently and hence make money. They did. And they made the benefits more generous than traditional medicare with the most of the difference.

Then congress held their reimbursement flat (after democrats won majority). Insurers soon dropped out when they were reimbursed less than enough to do it profitably. Then congress gave attracted them back (after republicans won a majority) with increased payments, which still exist today.

So it's congress that determines the cost. It doesn't cost more because the model has been "discredited". It just a matter of policy. As congress decides to take money away from this program, then benefits will recede and insurers will leave the market. There are millions and millions of people happy with these plans. So much for 'keeping what you like' if the current proposals actually become law.

»

Domestic Terrorism

Submitted by garyruehle on February 10, 2010 - 12:22am.

This by Squibcakes was obviously written by an insurance company hack. Here is my story of "happiness with these plans."

DOMESTIC TERRORISM

We have all read and heard horror stories about medical insurance companies and how they just plain refuse to pay for covered medical services and the horrible and life threatening and crippling strain this puts on the average American citizen, his family and his friends. Here is my personal horror story of how I was Totally Terrorized by my health insurance company. ENOUGH IS ENOUGH!

My story is repeated tens of thousands of times every year putting Americans into medical bankruptcy and worse, death! This is illegal, immoral, and just plain murder for profit! WHY are our lawmakers not helping US instead of the criminal enterprises calling themselves health insurance companies?

I have complete documentation from my doctors and the hospital showing my needed and emergency care. I have complete documentation from the medical director of Universal Health Care Inc. of St. Petersburg Florida, Dr. Edward Lowenstein, fully authorizing my care with approval letters, letter of guarantee, 5 e-mail guarantees, 2 claim numbers and 8 phone guarantees. THEN after the procedure is finished, Dr. Lowenstein of UHC denies my care through post claims underwriting! And the greed driven CEO of this company, Dr. Akshay Desai…from India, approves of this way of making a profit for his company and his huge political donations (payoffs) even though he personally knows this is killing and maiming people to do it.

While visiting in Thailand in August of 2008 I experienced escalating severe pain in my knee which was replaced by a prosthesis a year before. An examination and x-rays on October 15 showed a severe infection of the prosthesis that was eating away large amounts of bone material.
The doctor said I needed as soon as possible to have an Urgent operation to have the infected prosthesis removed, that it is an Emergency to do this as I would loose my leg or my life if it was not done as the infection was eating large amounts of bone material and spreading rapidly.
I knew my insurance policy was supposed to cover me for emergencies outside of the country so I immediately called them to determine my coverage. If not covered, I could fly back to the U.S. to get it done.
I told the lady I was calling from Thailand and I had been out of the country for over one year and needed to know what if any coverage I had over here. I emphasized that in Thailand if you do not pay your hospital bill, they will put you directly into a hell hole of a Thai jail until your bill is paid so I needed to know for sure. That is the law here, it is called defrauding a hospital and I was concerned about it. The lady I talked to said I should not worry I was completely covered as long as it was an emergency and I was admitted through the emergency room. She said I would not be covered for any elective procedure. I was e-mailed a document showing $30K coverage every year outside of the country for Emergency and Urgent service.
Three days later when being admitted to the hospital the office and I called again, 2 more times and was again assured I was completely covered, the hospital only needed to fax them copies of their bill and it would be paid is what they first told us.

After my procedure, the hospital several times requested a letter of guarantee from UHC covering my care. UHC totally ignored the hospital. The hospital office then comes after me to call my insurance company and get it straightened out. So as I am laying in bed recovering from major surgery, I am having to call them several times every night at expensive international long distance rates, being put on hold for 10 minutes at a time, also requesting this letter of guarantee and was told not to worry it would be sent. They even gave me a claim number, number U02250952 to guarantee payment and show I was covered!
The hospital did my operation, they had to remove my badly infected knee prosthesis, replace it with a TEMPORARY cement spacer to keep the bones from rubbing, and then I needed powerful IV antibiotics for 6 weeks EVERY DAY to get rid of the remaining bacteria. THEN they would replace my knee prosthesis with a second operation, this was the only way to cure my deadly infection, save my leg and my life and stabilize me.
After this major operation I had to spend over 2 hours EVERY night for 8 nights international long distance being jacked from one person to another trying to get a letter of guarantee.
THEN as I am laying in my hospital bed where I am supposed to be recovering, my insurance company now says they will not pay for the replacement of my knee as they now see that as an elective procedure that could be done in the U.S.! I have NO KNEE, am in a full leg cast and they say it is elective for me to get another one and I must return to the U.S. for it!

