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HEALTH PLANS: Blue Cross Settling Patients’ Lawsuits

Lisa Girion in the LA Times has had no small part in the story she reports today. Wellpoint’s Blue Cross unit is settling the patients’ lawsuits against its rather nasty habit of widespread retroactive cancellations. The settlement cannot have been that cheap, given that they had to pay all the bills, pony up cash and pay of their and the plaintiff’s lawyers. Still better than going before a jury, and better than having the state really throw the book at them. And they seem to be the only one that the plaintiff’s lawyers are getting anywhere with:

“All the other insurance carriers are in denial,” Shernoff said. “Blue Cross at least is not in denial anymore. They are in rehab now.”

On the other hand the statewide hospital lawsuit is still ongoing, and there are probably more fines to come from the Dept of Managed Health Care.

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  1. Sal D’Anna, Spring Valley, CA
    My battle with cancer, an insurer that canceled my coverage because I got sick, and tens of thousands of dollars of debt started out as a compassionate joke.
    My father was having health problems that his doctor didn’t understand, so I suggested that he go get a full body scan, something my mother had done a few years ago. Sometimes it finds hidden things.
    Last Christmas, he said, OK, “I’ll do it if you do it.” He was more than a little nervous so I decided to humor him. I called the clinic where my mother had gone and they said it would be a couple of months, unless we would go Friday the 13th of January. We’re not superstitious, so that was fine with us. A friend and his wife went with us as well.
    I thought I was there just to support my Dad. Unlike him, I didn’t even order a consultation with the doctor afterward. This was his appointment, not mine. About a week later, we went in to go over his results, and the doctor said my dad was fine but that she needed to talk with me. She said there was something odd, and that she wanted me to do an abdomen scan that would provide more detail.
    We did that on Jan. 31. I got the results on Feb. 3 over the phone. They said there was a definite tumor on my right kidney and they thought I should get right to my doctor. There was no discussion yet of cancer. At that moment, I was certainly grateful that my new insurance with PacifiCare had kicked in. They approved it on Jan. 24, taking effect Feb. 1. It wasn’t until a good deal later that I learned that I had an aggressive form of kidney cancer and that one of my kidneys would have to be removed. This was done May 12.
    I had first visited with my insurance broker in November, and after some back and forth he persuaded me to go with PacifiCare. I filled out the application Jan. 10, but on Jan. 18 he told me I had to submit an updated 2006 form. But he told me just to fill out the authorization pages and he’d fill out the rest from my previous application.
    On Aug. 13, I got a cancellation notice from PacifiCare. It said that I knew when I applied that I had kidney cancer, and accused me of fraud. If they had called the agent they would have learned I started the enrollment process in November, and the agent knew I was going to have the scan. But I wasn’t diagnosed with cancer until after the coverage actually started. If I’d known I was ill, wouldn’t I have bought something better than a crummy HMO?
    Not only have I had to put up with PacifiCare’s illegal, arbitrary cancellation of my policy, but my doctors failed to accurately diagnose my cancer, delaying the correct treatment and wasting precious time. As if that wasn’t enough, PacifiCare refused to pay the bills for my kidney surgery by the experts at the Cleveland Clinic because it was not in the company’s network. PacifiCare didn’t tell me that it wouldn’t cover the surgery until the day before the operation, waiting until after I had already traveled across the country, and contradicting the recommendation of my in network doctor.
    I also found out that since I didn’t have the PacifiCare insurance for 18 months, all other insurers could deny me coverage for having a preexisting condition. Now I am impossible to insure. Brokers tell me I’ll “never be covered.”
    I have paid out of pocket for lung and abdomen scans and I’m supposed to have them every six months—for life. Together, they are $1,000 each time. I still have to figure out how to deal with the $25,000 I owe my parents for a loan they gave me to partially pay for the $65,000 surgery that PacifiCare denied. I don’t know what the future will hold. I’m self-employed, and still not working as much as before all this.
    The only good thing about this story is that my Dad saved my life. My chances of survival are much better with the early detection. For that I’m grateful. The question now is how can I afford to stay healthy?

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