Real bad boy of health insurance: Assurant Dumps HIV patients

Records in that lawsuit indicate the Mitchell and Latham cases are not anomalies but part of a company policy to avoid paying huge claims by any pretext possible. Reporter Murray Waas writes that Assurant developed a computer program, triggered by billing codes for expensive health conditions, that would flag "every policyholder recently diagnosed with HIV for an automatic fraud investigation... their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all."

via blogs.westword.com

This one makes my blood boil. Folks purchase health insurance and think that means they get health care.

When they get sick and need it they find the health insurer playing what I think of as dirty tricks and the patient is hurt.

I heard another one yesterday in Texas - an insurer that covers pregnancy but not complications of childbirth.

It's bad enough that employees have to try to figure out if their real health care needs will be met by the plans their employers offer (answer: less every year). It's worse when individuals in the open market purchase their own plans. The plans are complex, the contract language appears to be intentionally obscure just so that the company can turn around & cut you off by pointing out "fraud" in the initial application.

People buying insurance are paying more and more for less and less and right when they need it they're being pushed in front of a bus.

Watch the small print folks, it can kill you. Really.

Comments

[Botox Injection]

I have the same opinion as some. Just think if you get health insurance you expect health care in return and now this problem is here, the one that are at loss are the ones who bought those insurance.

[jean]

whoa. Let me get this right
GOOD REASONING says it is ok to let people be denied access to insurance-which is not care and likely barely affordable as is- because they are buying a product that they are fearful they need but cannot tell the entity they may need help from ,that they may need the help ,becasue the help is based on profits, so then they would be barred from getting help?!
Is this Alice in Wonderland??
Oh sure
right
this makes sense
let's defend Assurant Their policies are defensible Sure absolutely
BY law.
Not in my book of morals.

[L Gordon Moore]

Hmmmm.
Well reasoned.

I guess then that my real concern is the concept of access to health care being contingent. Our system of health care access makes contingent access a key mode of success as a corporate strategy but that means there are people who are denied access. In the setting of the extremely unfortunate 17 year old with HIV it may make good sense to deny the expensive coverage but I would prefer to find a way to extend health care to all and stop all the time, effort, and money that is poured into efforts around eligibility.

Gordon

[Pete]

Be careful ascribing too much of the blame on the insurers. In the case of the Assurant/Jerome Mitchell case, there are a couple of important issues: (1) it seems to be undisputed that Mitchell's file included a note that he had known he had HIV prior to purchasing insurance. Mitchell claimed, and the jury agreed, that that note was an error. However, in defense of Assurant, the note was, in fact, in the record and if the note were accurate, it would be prima facie evidence of fraud. (2) If there were evidence that linked specific diagnoses with fraud, one would be hard-pressed to condemn an insurer for targeting such situations for investigation. It is hard for me to conceive of a situation that sounds more likely correlate with fraud than Mitchell's case: a 17-year-old purchases an individual policy and then, shortly afterwords, is diagnosed with HIV, an expensive to treat, fatal disease that can be tested for anonymously and has no obvious symptoms for some time after it is contracted.