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Denied / Delayed Insurance Claims

  • New law guarantees mental health parity in insurance coverage
    Mar 02, 2010


    A new federal law which took affect on January 1 will ensure that medical health costs are comparable to physical health benefits. In the past, recipients of mental health care or substance abuse treatment could pay twice as much for treatment as they would for doctor's office visits for physical health concerns.

    The new law applies to insurance groups with 50 or more employees and affects 140 million Americans. Higher deductibles and steeper co-pays will no longer be allowed for mental health or substance abuse treatment in comparison with other medical treatment.  It does not, however, require insurance groups to provide mental health and substance abuse treatments, although most already do. The law does not apply to individual insurance policies.

    The law as passed with broad bipartisan support in Congress. Mental health advocates are pleased with the results, while insurance providers feel that it is too expansive. However, the American Psychiatric Association claims that mental health only accounts for a fraction of health care costs overall.  
























     

  • Consumer group sues Anthem for restricting coverage
    Mar 02, 2010


    California's largest for-profit health insurance provider, Anthem Blue Cross, is being sued for violating California law by closing certain health insurance policies to new members while offering remaining members alternative plans with fewer benefits and higher rates.

    The class-action lawsuit is being brought by a Santa Monica-based Consumer Watchdog, who claims that the company is violating California's Health and Safety Code. In the state, when an insurance provider closes a policy, they must provide a comparable alternative. When a block of insurance is closed, it drives up premiums for remaining members, who now must divide costs among a smaller number of people. 

    The closing of certain policies to new members came about the same time that the company warned consumers that their rates would rise as much as 39%.



































     

  • WellPoint's CEO's defense of rate hikes seen as unapologetic
    Mar 02, 2010


    WellPoint, Inc.'s Chief Executive, Angela Braly was seen combative in her defense of the California company's rate hikes, in which consumers could see a rise as much as 39%. 

    She blames not the company, but physicians and insurance providers for driving up health care costs. She also claims that fewer healthy people are buying new insurance policies due to the present economic downturn. She says that WellPoint was forced to increase rates in order to break even.

    Ms. Braly made these comments during a House hearing in Congress on the rate hikes.






























     

  • Sebelius Rejects WellPoint's Explanation of Premium Increases
    Feb 16, 2010

    Health and Human Services Secretary Kathleen Sebelius has rejected the recent claims by WellPoint Inc, the parent company of health insurance provider, Anthem Blue Cross that their recent increases in premium are do to a combination of growing medical costs and loss of healthy consumers.

    Sebelius says it is “difficult to believe” that a company who made “2.7 billion in the last quarter of 2009” could justify this rate increase. WellPoint executives claims that Anthem Blue Cross has lost millions in the past year, due to consumers who have switched from their insurance provider to a lower-cost option in the weak economy. According the company, they have paid out more in claims than they are currently receiving in premiums.

    The Los Angeles Times reports that Californians could see “as much as a 39% increase” in rates. WellPoint maintains that this is in line with competing insurance providers in the area.

    The President, like Sebelius, has also singled out Anthem Blue Cross, citing it as another reason to reform health care. Congress has opened investigation on the company, which will face 3 inquiries over the rate increases. 

  • Insurance Cancellations Keys in Health Care Debate
    Sep 10, 2009

    Sept. 10, 2009


    The practice of insurance rescission has become a key component in the ongoing debate over health care reform, the Washington Post reports. While statistics on the number of policyholders who lose their coverage because of an existing condition remain hazy, some of the nation's largest insurers have recently paid nearly $20 milliion in fines for abandoning policyholders. For their part, the insurance industry argues that policy cancellation is necessary to help control fraud.





  • Grassley probing Aetna over healthcare plan that left Texas man owing $200,000.
    Jul 07, 2009

    Grassley probing Aetna over healthcare plan that left Texas man owing $200,000.
    The New York Times (7/3, B4, Abelson) reported that Iowa Sen. Charles Grassley (R) last week wrote to Aetna "asking for details about a policy it sold to a man in Texas that left him owing nearly $200,000 in medical bills. The man, Lawrence Yurdin, age 64, was included in a front-page article in The New York Times on Tuesday about the many people whose insurance coverage does not protect them from financial ruin in the case of a medical crisis. Although Mr. Yurdin and the hospital where he received heart treatments say they both understood that the Aetna policy covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the medical care he received. He and his wife, Claire, filed for personal bankruptcy in December." The Times notes that Grassley "also investigated some of the health plans that another insurer, the UnitedHealth Group, sold through AARP, the advocacy group for older people. Those plans, which also had sharp limits on coverage, are no longer being sold."

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