Will someone please stop that nasty Lisa Girion beating up sweet innocent health plans.

Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

If she doesn’t stop, those insurers might lose their reputations as darlings of the downtrodden consumer.

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7 Responses for “HEALTH PLANS: Lisa Girion puts boot in again!”

  1. Keach Hagey says:

    I wrote a column on this story for CBS News.com today. Check it out here:
    http://www.cbsnews.com/stories/2007/11/09/the_skinny/main3478314.shtml

  2. Peter says:

    Looks like Michael Moore and “Sicko” was right after all. It’s just not isolated anecdotal evidence.

  3. Terence says:

    From the facts made available, this rescission action was NOT based on a misrepresentation on a symptom or treatment that would cause one learned in medicine to suspect cancer…they rescinded this woman because of a weight change and a screening for a heart problem!
    If I were the regulator, I would review 1,000 applications approved and 1,000 application denied over past 18 months just to learn how the underwriters deal with weight change and screening for heart condition.
    A good PREEX analyst asks “had we known the history at time of the application, what would have been our desision?”. They are required to IGNORE the cancer treatment because nothing in the health history gave a hint of cancer; she could not have disclosed something that was to occur in the future.
    Questions arise, however:
    1. Is there any mention in the health history [published prior to application date] of advice to have a medical work up to investigate her health problems?
    2. What claims had been processed by her previous insurance carrier in six months prior to the application date?
    3. From the time the application was signed to the time that a physician determined that treatment for cancer should begin, how many months had passed?
    As for William Shernoff, he will no doubt gain through discovery ALL the rescissions made, and investigate each.
    Some will be “slam-dunk rescissions”–an obvious attempt to deceive on the part of the applicant.
    Others will be “marginal”–a case where the company was biased in their revisiting of the underwriting decision
    because they had become aware of the current medical condition .
    When I managed a PREEX department I NEVER advised the underwriter of the current condition—I only gave them the data that had been created/published prior to the application date. I saved millions for my employer.
    I received no bonus, however. But the results of my rescission activity appeared in the annual report!
    You may reach me at preexclaim@aol.com if you care to discuss…

  4. Peter says:

    From your post Terence I don’t really think insurance companies care what’s contained in a health insurance application. Just take what the applicant says, collect all those premiums, then if the insured gets sick that’s the time to go over the app. with a fine tooth comb looking for any loophole or reason to retractively deny coverage. It’s a win-win for the insurance carrier as no penality is incurred for a wrong approval of coverage at the application stage. If there was any desire to serve the applicant and not the company’s bottom line then any reason for denial would be made to the applicant BEFORE paying premiums so that the customer could look elsewhere for legitimate coverage that will be there when they need it. What a great business and the reason insurers serve NO useful purpose.

  5. The “facts made available” in the LA Times article indicate that the beneficiary was too busy styling hair while filling out the application to consider her responses seriously. A tragic outcome, but the article pretty much admits that the applicant did not disclose the facts in her application. See: http://www.pacificresearch.org/blog/id.229/blog_detail.asp

  6. Peter says:

    “But that’s ok: her broker filled out the form “as she styled a client’s hair in her busy shop” and “answered his questions as best she could and did not know whether he asked every question on the application”.”
    So could the actions of, “her broker” be the same as the actions of mortgage brokers who with a wink/wink, nudge/nudge made their commissions then passed the risk on to now bankrupt lenders and foreclosed home owners? And was this the case for all 1600 of the other healthcare policies?

  7. george says:

    Lisa Girion and the media present got up and walked out after the plantiff gave her testimony. They didn’t wait to report on the company’s assertions. The hearing continued for over a week after it ceased to be reported on. Would anyone be surprised to find out the plantiff had a medical history of cancer that she definitely knew about??? If you don’t want medical health insurance coverage for everyone in our society what DO you want? How much are you willing to give up to the government to manage such coverage. Bloody human inconsistencies abound in this fake outrage.

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