California Insurance Lawyer Blog

Suppose you are dying from cancer, but instead of putting all your energy into fighting the disease, your biggest battle is with your health insurer for treatment to keep you alive. That’s what Westlake Village resident Bob Iritano is up against, reports Los Angeles Times business columnist David Lazarus.Click- “Fighting Cancer and His Insurer."

After a round of chemotherapy that almost killed him because of an allergic reaction, Iritano’s doctors recommended a procedure called radio frequency ablation that, while it won’t cure his cancer, will temporarily eliminate his tumors and decrease the painful symptoms of his disease. The procedure, which Iritano much undergo every time his tumors grow back, was initially covered by his health insurer Health Net. But when he scheduled treatment again six months later, coverage was denied.

Iritano found out about the denial only minutes before the procedure was scheduled to begin. He was already robed in a surgical gown when he was told Health Net had deemed the procedure “experimental” and would no longer pay for it. Iritano’s physicians scoff at the notion, asserting that the treatment has been proven effective for more than 10 years.

Lazarus contacted Health Net to inform the company he was writing about Iritano’s case. A few days later, Iritano received a letter authorizing the procedure just one more time. But he wasn’t to expect the company had changed its policy about the experimental nature of the treatment.

“My best guess is that they want me dead as soon as possible,” Iritano told Lazarus. “They know that the premiums I pay will never cover how much they’ll spend on me.”

Wow.

Just as Congress applies the brakes to healthcare overhaul, California’s largest for-profit insurer, Anthem Blue Cross, reminds us why the federal government needed to get into the driver’s seat in the first place. The Los Angeles Times reports the health insurer will raise its prices March 1 for its 800,000 individual-coverage policyholders. See “Anthem Blue Cross dramatically raises rates for Californians with individual health policies.”

These premium adjustments, some customers say, amount to as much as a 39 percent increase. A San Rafael family, after doing the math, determined their health premiums will surpass their monthly mortgage payment. And that’s not all. Anthem informed its policyholders they could expect such adjustments at least every 12 months, or “more frequently in accordance with the terms of your health benefit plan.”

Under California law, health insurers can increase premiums whenever they want if they notify the state Department of Insurance and prove they are spending at least 70 percent of the premiums on health care. California Insurance Commission and Republican gubernatorial candidate Steve Poizner is “very concerned” about the rate increases, reports the Times, and is planning an independent investigation to ensure Anthem complies with state law. But as usual, this may be too little and too late.

Insurance brokers say that this increase is the largest they have seen so far. Mark Weiss, a Century City podiatrist and Anthem member for 30 years thinks “it’s just unconscionable.”

We agree.