PHILADELPHIA (Dow Jones) - movement of California last week to fine health the net Inc.. (HNT) $1 million, thereby the not know a connection between employing premiums and the cancellation of the individual insurance policy was the newest movement by automatic controllers there to stop health plans from falling registrations to releases. Takes California handle care automatic controllers aims at, what they regard as an invalid industrial practice: Revocations of individual covering, sometimes, after members became ill, based on the unintentional or insignificant omissions on applications of registrations. Health of plans say that cancellations are in a small break of cases happened and necessary, around fraud to stop and other policy owners protect investigations of five of the seven plans, which offer individual public health policies in the condition, to large fines and automatic controllers to anticipate more punishments led. Additionally recently suggested regulations could limit ability of the health insurers strictly to recall political guidelines. Cindy Ehnes, director California department handled health care, said in an interview, which none plans the health five its department, investigating had a sufficiently appropriate process for dropping the members, that are based on application form of discrepanices. Ehnes regards cancellation “the roughest punishment possible for a perhaps innocent omission of the information, which can be to the requirement without purchase, because he leaves the patient, if they are at their kranksten, not insured and uninsurable.” Ehnes and California insurance representative Steve Poizner last month suggested common regulations, in order to protect consumers in the individual health insurance market against invalid cancellations. Under other regulations the regulations would specify that health must state a plan that patients intentionally its medical stories misrepresented, before they dropped or limited a policy. Companies can insure to build whom wish it, said Ehnes, but registrations are a right, on its health plan membership and the faith that the insurer led its investigation their medical stories, before he made covering available. Before the expenditure the guidelines suggested by of political guidelines would explain, what determines an unacceptably ambiguous or senseless insurance company application for covering and plans erFordern to lead complete medical signing and investigations. They would also hold insurers from shifting of covering or of of delaying erForderlichen services during one investigation a registration. Health of plans say that they analyze the requests and the plan, in order to participate in the process. New regulations can take one year, in order to enter into effect, after general auditions and note. “, as it can be, cancellation an important protection against fraud is so unfortunate and puts to protection for our eight million members, that consent with the application process,” blue cross California wortfuehrer of cut Garcia avowed Dow Jones Newswires over email at the disposal. Cancellations affect generally owners of the individual policy, which they or family of members buy, instead of flat those, which are taken off by the group of an employer. Insurers sign covering for with employer-promoted the group not individually insurance. Since 2005 investigating California DMHC the cancellation practice of the blue cross of California, waving POINT a Inc. (WLP) subsidiary; UnitedHealth group of Inc. (UNH) Pacificare; Health net; non-profit emperor permanent emperor Grundlage health of plans and the non-profit blue sign of California. The DMHC calls itself the only unmarried handle care awake dog agency in the nation. While insurers resist a marking of the passing and legend cancellations of registrations affect a relatively small number, “the damage is to these individuals much meaning,” said Ehnes. “people must know, if they buy covering, which will be present this covering for it, if they need it.” The department condemned the blue cross of California $1 million in former times this year, be based on an overview of the organization, says the insurer to by routine recalled health insurance policy; she condemned the insurer $200,000 last year, says the organization illegaly the policy of a member had recalled. She condemned also the emperor Plan $325,000 for two cancellations. The DMHC said that in many cases, there was no proof that blue cross a complete Voreinschreibung led investigation the medical history of the applicants or adapted to its own signing policy and in all 90 tried cancellations, which insurer did not show that applicants intentionally their medical stories misrepresented. Blue cross of was other opinion, says was based the report largely on on facts which is based disturbances and enclosed exaggeration and unfounded-accuses. The company, of of California largest insurers, believes that condition law an agency of the intention of a registration erFordert too would not amount to or the intentional Misrepresentation of recalling to a policy rather, only that applicants know the facts of their medical history. Blue cross recalled less than 1% from new registrations for January 2003 and post-states not in a practice of importance for the department, “a signing engaged,” said Garcia. Last year ordered the DMHC emperor, in order to reinsert the covering of a registration, which was dropped after two decades with the insurer. The woman had applied, in order to combine insurance their family under an individual plan and neglected, in order to notice that an emperor Arzt had treated it recently for the beginning and arm pain; Emperor, which was threatened, over their law execution to report and sent a calculation for $13.000 for services, which the insurer should have covered, to it according to the DMHC. “the registration did not have a cause to the acceptance that emperor was not on message their poor and beginning pain,” the DMHC said _ emperors says it friendly regulates D affair, with D member to reinsert and received D care it to need. The insurer said that it important improvements to his touching debate, including which producing one, which formed obviously written application form, since the case arose 2004. Last week, department of Ehnes ‘ condemned of Los Angeles - created health net $1 million, thereby cannot to the DMHC investigators releases that the company had paid the employee premiums for meeting ratios health insurance political guidelines, which were recalled, after large medical requirements were paying. Health the net, which would say an agreement contract with the DMHC, it closed became, not in any reconciliation practice to engage itself, which was connected with the results of the company cancellation reviews. Health net president and managing director acorn jay M. Gellert apologized in a Pressekommuniqu� “for each possible misunderstanding with the DMHC” and said that “we remain at present by the policy in the agreement.” The DMHC continues to investigate whether the health net cancellations themselves were invalid and are possible to more fines. The test prod of the department health of the net should be concluded in January. The DMHC also continues to the investigate legality of the politics policies and intends to publish overview of report about the other three health insurers their practice it reviewing. Health net meanwhile suggests creation of an independent one, a third party lining in California to review insurancepolitik the cancellations for the handle care industry, a said wortfuehrer. The company also supports Gov. Arnold Schwarzeneggers plan to the warranty and needs covering for all Kalifornier, an approximation, whose some within and outside of the industry could do cancellations eliminate to suggest. Such a policy would address the problem the healthy people, which remain from insurance the pool, until they become ill. Cancellations were not a main focus for Pacificare UnitedHealths, which has approximately 30,000 particular politics of members in California, the said wortfuehrer Tyler bricklayer. The company reviewing the suggested in the determining process to participate DMHC regulations and plans. “the goal of Pacificare is to extend entrance to afFordable covering to so many individuals possible. Our politics are to energize individual members to please the few decisions much which are made, in order to stop a policy for omission of the health information about original application. It is critical that adjusted in the few cases, in which fraud was confirmed we functioned too simply the policy without further activity, “bricklayer, who is said in emailed note. - by Dinah Wisenberg Brin, Dow Jones Newswires; 215-656-8285; dinah.brin @ dowjones.com
(END) of Dow Jones Newswires 11-21-07 1312ET copyright (C) 2007 Dow Jones And company, Inc..
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