Breast Cancer Victims Targeted by Insurance Company

This particular insurance company runs a scam called "recission" to void valid insurance policies so they do not have to pay for the medical treatment of women who are diagnosed with breast cancer.  This particular company has made an art form of the practice. Here's the best part - it's all perfectly legal. Hey, you Tea Party People who think the USA doesn't need health care reform, better start praying no women in your family get breast cancer.

Reported at Yahoo News from Reuters
Exclusive: WellPoint routinely targets breast cancer patients
By Murray Waas Murray Waas – Thu Apr 22, 6:17 pm ET
LOS ANGELES (Reuters) – Shortly after they were diagnosed with breast cancer, each of the women learned that her health insurance had been canceled. There was Yenny Hsu, who lived and worked in Los Angeles. And there was Patricia Reilling, a successful art gallery owner and interior designer from Louisville, Kentucky.

Neither of these women knew about the other. But besides their similar narratives, they had something else in common: Their health insurance carriers were subsidiaries of WellPoint, which has 33.7 million policyholders -- more than any other health insurance company in the United States.

The women paid their premiums on time. Before they fell ill, neither had any problems with their insurance. Initially, they believed their policies had been canceled by mistake.

They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.

Once the women were singled out, they say, the insurer then canceled their policies based on either erroneous or flimsy information. WellPoint declined to comment on the women's specific cases without a signed waiver from them, citing privacy laws.

That tens of thousands of Americans lost their health insurance shortly after being diagnosed with life-threatening, expensive medical conditions has been well documented by law enforcement agencies, state regulators and a congressional committee. Insurance companies have used the practice, known as "rescission," for years. And a congressional committee last year said WellPoint was one of the worst offenders.

But WellPoint also has specifically targeted women with breast cancer for aggressive investigation with the intent to cancel their policies, federal investigators told Reuters. The revelation is especially striking for a company whose CEO and president, Angela Braly, has earned plaudits for how her company improved the medical care and treatment of other policyholders with breast cancer.

The disclosures come to light after a recent investigation by Reuters showed that another health insurance company, Assurant Health, similarly targeted HIV-positive policyholders for rescission. That company was ordered by courts to pay millions of dollars in settlements.

In his push for the health care bill, President Barack Obama said the legislation would end such industry practices.

But many critics worry the new law will not lead to an end of these practices. Some state and federal regulators -- as well as investigators, congressional staffers and academic experts -- say the health care legislation lacks teeth, at least in terms of enforcement or regulatory powers to either stop or even substantially reduce rescission.

"People have this idea that someone is going to flip a switch and rescission and other bad insurance practices are going to end," says Peter Harbage, a former health care adviser to the Clinton administration. "Insurers will find ways to undermine the protections in the new law, just as they did with the old law. Enforcement is the key."

In a statement to Reuters, WellPoint said various specified criteria trigger rescission investigations, including certain types of medical claims. The company said it changed its rescission practices to ensure they are handled appropriately after a 2006 review of its policies prompted by public concern over rescission.

WellPoint also said it created a committee which includes a physician for making rescission decisions. The company also noted that it established a single point of contact for members undergoing an investigation and enacted an appeals process for applicants who disagree with the original determination.

During the recent legislative process for the reform law, however, lobbyists for WellPoint and other top insurance companies successfully fought proposed provisions of the legislation. In particular, they complained about rules that would have made it more difficult for the companies to fairly -- or unfairly -- cancel policyholders.

For example, an early version of the health care bill passed by the House of Representatives would have created a Federal Office of Health Insurance Oversight to monitor and regulate insurance practices like rescission. WellPoint lobbyists pressed for the proposed agency to not be included in the final bill signed into law by the president.

They also helped quash proposed provisions that would have required a third-party review of its or any other insurance company's decision to cancel a customer's policy.

A WellPoint spokeswoman on Thursday denied such lobbying took place.

