Recently there was an article posted in the Chicago Tribune titled “Firm cancels health insurance coverage for girl, 17, after celiac disease diagnosis". The article talks about American Community Mutual Insurance Company rescinding a policy after being diagnosed with a condition. What makes the ‘image’ worse is that they did it to a minor. We are all looking for dependable affordable health insurance. This is the last thing we want to hear.
Just like anything else in the media, there is a twist to make it sell. If they don’t sell ads or newspapers, just like any other business they would shut down. The sad thing is the person that wrote the article actually states the obvious reason why they rescinded the policy.
The parents insisted they were truthful on the application. Even the application states that there were no prior medical problems. However, in the article it also states that American Community reviewed her files and found reports of dizziness, elevated cholesterol levels, ongoing fatigue and persistent cough. It continues to state that the father defended the findings of the insurance company. That tells me that they were not truthful on the application. Even if the ailment is not on the list provided on the application by name there is a question on the American Community application (similar to other carriers as well):
118. Been diagnosed or treated for any medical symptoms or condition not listed above? Yes or No
The father continued by saying “the insurance company cherry-picked from various doctors’ visits and that none of his daughter’s health problems were ongoing.” If you go back and re-read question #118 it doesn’t say ‘ongoing’. On top of it, if the wording was misinterpreted American Community would have given enough time to get the doctor with those records to write a letter clarifying his/her notes. The father gave HIS reasons for each one of the medical conditions. Shouldn’t that be good enough? The reality is that it’s not good enough. The insurance companies don’t make this stuff up. You can’t get around it if something is stated in the medical records, that’s why it is there. Maybe we should go more ‘European Style’ for the doctors – I’ve heard they don’t keep copies of the records. They give the results of the examination to the patient. This way you can actually see what is written down in the records.
According to the Illinois Department of Insurance, since 2007, American Community has had 12 rescission-related complaints, 6 just this year alone. However, with 11 of those complaints the Department of Insurance upheld American Community’s decision to rescind the coverage. The Department of Insurance is there to protect the consumer. In other words, there were 11 complaints that were justifiable to rescind the policy based on false information provided by the policy holder. The 12th case, presumably, is the case they are referring to in the article. Then there is the argument about having half the number of complaints just this year alone… Only consumers can dictate when they want to file a complaint. The article did not compare the number of complaints to any other carrier. It could be safe to ‘assume’ this could be the norm. Even if we cannot, we don’t have enough evidence to make a statement.
The article states that the department has investigated about 400 rescission-related cases industry wide since 2005. These are only complaint related. There are 1,000’s of rescissions every single year. People in general have good intentions to tell the truth and to be honest. However, the truth is that most people don’t fill out health applications every day. What may not be as important or a ‘problem’ to you could be a problem for the insurance company. This is where working with an independent health insurance expert is important. If you are not sure if you need to put it down or not, put it down. If you are like me, I’d rather see what kind of problems I will run in to now, when I don’t need insurance, versus when I actually need the health insurance at claim time.
The applicant in the article does qualify for Illinois Comprehensive Health Insurance Plan, or ICHIP. For a 17 year old female, they are looking at an average premium of $2,700 per year, not the $7,666 it states in the article. This is just another way to mislead people that just don’t know any better.
This should be a good lesson for those who might have withheld information on their application for coverage. Sure, it is a bad thing to have something like this happen to someone, especially a minor. Switch the roles a little and ask yourself if YOU were the insurance company and had to worry about fraud all the time. Wouldn’t you investigate to see if someone was not being truthful? If not, you would go out of business because people would take advantage of you!
Butch Zemar - Elite Benefits of America