nsurer faces off against lawyers Health Net trying to cancel policies for

[Coastie for Truth]

Health Net of California Inc. is locked in a legal battle over trying to drop health coverage to several professional organizations, including the San Francisco Trial Lawyers Association.

In 2003, Health Net tried to terminate policies with the trial lawyers, the Organization of Women Architects and other groups. The insurer, based in Thousand Oaks (Ventura County), has contended the associations did not have at least 1,000 members. That's the legal threshold that requires insurers to renew group coverage to professional organizations if that coverage is already in place.

The trial lawyers group, which has 500 to 600 members, is one of a few professional organizations that offer group coverage to their members, often sole practitioners who lack access to such policies. The option is often attractive to members because their alternative would be to seek health coverage as an individual, and rates and acceptance would be based on their medical history.

The lawyers association won a preliminary injunction in 2003 that has required Health Net to maintain coverage. They argued that their HMO contract had language prohibiting Health Net from terminating coverage unless "good cause" existed, which meant specific violations such as failing to pay premiums, committing fraud or misrepresenting their business.

---edited for brevity---

THIS IS NOT ABOUT LAWYERS--

THE ISSUE IS COVERAGE FOR "SMALL GROUPS" AND "INDIVIDUALS"

*Insurers want to get rid of policies with small professional associations because they typically don't make money

*Part of the problem is that such groups can be a refuge for people who couldn't get health insurance any other way, so they often have a high number of people with pre-existing health conditions.

*A San Francisco health insurance broker and consultant blamed the insurance industry for creating an environment that makes people struggle to find coverage.
"The most minor (medical) problems in the individual marketplace will cause (insurers) to drastically increase your rates or not to sell you coverage at all,"

*The health plan coordinator for the Organization of Women Architects, said health insurance is a key service the San Francisco group has been able to offer its members for more than 30 years. About 100 of the group's 350 members are insured under the Health Net policy.

MY SUGGESTION

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UNITED STATES PUBLIC HEALTH SERVICE COMMISSIONED CORPS DOCS IN SAILOR SUITS

[MrModerate]

1. I've got to doubt the wisdom . . .

Of trying to fuck-over 600 lawyers.

Jokes aside, isn't the insurance company just asking to run its own lawyers ragged and run up a huuuuuuge legal bill?

[salin]

2. I have to admit

that was one of my first thoughts... that if they were going to try to dump a professional organization due to the numbers (and 500-600 is a sizeable pool - our small nonprofit employs far fewer, but we get a group rate), that I am glad that they took on trial lawyers who will fight back and raise awareness. From the business side my reaction was like yours... per the insurance company... what a bunch of idiots.