This Is Incredible! I am in a full leg cast, IMPOSSIBLE to get on an airplane, must take IV antibiotics EVERY day which in itself is a 3 hour procedure I have no knee, only a piece of cement and they want me to come back to the U.S. and get it done where it will cost 80% MORE than in Thailand and where I have NO ONE to help me after it is over.

My doctor said I could not sit for more than one hour in a car because it would cause cramps and muscle spasms yet UHC wants me to sit for 28 to 36 hours on an airplane I could not get my leg into because of the full fiberglass cast that totally immobilized my leg!

UHC has now put me in a life and death situation, I cannot leave that CEMENT spacer in place of my knee for long or it too will become infected! They OK’d putting it in and will now let me loose my leg or my life by not finishing the procedure they sent my hospital a letter of guarantee starting to save a few lousy dollars!
From My Doctor

Ultimately, after the first half of the procedure was performed, UHC took the position that the re-implantation of the new prosthesis constituted elective surgery and would not authorize it to be done in Thailand .
This position ignored that fact that the full leg fiberglass cast prevented Mr. Ruehle from boarding any commercial airliner, that the altitude would increase swelling, that the antibiotic was a procedure that from start to finish took approximately four hours each day, that Mr. Ruehle was through this time (and still is) in extreme pain and discomfort, that his leg was missing bones and he was to be transported as little as possible, that long distance travel to the U.S. constituted a major health risk that no responsible medical provider would authorize, and that the re-implantation was simply the second half of the original procedure.
But that great healer Dr. Lowenstein knows better then all these experts and denies any care to me. To him it’s not an emergency, but an elective procedure. That he already authorized to be done here. Now he denies me.

It was like talking to a brick, my doctor told him, I told him, the hospital told him, my attorney told him, we sent documents to them that I COULD NOT fly or travel over 1 hour but they insisted I had to come to the U.S. to get done a procedure that they OK'd in the first place to start here in Thailand.
If I did not get the second part of the procedure done, I was again in danger as the cement spacer was only temporary, a foreign object in my body that in itself could cause new infection. I could hardly get around other than sitting or lying, unable to travel and NOW they refuse to finish this operation.
I really got upset by this time threatening to go to the news outlets, writes my congressman, TV 8 on your side, etc. Calli in the complaints department FINALLY told me they would cover the rest of the procedure and for me to NOT CALL them any more that this was between the hospital and the insurance company and all my calls were confusing the issue! FINALLY, peace of mine.....or so I thought.

My doctor decided that I was ok enough to have the procedure finished on the 23rd of February as my system looked cleared up of infection through the blood tests I had every week. So we made the appointment for the 23rd of Feb to finish the replacement started in November.
As life would have it, about the 8th of Feb I came down with severe diarrhea, vomiting, could not eat and was sleeping 16-18 hours per day as I just could not get out of bed for more than an hour each day.

It got worse. Being driven home from a check-up where I was given antibiotics I started to loose my eyesight, everything becoming a blinding white light, cars passing us just looked like spots, I was loosing awareness of what or who I was, or where I was. I felt in my mind like I was dying, I never felt like this in my life. When trying to get out of our truck, I just fell right back into it, I could not walk, even with crutches as I had no balance. I had to use a walker to get to my bed.
My wife immediately took me to the hospital where Dr. Pinij took one look at me and immediately had me admitted. He said that I was dying when I was admitted and I would not have lasted more than another 24 hours.
This was on Monday the 16th of Feb. They found my white blood count was dangerously low, my platelets were low, blood pressure was 90/70, my heart rate up from a normal of 68 shot up to 88 and I had acute infective diarrhea and Bicytopenia and my kidneys were in trouble.

They started IV antibiotics immediately, blood transfusions, platelet transfusions and something for my kidneys as they too were in trouble. The doctor said I truly WAS dyeing and this was an URGENT EMERGENCY now. So they cancelled my knee replacement as I had to be bacteria free to do this so the insurance company was never notified to get prior authorization for the knee replacement.

