Insurer targeted HIV patients to drop coverage

[meegbear]

Source: Reuters.com

In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.

Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.

So he hired an attorney -- not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight. But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.

In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy. In September 2009, the South Carolina Supreme Court upheld the lower court's verdict, although the court reduced the amount to be paid him to $10 million.

Read more: http://www.reuters.com/article/idUSTRE62G2DO20100317

---

By winning the verdict against Fortis, Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.

Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.

<snip>

:grr:

[Soylent Brice]

1. K&R

[pinto]

2. Unanimous 5-0 decision.

:thumbsup:

[Demoiselle]

3. I'm very glad he won the suit. What a nasty greedy no-hearted bunch of thieves.

[liberalhistorian]

11. That pretty much describes 99.99%

of insurance companies. Profit Uber Alles, by and at whatever means possible and to hell with the real human costs.

[Jokerman]

4. My insurance refused to pay for a checkup that included HIV test...

until I agreed to let them see the results.

This was many years ago when I had just entered into a committed relationship and we agreed to get tested. The doctor's visit included a general physical and several tests. I received a letter from Blue Cross telling me they wouldn't pay for the visit unless I signed a release for ALL of my records. I asked the rep if this had anything to do with the HIV test and she assured me that it was unrelated.

I sent a letter to my doctor authorizing the release of the HIV test results and NOTHING ELSE.

After receiving the results, the insurance company paid the bill.

Bastards.

[KILL THE WISE ONE]

28. your braver then me, i would never have allowed that

[WatchWhatISay]

5. He hasn't seen a penny yet

The case is going through the appeals process. Think the insurance company is trying to hold out for his death?

[groundloop]

6. Dam right, the bastards will drag out the appeals until their victim is dead

[closeupready]

7. If I'm not mistaken, such judgments survive plaintiff's death, and go to his estate.

So while I think this is a possibility, even if he did die, they would still have to pay.

[rfranklin]

9. If he dies in the meantime, they should be charged with homicide...

Nothing will change in a meaningful way until the top execs get serious jail time.

[T Wolf]

12. Nothing will change in a meaningful way until the top execs suffer the consequences they

inflict on their victims.

If the patient goes broke, the exec must be impoverished.

If the patient suffers physically because of the disease, the corporate cretin must also suffer physically.

If the patient dies, the parasitic predator must also die.

ONLY THEN will they maybe be inclined to behave responsibly.

[change_notfinetuning]

25. Nope. That's saved for parents with goofy religious beliefs, not people who

are motivated by profit - the true American GOD!

[FiveGoodMen]

26. "until the top execs get serious jail time"

Or something worse.

This IS turning into a war.

[BlueIris]

16. Yes, they are trying to hold out for his demise.

Sick, sick bastards.

[SCantiGOP]

19. Doesn't matter

If he dies and they eventually lose on appeal the money would go to his estate.

[awoke_in_2003]

27. Yep...

they count on people dying or giving up without a fight- which a lot of people will (afterall, who can afford a good lawyer?)

[Christa]

8. K & Highly rec'd

Kudos to this brave young man.

[Uncle Joe]

10. Kicked and recommended.

Thanks for the thread, meegbear.

[DFW]

13. This is John Grisham's villains "Great Benefit" turned into real life

Like a perverted version of Pygmalion, John Grisham's fictional company, "Great Benefit," which had a secret
policy of systematically denying EVERY claim over $5000, seems to have had some not-so-secret admirers. It
looks like some health "insurance" companies read the book, and instead of saying, "how despicable," instead
said, "hey, that sounds like a plan."

Sort of as if big corporations had read Ludlum's "The Matarese Circle," and thought it was a blueprint for
absolute corporate power, and instead of saying "ridiculous," instead said, "cool!" The way things are going,
I would no longer count the premise for the villains of Ludlum's book as complete fiction, either.

[colsohlibgal]

14. Good For The Court

As I've said before, health insurance companies have for some time been < pond scum. Hopefully the tide is changing, albeit not fast enough - as the road is uphill to give we, the "we" people, an advantage over the 'I" and the hell with everyone else people.

[Captain Hilts]

15. Insurers say ALL diseases are "pre-existing." Especially if you've got short term ins. nt

[Bluebear]

30. You said it.

[myrna minx]

17. K&R n/t

[Odin2005]

18. Insurance = SCAM.

[TZ]

20. So, anyone else want to tell me

that the status quo is better than a flawed HCR bill? I think this case shows why we need SOMEKIND of reform...:grr:
BTW, I have a chronic condition and my insurance company tried to pull similar crap on me. Fortunately I had an airtight case, legally and they knew it.

[bejamin wood]

21. I think in a worst case scenario...

...that he could at least get a structured settlement loan in order to begin treatment and buffer costs for a few years, but that may not be accepted if new appeals are allowed. Just thinking off the top of my head here...

I hope he gets what he needs fast.

[RedCloud]

22. Charge them with conspiracy to commit murder.

Show them you mean business!

[change_notfinetuning]

23. And the Obama bill fixes this for future cases like this, right? Just asking. n/t

[pundaint]

24. It doesn't matter Democrats support For-Profit-Insurers, not People.

Bring it up again when a Party that cares is in power.

[2QT2BSTR8]

29. Although I am currently out of work...I am grateful to not be working at my old job..an ins company.

[girl gone mad]

31. Now, let's FORCE everyone to buy this shit.

Brilliant. :eyes:

[grahamhgreen]

32. Yes, these are the people who will benifit the most from the senate bill - BIG INSURANCE!

[beyurslf]

33. he should qualify for medicaid coverage automatically if his income is low enough.

Even if he cannot get full medicaid benefits, he should s till have coverage for the treatment of his hiv. This doesn't make what the insurance company did, but he should have coverage for treatment of his HIV.

[LeftyMom]

36. As we all know, well-trained doctors on the forefront of HIV/AIDS research who accept Medicaid

are a dime a dozen. :sarcasm:

Fuckin' a, have you ever had Medicaid? Finding a competent doctor for even the most routine of medical care willing to accept it is damned near impossible.

[beyurslf]

38. I have medicaid now. And HIV. Have you ever had both?

I have a great doctor and excellent care. I have had since day one and I have twice had periods of no insurance and had medicaid to back up my coverage both times. Oh and before you think I live in SF or NYC, I live in Kansas.

[LeftyMom]

39. Just MediCal. Can't get a doctor fit to trim an ingrown toenail myself.

Seriously, three month wait for a doctor, they sent me to the ER instead.

I wouldn't trust anybody with a serious illness, or a minor one that might turn serious, for that matter, to the Medicaid system here- it's a mess.

[Hassin Bin Sober]

34. Why is this grifter entitled to 10 million?

Tort reform now!!!

:sarcasm:

[defendandprotect]

35. Ah, yes, but now insurance companies can be trusted to run ALL of our nations health care!!!

[ck4829]

37. K&R