Tuesday, October 13, 2009

Shameless Corporation of the Week Award


This weeks Shameless Health Insurer Award goes to American Community Mutual Company. The saga of 17 year old Brianna Rice starts in the summer of 2008. Her dad lost his job as a business consultant and also lost his group insurance. Continuing coverage with COBRA was too expensive so they took out a new policy with American Community Mutual in Illinois. Because the 17 year old was healthy, the monthly premium was only $130.00

In February, 2009, Brianna was diagnosed with celiac disease. On May 12 the insurance company rescinded her insurance and said it was a pre-existing condition and they would not cover any of the doctor or lab bills. Doctor visits from the distant past had mentioned dizziness, high cholesterol (a lab error), fatigue and a cough. They attributed those mentions to celiac disease and said they would not pay for treatment. A physical exam performed on July 2, 2008 showed no major health concerns.

Celiac disease is a digestive disorder and is treatable by eliminating wheat products from the diet. It does not cause cough, dizziness or high cholesterol. Some patients do experience fatigue.

If insurance companies can collect premiums and then cancel a policy when a patient gets sick, the insurance is virtually worthless. Brianna's father has called several other insurers in Illinois but they will not insure her based on the February diagnosis. She qualifies for the Illinois Comprehensive Health Insurance Plan (CHIP) which is designed to help people who cannot get insurance through the conventional market. The average premium is $7,666 to a high of $16,000.

Congratulations to American Community Mutual Insurance for winning this weeks "Shameless Corporation Award."

5 comments:

KM said...

I have a Internal Medicine doctor who does not take any insurance so the way it works at the time of the visit is I pay on my way out and submit the bill to my insurance. When and if I meet my deductible with Blue Cross Antham they should pay 50%. For 6 months I have been trying to get them to pay me with having met my $3,500 deductible. Twice I have mailed copies of the bills and waited the 3 time to get my check nothing happened so I called. Both times they said they never got my bills. But conveniently enough they got the bills when I had not met my deductible and they didn't have to pay or it was a physical the consider preventative.

I called today and somehow magicaly the phone agent found the bills were received. Now they said they needed more info. that they didn't get complete info. from my doctor. So if this can help anyone in my situation they wanted the TAX IF # of my doctor and office address. The office moved 6 months ago but in the same city and they said they didn't know if that was the same doctor or not. So each time a bill is submitted to Antham it has to have the physicians TAX ID and address. Along with the diagnose code of course which they had. I'm sure Antham was hoping I would never call back and they would not have to reimburse me my 50% of the bill. Hope this can help other people in my situation.

jobb said...

KM, at least you have the will and the intelligence to follow through and try to get the coverage you pay for. I do pity the patient who does not have the knowledge or the capacity to fight for their rights. I also pity the health workers who have jump through all the hoops to receive just compensation.

Kim said...

Hello
Hey till now I have just heard about Hall of fame,Hall of Shame is quite funny.I just read this story about Brianna and sometimes insurance companies do like this which is not good at least for patients.Thank you for sharing this with us.

h1n1

ERP said...

This whole preexisting condition thing has got to end. It is my understanding that if health care reform passes and everyone will be required to purchase (or otherwise obtain) insurance, the companies will do away with this policy in exchange. Please let's hope that happens.

KM said...

Jobb: Thanks. I have seen it from different sides working for doctors as well as my own experiences, and relatives and friends situations.

I had a friend denied for health insurance because of low Vitamin D. With a relative they added on a false diagnosis calling it suggestive that she has never had.

There is a surgeon I know who told me that if the doctor writes a letter against the conditions for denial and they deny again she has written a 2ed letter addressing those specific reasons. The surgeon was talking about the basically healthy person that is denied for a common problem that is controlled by med. or other treatment and might have been happened once a a rare occurrence.