It is different in Thailand than the U.S. , if you don't pay your hospital bill here, you go directly to a HORRIBLE Thai Jail, 70 men all hard core Asian criminals jammed into a large cage where you sleep on the floor. It’s called defrauding a hospital. You simply stay in jail until your friends and family come up with the money to pay off you bill then they let you out. THIS is where I almost went when UHC did not pay their bill, AFTER authorization my care at least 8 times by phone, a written letter of guarantee, a claim number given, and 5 e-mails from their own medical director, Dr. Edward Lowenstein, saying he would direct his claims manager to pay as soon as they received relative documents from the hospital, which they did, SEVERAL times.
To me these are written contracts between UHC and my Hospital guaranteeing they will pay for my procedure. He said in writing he would pay when he received an invoice and documents from the hospital and doctor. He received these documents several times costing the hospital office staff many wasted hours duplicating things for them for nothing.
THEN Dr. Lowenstein decides to deny payment saying the treatment given to me was elective and I needed to have it done in the U.S.! This was actually his 3rd excuse.
After I complained to CMS he than said that my treatment was not urgent or an emergency and I was only covered for urgent or emergency care! This is his 4th excuse.
My Thai doctors sent him several documents showing they had to do my procedure to SAVE MY LIFE! The good Dr. Lowenstein, medical director of UHC considered saving my leg and my life an ELECTIVE procedure that could be done in the U.S. That saving my leg and my life is not an emergency!
The only thing he uses his medical license for is to further injure or kill sick people for a profit for his company and his bonuses. His medical license is useless for helping or saving sick people as the oath he once took supposes of him. It is used for one thing, to help the bottom line of UHC and feather his own pocket with his bonus money.
This was his first denial of payment. He then proceeded to find 4 other excuses to deny me then he retroactively my many months prior to my procedure, des-enrolled me saying I was never covered in the first place and any approval letters and letters of guarantee, claim numbers, fax approvals and e-mail approvals sent by the good folks at UHC are now void and useless!
This is total outright FRAUD and mis-representation. It is known as “Postclaims Underwriting” also called “Retroactive Underwriting” and Florida law flatly prohibits this practice but insurance companies do is routinely. Why are none of these insurance officials being arrested for breaking the law?
At least seven written documents, contracts by Desais company they just arbitrarily toss out and refuse to honor leaving the patient to fight with them when the patient is at his weakest and most vulnerable. Attacked by their own insurance company when they are down.
They took my money then denied payment when I needed it. They gave seven written contracts that they would pay. They broke these contracts leaving my family and myself destitute. My feeling is this is outright fraud. This is my complaint.
And Dr Akshay Desai, their CEO agrees with this horrible decision as he has done nothing about it. Just take the money and have lavish parties and visit with big shots for photo ops and political donations.
When they denied me service, the hospital stopped all treatment to me including the daily IV antibiotics and physical exercise I needed for another 6 weeks to kill the remaining bacteria in my system and started charging me EVERY DAY for my room and the medications I desperately needed to save my leg and my life.
I had an armed guard put at my door to make sure I did not escape from the hospital without paying my bill. They were after me every day to pay on my bill or go to jail. My wife could not come to visit me without the collection department demanding money from her or her husband would go to jail. Everyone who saw me knows me as the foreigner that tried to cheat the hospital!
Suddenly I am living in true TERROR. The horror of my immediate life became immediately apparent when they had the Thai Police come to my room and take a report of this foreigner that was trying to defraud them and they wanted to press charges against me.
I just went through a major surgery yet had their collection department after me EVERY DAY trying to collect money or I would go to a Thai jail where I would get NO medical care and would probably die.
EVERY DAY my wife had to come up with money to pay on my bill or they would call the police for me. This made NO difference to Universal Health Cares medical director Dr. Lowest Stein who proceeded to dis-enroll me saying I was now out of the country to long! This is called Post Claims Underwriting and is illegal, immoral, and outright murder for profit.
He knew I was out of the country when he gave my hospital a letter of guarantee to start this 2 part procedure. He sent it.
If I was out of the country to long, they should have told me that on my FIRST phone call and I could have flown back to the U.S. for treatment. They did not. They said I was OK. Many times.
What a terrifying and horrifying experience I was going through. It was like a living nightmare brought on by the practices of Desai and his insurance company and how he runs it.
Even CMS does nothing about it, just takes the reports.
Dr. Lowerstein had previously FINALLY given the hospital a letter of guarantee that they would pay for my services, sent 5 e-mails to this effect, we had at least 8 phone approvals they would cover me, then this man changes his mind AFTER the procedure he authorized in the first place. He says after reviewing the several documents from Dr. Pinij, my personal doctor at AEK Udon International Hospital and my other doctors showing the urgent and emergency procedure they gave me to save my leg and life and the hospital offices themselves, he says he does not see this as an this as an emergency therefore it is not covered!
He used no less than FIVE DIFFERENT REASONS to deny my claim. Even though my doctors, the hospital and later my attorney all appealed to this he denied my claim putting me in a horrible terrifying life threatening situation.
I was terrorized EVERY day by the collection department and their threats of jail when I should be relaxing and healing from a major procedure. I did not know from one minute to the next if I would have the life saving IV's removed from my arm and taken by the Thai police directly to jail with my leg in bandages that had to be changed every day.
