Biovail Settles with SEC. Three Executives Still under Investigation.
March 24, 2008
The U.S. Securities and Exchange Commission said on Monday that
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$9 Million to Woman with Breast Cancer for Cancelled Health Insurance
March 14, 2008
A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer has been awarded more than $9 million in a case against one of California’s largest health insurers.
Patsy Bates, 52, a hairdresser from Gardena, had been left with more than $129,000 in unpaid medical bills when Health Net Inc. canceled her policy in 2004.
Arbitration judge Sam Cianchetti ordered Health Net to repay that amount while providing $8.4 million in punitive damages and $750,000 for emotional distress.
“It’s hard to imagine a situation more trying than the one Bates has had to endure,” Cianchetti wrote in his findings. “The rug was pulled out from underneath, and that occurred at a time when she is diagnosed with breast cancer, one of the leading causes of death for women.”
In fact, she was in the hospital getting prepped for surgery when she first learned Health Net was dropping her.
Some of the documents Health Net was forced to hand over revealed that senior analyst, Barbara Fowler, single-handedly dropped hundreds of policy holders like Bates from the rolls every year.
The shocker: the company awarded her bonuses based on how many policy holders she dropped.
The company called 2003 - the year Fowler dropped Patsy Bates - “a banner year” for her, for saving the company $6 million in what they call “unnecessary health care expenses.”
Health Net said it was implementing a freeze on policy cancellations that would last until the company sets up a third-party review panel to scrutinize cases.
“Obviously we regret the way that this has turned out, but we are intent on fixing the processes to maintain the public trust,” Health Net spokesman David Olson said.
Bates had previously been insured with another company but was persuaded to switch over to a Health Net policy after an agent suggested she could save money.
She said she had undergone surgery to remove the tumor and had received her first two chemotherapy treatments when doctors stopped treating her because her bills were going unpaid.
She went on to complete her cancer treatment through a state-funded program.
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New York Takes it to Fatcat Insurance Companies
February 21, 2008
On
Ingenix, Inc. provides data used by most major health insurance companies to determine reimbursement rates for out-of-network medical expenses. After six-month investigation, it was revealed that Ingenix has been operating on a defective and manipulated database, by placing an artificially low reimbursement rates to patients. Under the United insurers’ health plans, members pay a higher premium to have the option to use out-of-network doctors, while the insurers promise to cover up to 80% of either the doctor’s full bill or of the “reasonable and customary” rate depending on which is cheaper. While United insurers knew most simple doctor visits estimate around $200, they claimed that “reasonable and customary” rate is only $77. The insurers then only reimburse 80%, covering $62 for a $200 bill, and leaving the patients to cover the $138 balance.
However, insurers argue that Mr. Cuomo’s investigation does not take into account how the doctors determine what they charge for their services.
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