- 3,864
Wouldn't it be so much easier just to sign it in blood?
Health Net Redux
- Thread starter somarco
- Start date
Wouldn't it be so much easier just to sign it in blood?
- 14,808
Why can't I simply tell the applicant "you don't need to mention that" when they fill out the app?
- 3,384
- Thread starter
- #24
Just got off the phone with the VP of Corporate Communication for Health Net. Quite a bit she cannot say for legal reasons but did reveal an interesting tidbit.
It seems that Ms. Bates was awarded damages under a class action suit over use of Phen-Fen. As I recall, and I am trying to find the answer, in order to make a claim you had to prove you used Phen-Fen AND had an echocardiogram to prove heart damage.
Seems this was never part of the application in addition to the issue over her actual weight.
I will post on InsureBlog, hopefully next week, once the details of our interview have been reviewed and cleared by H N legal.
If anyone has details on the criteria for participating in the Phen-Fen class action suit, as it pertains to proving damages, a link would be appreciated.
Almost forgot . . .
Health Net supports legislation mandating health insurance for everyone AND requiring guaranteed issue of individual health insurance.
Apparently they don't understand this approach does not work.
Perhaps that explains why they got in this mess from the beginning . . .
It seems that Ms. Bates was awarded damages under a class action suit over use of Phen-Fen. As I recall, and I am trying to find the answer, in order to make a claim you had to prove you used Phen-Fen AND had an echocardiogram to prove heart damage.
Seems this was never part of the application in addition to the issue over her actual weight.
I will post on InsureBlog, hopefully next week, once the details of our interview have been reviewed and cleared by H N legal.
If anyone has details on the criteria for participating in the Phen-Fen class action suit, as it pertains to proving damages, a link would be appreciated.
Almost forgot . . .
Health Net supports legislation mandating health insurance for everyone AND requiring guaranteed issue of individual health insurance.
Apparently they don't understand this approach does not work.
Perhaps that explains why they got in this mess from the beginning . . .
- Thread starter
- #25
Health Net's letter to brokers following the arbitrator's ruling . . .
Dear Broker,
You may have heard news reports about an arbitration award involving Health
Net. The case focused around the rescission of an individual member's
policy. The member suffered from a serious illness and anyone would feel
sympathy for her.
We want everyone who properly obtains a Health Net policy to get the care
they need. So, we want everyone who applies for a policy to understand how
important it is to give us accurate information. If they don't, it
undermines the underwriting process.
We are writing to remind you of steps you can take to help us avoid
rescissions in the future;
• Make sure your clients understand the importance of being completely
truthful and accurate in their application.
• Work with your clients to verify all of the information on the
application. When we have rescinded policies because of inaccurate
information, we believed that the individual knew that certain information
was inaccurate and should have been disclosed.
• Ask about other family members who are applying. Make sure the health
histories for all family members are complete.
• Always ask the applicant to personally fill out the application and
sign it.
• Remind them that failure to disclose a material fact could have
serious consequences including the loss of insurance.
• If there's any doubt about whether a fact is material, it's always
best to disclose it on the application form.
We also wanted you to understand our position on the recent case. Here is
the statement we issued to the news media:
Yesterday we received an arbitration decision in a case involving the
rescission of an individual insurance policy. While we do not agree
with all of his conclusions, the arbitrator raised some serious
concerns. Some of these concerns have already been remedied over the
past few years, and we intend to address the remaining issues he
raised.
Effective immediately we are doing the following things:
First, we will rescind no policies in the future without a binding
external third party review process.
Second, we will ensure our application and underwriting process is
clear and understandable, and that we get all necessary information
before issuing a policy.
And third, we will do a comprehensive review of all parts of the
process including enhanced broker review, training and education.
We will be making specific announcements in the coming weeks. We will
also urge the passage of legislation in California to address these
matters on a statewide basis.
We take this very seriously and are committed to resolving these
issues.
We appreciate your support in working to provide affordable coverage to
more Californians who are not covered by group policies such as employer
coverage. We remain hopeful that the larger discussions in Sacramento and in Washington about health-care reform will help resolve some of the issues that are raised by this case. In the meantime, we look forward to working closely with you – and with health-care providers – to ensure that we serve as many individuals as possible.
Dear Broker,
You may have heard news reports about an arbitration award involving Health
Net. The case focused around the rescission of an individual member's
policy. The member suffered from a serious illness and anyone would feel
sympathy for her.
We want everyone who properly obtains a Health Net policy to get the care
they need. So, we want everyone who applies for a policy to understand how
important it is to give us accurate information. If they don't, it
undermines the underwriting process.
We are writing to remind you of steps you can take to help us avoid
rescissions in the future;
• Make sure your clients understand the importance of being completely
truthful and accurate in their application.
• Work with your clients to verify all of the information on the
application. When we have rescinded policies because of inaccurate
information, we believed that the individual knew that certain information
was inaccurate and should have been disclosed.
• Ask about other family members who are applying. Make sure the health
histories for all family members are complete.
• Always ask the applicant to personally fill out the application and
sign it.
• Remind them that failure to disclose a material fact could have
serious consequences including the loss of insurance.
• If there's any doubt about whether a fact is material, it's always
best to disclose it on the application form.
