Fool me once, shame on you! Fool me one million times, you owe $9.92 billion dollars!

The LA Times reports today that PacifiCare faces fines up to $9.92 billion dollars for close to one million incidences of mismanaging medical claims, refusing to pay for covered benefits, losing thousands of patient records, and failure to pay claims to doctors. Furthermore, state regulators at the Department of Insurance received countless complaints that the company ignored consumers’ requests for help. The $9.92 billion fine is based on a $10,000 penalty for each of the 992,936 violations that regulators have investigated and validated. (Read the whole article here.)

One of the provisions of the Federal Health reform law that goes into effect on September 23, 2010 (read more at provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process. Clearly, no such system was in effect for the 1,000,000 consumers who suffered at the hands of PacifiCare, now owned by United Health, the very same United Health that raked in $81 billion in profits last year. For any who still believe that the free market can take care of the problems in our health care system, I present 1 million witnesses to the contrary.

Last week the California Legislature ended its session with mixed results, passing some insurance regulation bills, but rejecting others. This month, Governor Schwarzenegger has the opportunity to sign these bills into law, and making California a safer place to be insured.

Health Access California promotes quality, affordable health care for all Californians.
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