Health Insurance policy targeting

[Guest guest]

Reading all of this stuff about Kass and Cigna not paying for the Carnitor and it makes me think I need to write to you all to let you know about what we are experiencing with Humana. My point is not to scare you necessarily (although I do think we all need to have a fairly healthy sense of fear) but to make you aware of what is probably going on with other medical insurers with high claim cases like all of our children. My family has been insured by Humana, Inc, though my husband's small business employer for the last 11 years. We have increasingly had to absorb the cost of the premium but of course felt it worthwhile because of the children's medical issues. In early December I became aware that one of the CEOs of Humana was apparently targeting our policy for termination. Why? Because of the high cost of the boys' care. His actions are illegal and unethical but unfortunately will be hard to definitively prove. Several exchanges between the CEO and myself transpired since that time - always polite. On Tuesday I filed a formal complaint with the Office of the Insurance Commissioner. If we lose our health insurance the State of Wisconsin will be responsible for my sons' medical bills as they are both part of the Beckett MA waiver Program. More important to me, my Sam's very life will be at stake without access to the specialized systems of care that Humana pays for. Sam is a vibrant, joyful first grader who loves nothing more than to go to school and play with friends . He does not deserve to live in Children's Hospital permanently because of Humana's disregard for the law but he would because of a little known part of MA law which says that care at home much be cheaper than care in the hospital. Due to the way MA fee structures are set up - care in the hospital would actually be cheaper in Sam's case. Though I imagine we could eventually find someone to champion the cause to change this - Sam would languish in the hospital in the meantime and he would not survive that. The rate of error is too high for someone as complex as him. Our case was immediately elevated to the expedited status and the Commissioner and his staff Director of managed care will be handling this case. I have been trying to impress on everyone (hospital administration, legislatures, etc. ) that as a state we can not afford to stand by and let this happen. Not only would it allow Humana to pass off to the State bills that they should be paying but it would also lead to a very dangerous precedent that could have devastating consequences . Small businesses like the one my husband works for and families with chronically ill children cannot fight Fortune 200 companies like Humana. There is no doubt that the law is on our side but unfortunately it takes a lot of money to prove that.This could be any of you and I urge you to watch what decisions are made about your policy closely. If your premium prices are rising beyond the rate of others in your state then the company has probably taken you out of a risk pool in order to watch your policy closely and be able to pin point exactly where the high costs are. If you are self employed or part of a small business be very careful to cross every t and dot every I on your contract. They hold a microscope up to the high claim policies and will pull the policy for any technicality they find. They literally have had lawyers pouring over this policy to find something amiss and finally found something that they had never had a problem with before. The law is not on their side but they are pursuing the termination anyway. I am not trying to make you scared but I am trying to raise your awareness of how closely your policy is watched if your child or you have high claims. I will close with the last paragraph of my formal complaint to the OIC. "While I can appreciate that this is not a policy that anyone in their business wants, the fact remains that Humana is engaged in is a high risk business and as such there will be times that they are responsible for chronically ill individuals who have a high expenditure of health care dollars. Engaging in unethical and questionably illegal behavior is not acceptable, nor will it lead to global health care savings and reform. I urge you to consider that if Humana is permitted to target our policy and terminate it for, at best, technical issues that have been perfectly acceptable to Humana in years past, then it will be that much easier for Humana and other health care insurers to subsequently target other policies with high cost claims. On many different levels, our country and the State of Wisconsin can ill afford allowance of such discrimination." Anne