From: Subject: Firm cancels health insurance coverage for girl, 17, after celiac disease diagnosis: Yet ANOTHER Reason for STRONG Health Insurance Reform
Ah, Cruel Jack, is THIS her fault? Are you going to say, "Suck it up, Brianna, you don't deserve health care?" How far WILL you go in your defense of vile insurance companies, Jack? chicagotribune.com <http://chicagotribune.com/> CONSUMER WATCH Firm cancels health insurance coverage for girl, 17, after celiac disease diagnosis American Community Mutual's rescission numbers 'cause for concern,' says director of Illinois Department of Insurance Jon Yates September 17, 2009 When 17-year-old Brianna Rice was diagnosed with celiac disease in February, she had health insurance. She doesn't now. In the months that followed her diagnosis, her insurance company, American Community Mutual Insurance, combed through her medical records and ruled that her parents lied on her application last year. In May, American Community not only canceled her policy, but also rescinded coverage all the way back to the day it started -- Nov. 1. Her parents, Dale and Pat Rice of Deerfield, insist they were truthful on Brianna's application and say the insurance company is trying to back out of covering their daughter because of the February diagnosis. American Community disagrees, saying that if the Rices had given the company Brianna's full heath history when they applied for coverage, it would never have been granted. The Rices filed a complaint with the Illinois Department of Insurance, then fired off an e-mail to What's Your Problem? "We are livid," said Dale Rice, who, along with his wife, is out of work. "When a private insurer gets legitimate claims and seeks to find excuses not to pay them, they are clearly demonstrating morally and ethically bankrupt behavior." The family's situation shows just how quickly health insurance problems can lead to financial ruin. With their daughter's unpaid medical bills exceeding $20,000 and mounting, the Rices fear losing their home. Pat Rice said she cashed in some of her retirement account to pay bills. "The next step is really bankruptcy," her husband said. Their saga began in the summer of 2008 when Dale Rice lost his job as a business consultant. The family had group health insurance through his employer at the time, but decided continuing that coverage through COBRA was too expensive. The couple consulted an insurance broker, who suggested Brianna apply for coverage with American Community. On Brianna's application, the Rices noted no prior medical problems, and Brianna was granted coverage starting Nov. 1, with a monthly premium of about $130. After the teen's diagnosis in February, American Community reviewed her medical files and found reports of dizziness, elevated cholesterol levels, ongoing fatigue and a persistent cough. On May 12, the firm sent the Rices a letter saying it was rescinding coverage. "The coverage you applied for would not have been issued for Brianna if we had known this medical history at the time of application," the letter said. Dale Rice said the insurance company cherry-picked from various doctors' visits, and that none of his daughter's health problems were ongoing. He attributed the dizziness to dehydration, the fatigue to his daughter staying up late surfing the Web, the elevated cholesterol to an inaccurate test, and said the cough is now gone. None of the issues were serious medical problems, and none stuck out in his mind when he filled out the application, Rice said. He sent the Problem Solver a copy of Brianna's July 2, 2008, physical, which showed no major health concerns. "[Insurance companies] look for anything that they could say 'you didn't tell us about,' " Rice said. "They hope that people just lay down and die and don't fight." Ellen Downey, spokeswoman for American Community, said the company studied Brianna's history thoroughly before deciding to revoke her coverage. "We take very seriously the decision to rescind a policy as we know the importance of insurance coverage in people's lives," Downey said in an e-mail. She said the company relies on accurate information on the customer's application "in order to adequately underwrite our policies, manage the risks we accept, and be fair to all of our policyholders." Downey said, "We never rescind policies when applicants provide accurate and complete information at the time of application." The firm has had 12 rescission-related complaints investigated by the Illinois Department of Insurance since 2007, including six this year, Downey said. The Department of Insurance upheld American Community's decision to rescind coverage in 11 of those complaints, Downey said. The 12th case, presumably, is Brianna's, which remains under review. Department of Insurance Director Michael McRaith said he cannot comment on Brianna's case, citing privacy rules. But he said his department has investigated about 400 rescission-related cases industrywide since 2005. The rate at which customers have complained about American Community, he said, is alarming. "That number of rescissions in itself is cause for concern," McRaith said. "Today and at all times we are concerned about any company with that number of rescissions in our state in a short period of time." If American Community does not reinstate Brianna's coverage, her family will have few options. Dale Rice said he has called several insurance companies, but none will cover her based on the February diagnosis. Celiac disease, a digestive disorder, is treatable by eliminating the consumption of wheat products. If left untreated, it can damage the small intestine and prevent food from being properly absorbed. Elaine Monarch, founder and executive director of the Celiac Disease Foundation, said the condition affects one out of every 133 people. McRaith said uninsured Illinois residents under the age of 19 can qualify for the state-run All Kids insurance program. But not all of Brianna's providers accept All Kids because the program's payments are generally lower than those from other insurance plans. Brianna also qualifies for the Illinois Comprehensive Health Insurance Plan, or CHIP, which is designed to help people who cannot get insurance through the conventional market. But CHIP's premiums can be prohibitively expensive. McRaith said the average yearly premium is $7,666, with some premiums running as high as $16,000. [but only for a year, probably, unless her state continues coverage while she's a student] If American Community does not change its mind, "we'd be out of luck," Dale Rice said. "Now, our sick daughter, Brianna, is tattooed with a new pre-existing condition, along with an unfair and unrelated insurance rescission that other insurance companies don't want to touch." *** exposing the hidden truth for further educational research only *** CAVEAT LECTOR *** In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. NOTE: Some links may require cut and paste into your Internet Browser. Please check for daily real news posts and support the truth! 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