Health Insurance Canceled, After Teen Diagnosed With Celiac Disease

September 21, 2009

(ChattahBox)—American Community Mutual Insurance drove an Illinois family towards the brink of bankruptcy, with a simple cold-blooded bureaucratic decision to cancel the health insurance of the family’s teenage daughter, after she was diagnosed with celiac disease. The family is now facing thousands of dollars in medical expenses and is in danger of losing their home.

Health insurance companies are increasingly engaging in a deplorable practice called, rescission where insurers search for evidence of untruthfulness on applications, or comb through medical records to find an ailment that may qualify as a pre-existing condition, and then abruptly cancel insurance coverage.

Many rescissions take place soon after an insured is diagnosed with a major medical condition or suffers from serious injuries, requiring expensive medical treatments. It’s a simple dollars and cents calculation made by the health insurance company, that is in the business of making money, not saving lives, which plunges families into bankruptcy or worse, results in death from lack of needed medical treatments.

Dale and Pat Rice of Deerfield, Illinois purchased an individual health insurance policy from American Community Mutual for their 17-year old daughter Brianna, in November 2008, after Dale lost his job and couldn’t afford the COBRA payments to continue with his employer-provided health insurance.

In February 2009, Brianna was diagnosed with celiac disease. On May 12, the insurer sent the Rices a letter stating it was rescinding coverage, dating back to Nov. 1, the date of the policy, because the company said the couple lied on their daughter’s application:

“The coverage you applied for would not have been issued for Brianna if we had known this medical history at the time of application,” the letter said.

The company claimed that while searching through Brianna’s medical records and doctor’s visits, they found instances of dizziness, elevated cholesterol levels, ongoing fatigue and a persistent cough.

The Rices say the company cherry-picked through their daughter’s medical records to find an excuse to cancel her coverage, because of her celiac disease diagnosis. None of the medical problems listed by American Community Mutual were ongoing problems:

“He attributed the dizziness to dehydration, the fatigue to his daughter staying up late surfing the Web, the elevated cholesterol to an inaccurate test, and said the cough is now gone. None of the issues were serious medical problems, and none stuck out in his mind when he filled out the application, Rice said.”

A copy of Brianna’s July 2, 2008, physical, showed no major health concerns.

Ellen Downey, spokeswoman for American Community claims the family lied on the policy application, by not listing Brianna’s cough and other minor temporary ailments. “We never rescind policies when applicants provide accurate and complete information at the time of application,” said Downey.

Meanwhile, the Rices face mounting unpaid medical bills in excess of $20,000 and are unable to purchase health insurance for their daughter, because now she is branded with a “pre-existing condition.”

The couple has filed a complaint with the Illinois Department of Insurance, which has investigated 12 rescission complaints from American Mutual, since 2007, but has held in favor of the insurance company 11 times. The Rice’s complaint is presumably the 12th and is under review. Six of the rescission complaints against American Mutual were filed just this year.

Department of Insurance Director Michael McRaith, acknowledged the high number of rescission complaints from American Mutual. “That number of rescissions in itself is cause for concern, said McRaith.

On American Mutual’s Web site, the company promotes the slogan: “People who care. Policies that protect.” All of that corporate caring and protection were not extended to the Rices, nor to the scores of other customers around the country with cancelled insurance.

The practice of rescission occurs every day by every single private health insurer in the country. This despicable practice calls out for reform and illustrates the need for a public health option in any meaningful health reform bill.

Source: Chicago Tribune


Comments

18 Responses to “Health Insurance Canceled, After Teen Diagnosed With Celiac Disease”

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    I believe there must be more to this story. Can’t children under 18 get insurance from state plans? Plans that charge according to your income. What ever happened to getting a job to pay for your own health insurance. Aren’t government officials addressing unemployment rates, instead of health insurance reform? Insurance companies would go broke and rates would skyrocket if we could cancel insurance when we don’t need it and get it when we need it. If it goes any higher, who will pay for the working American Insurance?

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