American Health Care: Nurse Wages Battle with BlueCrossBlueShields Over Policy Cancellation
Robin Beaton, RN, worked as a nurse for 30 years ... 59, almost didn’t get the double mastectomy she needed when she was diagnosed in June 2008 with HER2 positive breast cancer, an aggressive form of the disease. Beaton, who lives in Waxahachie, Texas, was not among the approximately 45 million Americans who do not have health insurance. In fact, Beaton, a retired nurse, purchased an individual health insurance policy in December of 2007 through Blue Cross and Blue Shield and paid the $400 premium every month. Yet she was denied treatment for her breast cancer — the very first claim she had made on the policy — because her insurer, Blue Cross and Blue Shield, canceled her entire policy after she made the claim.
Insurance officials told her they canceled her coverage because she had failed to inform them about a visit to a dermatologist for acne. The company interpreted a word in the dermatologist’s notes to mean she had a precancerous condition. The dermatologist himself called the insurance company and told officials they were wrong, and that Beaton did not have a precancerous condition. Blue Cross pulled her records anyway and started an investigation into her medical history for the previous five years. After the investigation, which found she had not done anything beyond incorrectly stating her age, the insurer still refused to resinstate her policy.
At least that was until Beaton’s congressman, Rep. Joe Barton, R-Texas, stepped in and told Blue Cross and Blue Shield that he and the Susan G. Komen Breast Cancer Foundation would hold a press conference to tell the media about Beaton’s circumstances. “I’m not out to get insurance companies,” Barton told Nurse.com in a phone interview from his Washington, D.C., office. “But when you portray youself like a paternal uncle and say you are going to do everything you can to take care of your policyholders and yet you have a business practice to break that policy, then that is wrong.”
The business practice Barton is referring to is called insurance rescission, the canceling of individual insurance policies, usually after a person is found to need expensive treatment...
To read more, click onto link below...
http://news.nurse.com/article/20090720/NAT...
Insurance officials told her they canceled her coverage because she had failed to inform them about a visit to a dermatologist for acne. The company interpreted a word in the dermatologist’s notes to mean she had a precancerous condition. The dermatologist himself called the insurance company and told officials they were wrong, and that Beaton did not have a precancerous condition. Blue Cross pulled her records anyway and started an investigation into her medical history for the previous five years. After the investigation, which found she had not done anything beyond incorrectly stating her age, the insurer still refused to resinstate her policy.
At least that was until Beaton’s congressman, Rep. Joe Barton, R-Texas, stepped in and told Blue Cross and Blue Shield that he and the Susan G. Komen Breast Cancer Foundation would hold a press conference to tell the media about Beaton’s circumstances. “I’m not out to get insurance companies,” Barton told Nurse.com in a phone interview from his Washington, D.C., office. “But when you portray youself like a paternal uncle and say you are going to do everything you can to take care of your policyholders and yet you have a business practice to break that policy, then that is wrong.”
The business practice Barton is referring to is called insurance rescission, the canceling of individual insurance policies, usually after a person is found to need expensive treatment...
To read more, click onto link below...
http://news.nurse.com/article/20090720/NAT...