THIS is the horrible situation MY insurance company, Universal Health Care Inc, its CEO Dr. Akshay Desai and his medical director Dr. Edward Lowenstein has put me in. Living in fear EVERY moment of EVERY day. Not knowing if my wife found anything else from our house to sell so she could bring them some money.
Universal Health Care took my money for my premiums every month knowing I was living out of the country for an extended period of time every year, what country and where I was at, I always phoned them to keep them up to date with where I was traveling at even! Living in a foreign land, available emergency medical care was most important to me and not neglected. And in my hour of need, they treat me like I am some sort of criminal and will allow me to DIE in a most HORRIBLE way and say….”sorry, there is nothing we can do?” They sold me a policy they knew at the time was totally illusionary to my requirements.
My blood pressure rose dramatically and needed to be medicated. I was going crazy by this time, mentally exhausted, getting physically sick again my leg swollen down to my foot, in a foreign country and not knowing what to do. Now I am being CHARGED for every day I am in the prison hospital, charged for my room, my medicine and IV medication I desperately needed after a major surgery, any food I ate. Almost $100 per day was adding up against my bill that had to be paid in FULL before they would release me.
My attorney sent letters to Dr. Lowenstein and Universal Health Care indicating that I could loose my leg or my life, the man was completely unmoved by all this, totally willing to let me DIE and actually now started using the full backing of Universal Health Cares powerful Legal Staff against me.
They do not even try to help me, their customer, No in my time of serious need from those I put my complete medical insurance trust in, treat me like some mangy cur to be tossed out the back door and sick their legal dogs on me to scare me away no matter WHAT the consequences to me or my family or those around me who will be so tragically affected by these their decision so save their companies bottom line a few more precious DOLLARS and human life and limb be damned..
WHY must we the consumer suffer like this at the hands of people like Dr. Edward Lowenstein whose sole job with Universal Health Care is to TURN DOWN as many claims as possible for his bonus money?
And what to think of an insurance company that pays bonuses to their employees for policies that they cancel.
I ended up having both a mental and physical breakdown with terrible swelling of my knee and leg and went into convulsions where they had to rush me to the Emergency Room for treatment and to get my shaking and convulsing under control and to reduce the swelling so I did not loose my leg.
My doctor that did my operation and saw me in the ER as I was having my breakdown from mental stress and strain felt so sorry for what I and my family were going through because of Universal Health Care that HE gave the hospital over $2,000 of HIS OWN money to put against my bill and signed a hospital paper that if I did not pay the balance he would be responsible for it!
My wife and family too were terrified, not knowing what was going to happen to me. I was not allowed to come home at night, I was a prisoner in the hospital with an armed guard every place I went, expecting to go to a real jail any moment.
My wife was forced to pawn all her jewelry and wedding gifts and sell everything of value in our house for whatever she could get for it to pay on my bill to keep me out of jail loosing considerable face with her friends and neighbors, something very important to Asian people. She had to give her beautiful truck, a 2006 Isuzu to the hospital to keep me from being sent to jail. This in turn cost us the loss of our business as we had no transportation now or any money to work with.
We were all terrorized not knowing from one minute to the next what was going to happen to us all thanks to the policies of Dr. Akshai Desai of St. Petersburg, Florida and Universal Health Care Inc.
Finally after my extremely upset wife sold everything of value that we had in our house , even having to show the hospital our bank accounts then turning them over to the hospital and us borrowing from every person we could think of, the hospital finally released me.
I now had less that $100 to take care of my entire family and pay our bills and eat. And no transportation or way to work.
Universal Health Care and Dr. Akshay Desai left us medically bankrupt AND destitute with almost no food to eat. He totally sucked us dry in order to squeeze every dollar he can for his company and his excesses.
I still needed the 6 weeks of IV antibiotic treatment EVERY day and had to beg and borrow again for this treatment which was never completed as each treatment was over $60 per day or over $2,500 for the 6 weeks. This made no difference to Dr. Loserstein whose only job I can see is to use his medical license as a sham to deny services and overrule the decisions of credible medical doctors.
This is only a short version of the horrors I faced thanks to Universal Health Care of St. Petersburg , their staff and Dr. Akshay Desai in particular. And I say Dr. Desai in particular as he is the CEO of this corrupt company and obviously approves of the service his company fails to provide the people who depended on his company. Thinking they were covered only to find in their time of need UHC will certainly disenroll them using post claims underwriting and to see their formidable legal department turned loose on them when they are at their weakest leaving them to loose limbs or their very life. This is Criminal. These people are no different than murderers. They deny care letting people die.
And remember, I am only one of hundreds of thousands of similar horror stories that feed the greed of these terrible health insurance companies. No one is reading about them. But we are literally dying because of insurance companies drive for profit.
The insurance companies and health care industry, “Big Pharma” are bleeding us dry to where we have nothing left for ourselves and our families except medical bankruptcy and loss of our entire lives work and possessions.
Who is helping us, the American Taxpayer? Why are our legislators bending over backwards to provide for the criminal INSURANCE COMPANIES? Their payoffs through their lobbyist at the cost of the health and welfare of American People must stop. We are dying out here, is no one listening?

