Insurer Used a Computer program to drop HIV patients coverage

[democracy1st]

(Reuters) - 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.

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.

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

[Egnever]

1. No surprise there

Dont they all do this? I would assume they are all looking to the most expensive cases to try and get them off the books.

With any luck cases like this are going to be greatly reduced with the passage of this health care bill.

[Are_grits_groceries]

2. My state and county finally

did something right!

[Rhiannon12866]

3. Wow! K&R!

I heard about this, but didn't know the complete story! Thanks for posting! :thumbsup:

[PA Democrat]

4. And in 2007, the same company, now called Assurant Health was STILL

doing the same thing. I experienced it first hand, and I have no doubt they are still engaged in the same despicable practice.

Any claim for treatment of a catastrophic or chronic illness is kicked out by their computer system and a FRAUD investigation is started. They bombard the insured with paperwork asking for a comprehensive list of every doctor, every hospital, every pharmacy the person had used for the past five years. Then they harass each one of those entities for copies of records, and scour those records for any bit of information, no matter how far-fetched to justify a denial.

For me, it was four months after my treatment, and a literal mountain of paperwork, form letters and utter bullshit later, that they determined that my very treatable stage 0 cancer was a preexisting condition, based upon a doctor's visit more than three years earlier for something that every medical professional I spoke with concurred could in no way be related to the particular type of cancer I had.

Connecticut State Attorney General Richard Blumenthal at that point in time had initiated his own investigation into the pattern of unjustified claim denials by Assurant. It was from his office that I learned about Assurant's computer coding to kick out all claims for cancer treatment of any kind to initiate a fraud investigation. I filed a complaint with my state's insurance department and contacted a state legislator who offered me assistance. I eventually got my claim paid. Had I needed additional treatment, I don't know what would have happened.

Oh, and Assurant gave bonuses to the claims processors who deny the highest percentage of claims. And people find Mafia hit men despicable.

[Orsino]

5. South Carolina isn't all idiot governors, lieutenant governors and horse-fuckers.

Way to go, SC! :thumbsup: