The LA Times has an interesting story about Kaiser health plans working with the state to develop standards “to protect” policy holders from abrupt and unfair insurance coverage cancellations.
Oakland-based Kaiser said its proposed standards would include the requirement
that it consult with policyholders before deciding whether to rescind their
So, is that kind of like the playground bully asking my permission before playing Wac-a-Mole? (me being the mole)
Such a consultation would help the HMO determine whether policyholders
intentionally submitted inaccurate information about their health conditions in
order to obtain coverage. (emphasis added)
The Times says, “With the move, Kaiser embraces a standard for cancellation pushed by consumer advocates, the first sign of a substantive split within the health plan industry on this issue.”
While I appreciate that Kaiser is breaking with the status quo — such as Blue Cross and Blue Shield, who think it’s OK to take back hundreds and thousands of dollars in treatment, let it be clear that it’s not good enough.
It still allows insurers to subjectively decide — after (rather than before) they’ve asked patients if they “intentionally submitted inaccurate information.” It does not use independent and consistent standards and there is no neutral third party (ahem, Department of Managed Health Care, anyone?) that is stepping in to police.
It also assumes patients have the medical background and knowledge (without the benefit of having been to medical school) of knowing what to report.
Patients are bombarded with these kinds of seemingly simple, innocuous and nebulous questions when applying for insurance. When I was 21 years old and not yet eligible for health insurance at my first job, my worrywart mother made me go out and get insurance on the individual market. I filled out a lengthy questionnaire and disclosed that I used to have shortness of breath as a child. I was denied coverage.
Should I have reported the shortness of breath? I had never been diagnosed for asthma – therefore, could truthfully say that I didn’t have a chronic illness. But I had been checked out by a doctor for the shortness of breath. Had I not reported that visit, I could be willfully withholding information.