Congress asks top health insurers about medical claim denials for those with pre-existing conditions

U.S. Congressional members requested chief executives from the country's four biggest health insurers to testify at a hearing on March 23 about medical claim denials for patients with pre-existing medical conditions. Yesterday, CEOs from UnitedHealth Group, Humana, Aetna and Wellpoint Inc., Anthem's parent company, were sent letters from the chairmen of the U.S. House Committee on Energy and Commerce and its investigations subcommittee.

In the letters, Committee Chairman U.S. Representative Henry Waxman, D-Calif., and Subcommittee Chairman U.S. Representative Bart Stupak, D-Mich., asked for background information as far back as 2005, relating to coverage denials for patients with pre-existing conditions and maternity coverage through individual policies. The request includes internal emails and documents associated with underwriting policies and practices, and asks for delivery by March 12.

This hearing expands legislators' inquiries into Anthem's proposed rate hike by as much as 39 percent, affecting up to 800,000 insurance participants in California. Last week, Wellpoint President Angela Braly described the hike in premiums to a Congressional committee as "the most prudent choice, given the rising cost of care and the problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times." While Anthem's proposed increases ignited the controversy, the issue has helped refocus the nation on the accelerating costs of healthcare and why it matters to pass healthcare legislation.

Within California, state Attorney General Jerry Brown took action last fall by launching an investigation into a seemingly high rate of claim denials by large health insurers in California. Recently, he subpoenaed material relating to finances from the big seven California health insurers-Aetna, Anthem, Cigna, Health Net, Blue Shield, Kaiser Permanente and PacifiCare-to evaluate whether these companies are discussing higher rate increases. Additionally, Brown is looking into whether Anthem's steep rate hikes for patients in California are legal under state law.

To learn more:
- read this San Francisco Chronicle article

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.