We also wanted you to understand our position on the recent case. Here is
the statement we issued to the news media:
Yesterday we received an arbitration decision in a case involving the
rescission of an individual insurance policy. While we do not agree
with all of his conclusions, the arbitrator raised some serious
concerns. Some of these concerns have already been remedied over the
past few years, and we intend to address the remaining issues he
raised.
Effective immediately we are doing the following things:
First, we will rescind no policies in the future without a binding
external third party review process.
Second, we will ensure our application and underwriting process is
clear and understandable, and that we get all necessary information
before issuing a policy.
And third, we will do a comprehensive review of all parts of the
process including enhanced broker review, training and education.
We will be making specific announcements in the coming weeks. We will
also urge the passage of legislation in California to address these
matters on a statewide basis.
We take this very seriously and are committed to resolving these
issues.
We appreciate your support in working to provide affordable coverage to
more Californians who are not covered by group policies such as employer
coverage. We remain hopeful that the larger discussions in Sacramento and in Washington about health-care reform will help resolve some of the issues that are raised by this case. In the meantime, we look forward to working closely with you – and with health-care providers – to ensure that we serve as many individuals as possible.
- 3,864
All carriers support Universal Coverage - NOT a government plan.
With Universal Coverage - carriers sales would be through the roof and they don't have to pay these pain in the a$$ agents.
With Universal Coverage - carriers sales would be through the roof and they don't have to pay these pain in the a$$ agents.
- 7,790
- 3,384
The diagnosis of a Fen Phen injury is not simple and requires echocardiogram testing and a meticulous review of a patient's medical background. Some people who took Fen Phen years ago are just now being diagnosed with life threatening cardiovascular problems
Defective Drug Information -Fen phen class action
- 3,384
IMPORTANT! All echoes must be completed before Jan. 3, 2003! To ever obtain anything for damaged heart valves, you must have an echocardiogram by January 3, 2003 which shows at least mild aortic or mitral regurgitation. For more important fen phen deadline information, read below, and to ensure that you do not blow any important deadlines, contact Feldman & Rifkin, LLP toll free 888-766-2690 or fax all echo results to us at 215-885-3303, include your phone number, and we will call you back to discuss your situation.
FenPhenCental
FenPhenCental
- 3,384
Fen Phen Injuries
[SIZE=-1]To qualify for many rights and benefits under the class action, an individual needs to have at least "FDA Positive" valvular heart disease. This is defined as having at least mild aortic regurgitation (also sometimes called "insufficiency") or moderate or greater mitral regurgitation. The terms "mild," "moderate," and "severe" referring to regurgitation can be defined numerically, although such regurgitation is more frequently identified by the general categorization. So, while this information is not necessary for the rest of this paper, the technical definition of these terms in the settlement are as follows:[/SIZE]
[SIZE=-1]Aortic regurgitation:[/SIZE]
[SIZE=-1]JH/LVOTH = jet height/left ventricular outflow tract height[/SIZE]
[SIZE=-1]Mild Aortic Regurgitation > 10% and < 25% or 11-24% JH/LVOTH[/SIZE]
[SIZE=-1]Moderate Aortic Regurgitation = 25% ?— 49% JH/LVOTH[/SIZE]
[SIZE=-1]Severe Aortic Regurgitation > 49% JH/LVOTH[/SIZE]
[SIZE=-1]Mitral Regurgitation:[/SIZE]
[SIZE=-1]RJA/LAA = regurgitant jet area/left atrial area[/SIZE]
[SIZE=-1]Mild Mitral Regurgitation > 5% and < 20% or 6-19% rJA/LAA[/SIZE]
[SIZE=-1]Moderate Mitral Regurgitation = 20% — 40% RJA/LAA[/SIZE] [SIZE=-1]Severe Mitral Regurgitation > 40% RJA/LAA[/SIZE]
[SIZE=-1]To qualify for many rights and benefits under the class action, an individual needs to have at least "FDA Positive" valvular heart disease. This is defined as having at least mild aortic regurgitation (also sometimes called "insufficiency") or moderate or greater mitral regurgitation. The terms "mild," "moderate," and "severe" referring to regurgitation can be defined numerically, although such regurgitation is more frequently identified by the general categorization. So, while this information is not necessary for the rest of this paper, the technical definition of these terms in the settlement are as follows:[/SIZE]
[SIZE=-1]Aortic regurgitation:[/SIZE]
[SIZE=-1]JH/LVOTH = jet height/left ventricular outflow tract height[/SIZE]
[SIZE=-1]Mild Aortic Regurgitation > 10% and < 25% or 11-24% JH/LVOTH[/SIZE]
[SIZE=-1]Moderate Aortic Regurgitation = 25% ?— 49% JH/LVOTH[/SIZE]
[SIZE=-1]Severe Aortic Regurgitation > 49% JH/LVOTH[/SIZE]
[SIZE=-1]Mitral Regurgitation:[/SIZE]
[SIZE=-1]RJA/LAA = regurgitant jet area/left atrial area[/SIZE]
[SIZE=-1]Mild Mitral Regurgitation > 5% and < 20% or 6-19% rJA/LAA[/SIZE]
[SIZE=-1]Moderate Mitral Regurgitation = 20% — 40% RJA/LAA[/SIZE] [SIZE=-1]Severe Mitral Regurgitation > 40% RJA/LAA[/SIZE]
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