Have you ever been denied coverage on a health care issue that you thought was covered by your health care insurance plan? Has your concern over a future disability/ illness been identified as the reason for health care denial even though it is not an actual diagnosed condition? Do you believe that you are a victim of irresponsible medical history investigations carried out by the insurance provider? Have you been particularly affected by health coverage cancellation/rescission by Time Insurance Company (Assurant Health) stating incomplete medical history as a reason? If yes, then you are one of the many health care policy seekers who have been unjustly denied coverage.
Assurant Health, also known as Time Insurance Company has been a player in the health insurance industry for over 110 years and is currently the number one seller of temporary health insurance in United States. Assurant health, along with other providers have been under the public ire for making hundreds of millions in profits by rescinding or cancelling health care coverage for sick people. The company’s CEO testified before the Congress last year in relation to the $150 million saved over five years by unfairly rescinding 8,500 policies. In 2007, the company was fined $2.1 million in Connecticut for improper medical claim denials, leading to a number of other lawsuits against the company that resulted in out of the court settlements.
$37 Million Settlement: A Recent Example
In February 2010, Jennifer Latham, a Lafayette based woman whose policy was rescinded after she was involved in a devastating car accident finally won $37 million in damages against Milwaukee-based Assurant Health. After being severely injured in a car accident that left her unable to work, Latham, who was holding a short term health insurance policy that she signed up for five months before the accident, was denied health care coverage and her policy was rescinded, i.e., her policy was made void as if it never existed on the grounds of failing to disclose her complete health history information in her application. This led to mounting medical bills to the tune of $200,000 to date while she lost her home in foreclosure and has been living on disability check. Her four-year battle with the insurance company to pay for her damages finally culminated in a $37 million verdict – a verdict that has brought back the improper cancellation of health insurance policies back into the limelight.
What does health insurance policy rescission mean to you?
For individuals paying for their own health policies, rescission, i.e., cancellation of policy with retrospective effect, usually on grounds of alleged fraud on the application makes it very difficult to obtain health insurance with any other provider. In these cases, you should be clear about the insurance policy guidelines and should contest the denial. You could also approach a private legal counsel or state health insurance consumer advocate if you believe that the health insurance provider has been unjust in denying the coverage.
What should you do in case of medical coverage denial?
In case of medical coverage denial, you should first understand the policy guidelines to check if the coverage that you are seeking is included in the policy. Then you should investigate the reasons for denial and should keep record of all the correspondence carried out with the insurance provider for the same. After gathering all the documents from the insurance provider that supports the reasons for denial, you could approach a state health insurance consumer advocate or any nonprofit or for-profit entity that offers advice in this area. (Patient Advocate Foundation is one such nonprofit entity that handles health-insurance appeals free of cost.) Researching scientific evidence behind the need for a particular treatment can also be helpful in appealing for coverage.
A final appeal can be made in the federal court or through a state appeal process handled by state insurance regulator. Please be aware that each state has different laws regarding the appealing process and you should consult a lawyer well versed in your state law to be able to better understand and take advantage of the appealing process.