The new law does leave open the possibility of reform in this area, these sources say. The reason, they say, is that much of the new legislation is essentially a roadmap, with regulations to be decided later.

"The lack of specificity doesn't mean that nothing is going to be done," said a senior congressional staffer who has played a key role in the health reform debate. "The law grants HHS (the Department of Health and Human Services) the discretion to promulgate regulations. This is very much a work in progress."

Among other things, the staffer said, the White House could revisit proposing tough new regulations requiring third-party review of policy cancellations.

Victoria Veltri, the general counsel of Connecticut's Office of Healthcare Advocate, a state agency that investigates complaints by policyholders, says she has seen the success of such a process in her home state. One company, Aetna, has voluntarily agreed to engage in the third party review, with what she described as favorable results.

"I haven't seen an Aetna case in our office since they went to the third party review process," she said. "It's a powerful tool to have a third set of eyes required before someone is rescinded."

For its part, WellPoint said it began offering third-party reviews in 2008.

A senior Obama administration official said he remained confident that mandatory third-party reviews of rescissions is not entirely out of reach.

"It might take some wrangling with the insurance industry, some strong-arming, maybe even use of the presidential bully pulpit," he said on condition of anonymity.

Breast Cancer and the 'Fat Taboo'

From Isis:

Discovery News
Analysis by Benjamin Radford

Mon Apr 12, 2010 11:57 AM ET
Breast cancer is the most common cancer among women, and obese women are up to 60% more likely to develop cancer as compared to healthy-weight women. A new study found that up to a third of breast cancers in Western countries could be avoided if women ate less and exercised more.

This is wonderful news, and has important implications for human health. Will women take the advice to heart and start eating less and exercising more?

Fat chance.

Two-thirds of American adults are overweight—more of them women than men—yet fewer than one-quarter are dieting. In 2004, the Centers for Disease Control found that women eat over 300 more calories a day than they did in 1971. Fewer than one-third of Americans get regular exercise.

Most Americans, including women, are fat and happy. Of course everyone would love to cut their cancer risk by one-third—unless it means skipping that extra scoop of ice cream, or jogging three times a week. Reducing cancer risk isn't that important. Until you get it.

As Associated Press reporter Maria Cheng noted, there is a reluctance on the part of many doctors to make too much of this study: "Any discussion of weight and breast cancer is considered sensitive because some may misconstrue that as the medical establishment blaming women for their disease."

That's right: there is an institutionalized "fat taboo," in which some fear that if women (most of whom are overweight) are (truthfully) told that they can reduce their risk of cancer by slimming down will blame themselves if they get cancer. Some activists are also concerned that encouraging overweight women to lose weight will somehow lead to an epidemic of anorexia. The reasoning goes that it may be better to just pretend that there's nothing women can do to reduce their risk of cancer than to tell them to slim down and get in shape. Of course, this advice cuts both ways: If women (or men, for that matter) are told that they can cut their risk of cancer by as much as a third, it means they are empowered to do something, to take charge of their own health.

No one should be "blamed" for getting a disease, but nor is it a good idea to simply ignore the person's lifestyle choices that greatly increase their chances of getting that disease. If a person chooses an unhealthy lifestyle (smoking, poor diet, lack of exercise, etc.), doctors should not be shy about warning them the risks they are assuming.

As Cheng noted, some breast cancer groups agree: "Karen Benn, a spokeswoman for Europa Donna, a patient-focused breast cancer group, said it was impossible to ignore the increasingly stronger links between lifestyle and breast cancer. 'If we know there are healthier choices, we can't not recommend them just because people might misinterpret the advice and feel guilty,' she said. 'If we are going to prevent breast cancer, then this message needs to get out, particularly to younger women.'"

Personally I find the idea that women need to be treated like children insulting; I believe women are smart enough that they can handle the knowledge that they have a significant amount of control over their chances of developing cancer. Knowledge is power, and if, in the process of saving lives, some women get their feelings hurt because they are told to lose weight and get fit (or feel guilty if they don’t), then too bad.