qotd: Health Net's Gellert temporarily suspends reprehensible conduct (fwd)
Dana C. Iorio
Dana
---------- Forwarded message ----------
Date: Mon, 25 Feb 2008 10:14:50 -0800
From: Don McCanne <d...@mccanne.org>
To: Quote-of-the-Day <quote-of...@mccanne.org>
Subject: qotd: Health Net's Gellert temporarily suspends reprehensible conduct
Los Angeles Times
February 23, 2008
Health Net ordered to pay $9 million after canceling cancer patient's policy
By Lisa Girion
One of California's largest for-profit insurers stopped a controversial
practice of canceling sick policyholders Friday after a judge ordered Health
Net Inc. to pay more than $9 million to a breast cancer patient it dropped in
the middle of chemotherapy.
The ruling by a private arbitration judge was the first of its kind and the
most powerful rebuke to the state's major insurers whose cancellation practices
are under fire from the courts, state regulators and elected officials.
When Health Net dropped (Patsy Bates) in January 2004, Bates was stuck with
more than $129,000 in medical bills and was forced to stop chemotherapy for
several months until she found a charity to pay for it.
Health Net Chief Executive Jay Gellert ordered an immediate halt to
cancellations and told The Times that the company would be changing its
coverage applications and retraining its sales force.
"I felt bad about what happened to her," he said. "I feel bad about the whole
situation."
Gellert said he would move quickly to "give people the confidence that they can
count on their policy." Specifically, he pledged to stop all cancellations
until an external review process could be established to approve all
cancellations.
http://www.latimes.com/business/la-fi-insure23feb23,1,5039339.story
And...
Case No.: BC321432
Interim Arbitration Award (Binding)
Patsy Bates vs. Health Net, Inc. et al
By Sam Cianchetti, Judge, (Retired)
After consideration of all evidence submitted and the law as set forth in CACI
Section 2330, Arbitrator finds Health Net failed to satisfy the obligation of
good faith and fair dealing it owed to Patsy Bates. Specifically, Arbitrator
finds Health Net was primarily concerned with and considered its own financial
interests and gave little, if any, consideration and concern for the interests
of the insured.
In addition to the violations of guidelines and statues noted above, further
evidence of Health Net's bad faith is the bonus practice it put in place,
whether large or small, was tied in some respect to whether an employee met
certain rescission goals. It is difficult to imagine a policy more
reprehensible than tying bonuses to encourage the rescission of health
insurance that helps keep the public well and alive.
It is hard to imagine a situation more trying than the one Bates has had to
endure. She had valid health insurance, thinks simply she's making a change
when the rug was pulled from underneath and that occurred at a time when she is
diagnosed with breast cancer, one of the leading causes of death for women.
The evidence, Arbitrator finds, was clear and convincing in establishing Health
Net's oppressive conduct in this case. Health Net paid no attention to its own
guidelines when it examined the Bates' application. It ignored statutory
mandates. Obvious errors, one of which amounting to criminal conduct, were
ignored. Bates' disaster could have been totally avoided through very limited
investigation. Health Net showed no concern for its obligation under Insurance
Code Section 10384. Bates' rights under Section 10381.5 were violated.
Throughout the hearing, and in its closing argument, Health Net has attempted
to shift the blame in this case to Patsy Bates. However, it was Health Net's
conduct that was reprehensible. From the initial review of the application to
the rescission the evidence supports a finding Health Net's primary concern was
its own financial well-being.
http://www.calendarlive.com/media/acrobat/2008-02/35955051.pdf
Comment: What did Health Net and its Chief Executive Jay Gellert learn from
this? Did they learn that they should cooperate with our effort to see that
everyone would have health care without being exposed to financial hardship?
No.
What they learned is that they need to improve the process through which they
cancel the policies of individuals who do need health care. They learned that
it is in the interests of Health Net's financial well-being to avoid criminal
conduct when they cancel those policies.
In spite of the findings of the arbitration, what they did not learn is that
they have an obligation to the well-being of those they insure.
As a business model, the private insurance industry will always make an effort
to insure those who don't need health care, and to reject those who do.
Increased regulation, such as enacting guaranteed issue, may make this task
more difficult for them, but it will never eliminate their effort to avoid
paying for health care (e.g., selective marketing to the healthy workforce,
etc.).
We want a health care financing system that is designed to pay for the health
care of those who need it. Jay Gellert still does not seem to understand that a
health care financing system that is designed to avoid paying for that care is
"reprehensible."
If we are sincere in our advocacy of health care for everyone, the private
insurance industry has to go. Their conduct is now and always will be
reprehensible.
_______________________________________________
Quote-of-the-day mailing list
Quote-of...@mccanne.org
http://two.pairlist.net/mailman/listinfo/quote-of-the-day