Department of Health and Human Services calls on insurer WellPoint to change practices for women with breast cancer
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WellPoint should immediately end its practice of dropping health insurance coverage for women with breast cancer, Health and Human Services Secretary Kathleen Sebelius said on Friday.
Reuters reported on Thursday that WellPoint was using a computer algorithm that automatically targeted patients recently diagnosed with breast cancer. The software triggered an immediate fraud investigation by the company as it searched for excuses to drop coverage, according to government regulators and investigators.
In a statement responding to the Reuters story, WellPoint said it uses software to look at a series of diagnostic codes covering conditions that patients would likely have known about when they applied for insurance coverage, but maintained it does not single out breast cancer.
In a letter sent to the insurance company, Sebelius noted that the recently passed healthcare insurance overhaul would prohibit dropping clients because of their condition. The provision goes into effect in the fall.
“As you know, the practice described in this article will soon be illegal,” Sebelius wrote. “The Affordable Care Act specifically prohibits insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact.
“WellPoint should not wait to end the unconscionable practice of deliberately working to deny health insurance coverage to women diagnosed with breast cancer. I urge you to immediately cease these practices and abandon your efforts to rescind health insurance coverage from patients who need it most,” the secretary wrote in a letter released by her department.
-- Michael Muskal