Gary M Ruehle
727-827-8481

Some Of The Laws UHC Has Broken
Being Victimized By Post-Claim Underwriting
Post-claims underwriting is the practice of cancelling a health insured's policy for supposed omissions of information in the insured's original application for coverage after the policyholder submits a claim, usually a major claim.
________________________________________

• Coverage Rescission. A rescission is the retroactive cancellation of health coverage, also called postclaims underwriting or retroactive underwriting meaning that not only is
an individual’s coverage cancelled, but the insurance company is no longer responsible for claims previously
submitted. when a plan rescinds an individual policy, it also refuses to pay providers after they have provided treatment.
For individuals who have accumulated significant medical bills – the exact claims which prompted the post-claims underwriting – this can be a financial hardship or major crisis.

The practice is "rescission": an insurance-industry procedure of retroactively canceling approved health-insurance policies obtained in the individual market after the policyholders get sick and file large medical claims. when a plan rescinds an individual policy, it also refuses to pay
providers after they have provided treatment.

Post-claim underwriting is an unethical practice in the insurance industry. The contention is that insurers engaging in that conduct are acting improperly and in bad faith when, instead of looking to pay the claim, they begin to search for all the things in the application that will allow the policy to be rescinded. The whole purpose of insurance is defeated if an insurance company can refuse, without justification, to pay a valid claim.
An insurer has an obligation to its insureds to perform all necessary underwriting at the time coverage is applied for, and not thereafter. It is unfair for an insured to purchase an insurance policy, pay all required premiums, and believe they are protected for covered losses, only to learn after the claim is submitted that they are not insured.
The American Association of Justice (AAJ) has released a report which looks at the insurance industry's rescission and cancellation practices. The report is entitled Tricks Of The Trade: How Insurance Companies Deny, Delay, Confuse and Refuse.
Rescission
The AAJ's report dedicated an entire section to the insurance industry's practice of abandoning the sick by rescinding policies - an issue which never ceases to be in the news.
Consumer advocates say that insurance companies are driven by profit to revoke coverage based on even inconsequential discrepancies between the application and the medical record. Many insurers even pay employee bonuses for meeting a cancellation quota and for the amount of money saved.

"This amounts to post-claims underwriting," says healthcare advocate Jerry Flannagan of Consumer Watchdog, a nonprofit consumer education and advocacy group. "They're supposed to look at your medical records ahead of time -- but once they offer the coverage, you should be able to rely on it."
"Industry schemes to maximize profits at the expense of patients are unfair and unlawful, and they must be stopped. . "Health insurance companies may say they are providing coverage, but time after time they do everything they can to avoid paying for health care for their policyholders."

Last week, L .A. City Attorney Delgadillo launched a first-of-its-kind, prosecutor-sponsored website - www.ProtectingTheInsured.org in order to collect information from consumers, doctors, and hospitals as part of the ongoing investigation into the unlawful, fraudulent, and unfair activities of health insurance companies.

For more information, consumers are asked to visit www.ProtectingTheInsured.org or City Attorney Rocky Delgadillo´s website at www.lacity.org/atty

Just an example of what all health insurance companies are doing
Rocky Delgadillo said the insurer, Health Net Inc. which is based in Woodland Hills (Los Angeles County), saved more than $35 million in medical expenses by illegally rescinding the policies of at least 1,600 members. The lawsuit was filed Wednesday in Los Angeles Superior Court. (The total suffering these people experienced is absolutely unmeasureable and criminal.)
When a plan rescinds an individual policy, it also refuses to pay providers after they have provided treatment.

