Orshe

Accounts regarding insurance companies refusing coverage and pulling borderline scams are all too common (what kind of world is this, anyhow?). But yesterday’s chronicle that a large insurer may have to compensate for it is a surprise.

It’s good news the courts are taking heavy action on issues in the health industry, after all these are multi-million dollar powerhouse companies that rely on you handing over cash every week or month for your health insurance. If they had it their way, they would deny your every claim because actually paying money back out takes away from their bottom line. It’s built on the principal off all take and no give returns profit.

Heavy regulation needs to be in place, and enforced to ensure people receive what they are paying for. After all, if people start thinking “Is Health Insurance a Scam?” then the companies themselves will wind up bust.. They just don’t seem to see this.

One of California’s largest for-profit insurance companies ended a disputed exercise of canceling sick insurance policy bearers Friday after a justice dictated Health Net Inc. to pay off more than $9 million to a breast cancer patient it dropped in the middle of chemotherapy.

The finding by a private arbitration judge was the first of its variety and the most powerful rebuke to the state’s major insurance companies whose cancellation exercises are under fire from the courts, state governors and elected officials.

Addressing Woodland Hills-based Health Net’s actions “egregious,” Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, found that the company broke state laws and acted in bad faith.

“Health Net was mainly worried with and believed its own fiscal interests and gave little, if any, consideration and concern for the interests of the insured,” Cianchetti published in a 21-page ruling. (LA Times)

The second surprise is that the company is not appealing the award. They can’t. This was a outcome of binding arbitration, the forum preferred by insurance policy companies for settling disputes. It Is cheaper for them and they hold more pull. But in this case not only must the company pay but it even acknowledges complete obligation. Responsibility for what? Sticking a breast cancer patient with $129,000 in invoices, driving her to discontinue her chemotherapy until a charity agreed to help her pay:

“I felt bad about what occurred to her,” [Health Net Chief Executive Jay Gellert] said. “I feel bad regarding the whole state of affairs.”

Gellert said he would move rapidly to “give individuals the assurance that they can depend on their insurance policy.” Specifically, he committed to end all cancellations until an external review procedure could be established to approve all cancellations.

This isn’t a exercise limited to this company. Blue Cross is already said to be re-evaluating their practices, antecedently supported as a room to contain costs. No doubt welshing on dedications to policy holders contains prices. One method this is concluded is to find pre-existing conditions as an excuse, promoting employees to do this creatively via incentives for meeting cancellation quotas. Of course the cancellation only comes when the policy holder makes a claim. Prior to that they are only too prepared to collect premiums.

“It’s challenging to think a insurance policy more wrong than tying incentives to encourage the rescission of health insurance that holds the public well and alive,” the judge wrote.

The bulk of the award — $8.4 million — was correctional damages, which are planned to teach the defendant a example. Such awards are highly unique in private arbitrament, the forum selected by insurance firms and other companies to determine conflicts.

Health Net’s lawyers had debated that Bates’ suffering was negligible, a situation that aggravated the justice.

“It’s hard to envisage a situation more trying than the one Bates had to tolerate,” Cianchetti wrote. “She had sound health insurance, believes she’s making a change when the rug was plucked from underneath and that occurred at a time when she is diagnosed with breast cancer, one of the superior reasons of death for women.”

It remains to the seen whether this message from an shocked judge will be heard by the industry. It sets the discrepancy between Democratic Presidential prospects Clinton and Obama into position. They are arguing about whether private health insurance should be mandatory for all (CLinton), or for most (Obama), Americans. The answer is neither. We shouldn’t be trusting on private insurance companies. A national health care plan should be publicly financed, like Medicare.

You’d think we’d have had enough of being in the hands of a rapacious industry like the health insurance industry. You’d think.