Health& Safety Codes prevents a health plan from “rescinding a contract for a material misrepresentation or omission unless the plan can demonstrate (1) the misrepresentation or omission was willful, or (2) it had made reasonable efforts to ensure the subscriber’s application was accurate and complete as part of the pre-contract underwriting process.”
Because of the number of people who died due to rescission of their otherwise valid health care policies, 25,000 children and 50,000 adults, we should put those who run the insurance companies, or reward their employees for terrorizing people by refusing care in jail. Forever. This is Premeditated MURDER and Domestic Terrorism on a GRAND scale. I was terrorized every day with jail.
This is an outrage that can only be eliminated by making the insurance companies pay a price for the damage that they do. America, wake up! Each one of you who thinks that you are covered has no way of knowing - until it is too late - that this is the normal practice of the people who gladly take your money until you are sick or injured, and then they let you go down the toilet by dis-enrolling you on a pretense. It should be considered domestic terrorism.

WHY are our lawmakers doing NOTHING about this?
WHY are our so many of “our” representatives siding with these criminals?

Gary M. Ruehle
727-827-8481
garyruehle@yahoo.com

»

Save over 80% on high quality overseas medical care.

Submitted by garyruehle on February 10, 2010 - 12:26am.

See www.theanewyou.com for information on medical tourism for those who cannot afford medical care in America.

Gary

»

Health CARE for EVERYONE, so easy.

Submitted by garyruehle on February 18, 2010 - 4:29am.

It is SO simple to get ALL Americans very inexpensive FULL coverage for ANY medical need with no pre-existing condition exclusions. Get rid of the for profit insurance companies that pay their criminal CEO's hundreds of MILLIONS of dollars in obscene salaries and bonuses. They get this money through post claims underwriting and denial of justifiable services killing over 50,000 adults and 25,000 children EVERY YEAR in their need for greed. This is murder for profit and no one is doing anything.
I almost lost my leg and died when Dr. Ed Lowenstein, medical director for Universal Health Care Inc of St Petersburg Florida denied payment of my claim AFTER APPROVING it 8 times in writing! I was in Thailand at the time and was approved for emergency service outside the country for $30K every year. Yet he denied my care which almost cost me my leg and my life!
This is why a single payer plan would work, it would eliminate BILLIONS of dollars in CEO salaries and bonuses which would then go to paying for the medical care we are now being denied. We do NOT need these CEO Criminals, they accomplish NOTHING except misery and pain for their customers when they need help the most by sucking all the money that we need for medical care into their obscene salaries and bonuses. For my personal horror story, Google: domestic terrorism/gary's blog and "Dr. Edward Lowenstein,St Petersburg" the criminal medical director of Universal Health Care Inc.

For his bonus money he terrorized me by leaving me to lose my leg and die through denial of treatment and post claims underwriting.
Thank You
Gary M Ruehle
727-827-8481

»

Health CARE for EVERYONE, so easy.

Submitted by garyruehle on February 18, 2010 - 4:34am.

It is SO simple to get ALL Americans very inexpensive FULL coverage for ANY medical need with no pre-existing condition exclusions. Get rid of the for profit insurance companies that pay their criminal CEO's hundreds of MILLIONS of dollars in obscene salaries and bonuses. They get this money through post claims underwriting and denial of justifiable services killing over 50,000 adults and 25,000 children EVERY YEAR in their need for greed. This is murder for profit and no one is doing anything.
I almost lost my leg and died when Dr. Ed Lowenstein, medical director for Universal Health Care Inc of St Petersburg Florida denied payment of my claim AFTER APPROVING it 8 times in writing! I was in Thailand at the time and was approved for emergency service outside the country for $30K every year. Yet he denied my care which almost cost me my leg and my life!
This is why a single payer plan would work, it would eliminate BILLIONS of dollars in CEO salaries and bonuses which would then go to paying for the medical care we are now being denied. We do NOT need these CEO Criminals, they accomplish NOTHING except misery and pain for their customers when they need help the most by sucking all the money that we need for medical care into their obscene salaries and bonuses. For my personal horror story, Google: domestic terrorism/gary's blog and "Dr. Edward Lowenstein,St Petersburg" the criminal medical director of Universal Health Care Inc.

For his bonus money he terrorized me by leaving me to lose my leg and die through denial of treatment and post claims underwriting.
Thank You
Gary M Ruehle
727-827-8481

»