INDIANAPOLIS – Today, WellPoint, Inc. issued the following points of clarification in response to the Reuters article published this morning.
- Today's Reuters story alleging that WellPoint employs a targeted rescission policy for members with breast cancer is inaccurate and grossly misleading. The story incorrectly reports that WellPoint singles out women with breast cancer for aggressive investigation with the intent of canceling their insurance. This is simply wrong. In fact, WellPoint works to prevent breast cancer, to detect it early, and to get our members into treatment. We also work to ensure that all of our members are getting best practice care for breast cancer.
- The story also misstates the role of what it terms computer algorithms. Contrary to how its use was portrayed in the story, such software is used to look at a series of diagnostic codes meant to capture conditions that applicants would likely have known about at the time they applied for coverage. We do not single out breast cancer or pregnancy.
- The story focuses heavily on the practice of rescissions. As part of our normal business practices, WellPoint monitors claims for a variety of things, from indications of potential fraud to potential opportunities to improve quality and better coordinate care. If something appears that it may be associated with a material misrepresentation, we may initiate an investigation.
- In fact, last year less than one-tenth of 1 percent of our individual members' policies were rescinded.
- The story is also wrong in reporting that WellPoint lobbied aggressively to quash proposed provisions that would have required a third party review of company decisions to rescind a customer's policy. WellPoint did not lobby against that issue. In fact, WellPoint was the first company in the industry to institute third party reviews back in 2008, a move that was cited at the time as a model for the industry.
- In response to public concern over the practice of rescissions, WellPoint in 2006 undertook a thorough review of our policies and procedures. Following that review, WellPoint was the first insurer to announce the establishment of a variety of changes to our rescission practices in an effort to ensure that rescissions are handled as accurately and appropriately as possible. These changes include: 1) creating a new Application Review Committee which includes a physician that makes rescission decisions, 2) establishing a single point of contact for members undergoing a rescission investigation, and 3) establishing an appeal process for applicants who disagree with our original determination, which includes a review by an Application Review Committee not involved in the initial decision.
- Another significant error in the Reuters story is that WellPoint rescinded coverage to Robin Beaton. As noted during her public testimony during the US House Energy and Commerce Committee hearing, Ms. Beaton is NOT a WellPoint member, but rather was insured by another company.
- The quote in the Reuters article from the 2007 DMHC investigation stating that "there was no evidence that (Blue Cross), before rescinding coverage, investigated or established that the applicant's omission or representation was willful" was an erroneous statement of the legal standard. Even under that standard, in its investigation the DMHC found that more than 90% of Blue Cross' rescissions met that heightened standard.
- Yet another inaccuracy is the false implication at the beginning of the article that Ms. Reilling's coverage was dropped due to breast cancer. If Ms. Reilling would be willing to sign a HIPAA waiver, we would be happy to disclose the facts in her case. Also a small point, but indicative of the inaccurate reporting in this story, Reuters misspells Ms. Reilling's name repeatedly throughout.
- Further, as was shared with Reuters previously, WellPoint is committed to member education and advocates for early detection of breast cancer. In fact, WellPoint employs an internal Health Equities team, devoted entirely to addressing health disparities. Our HealthCore subsidiary has done extensive research into disparities that exist today in the diagnosis and treatment of breast cancer. We are using these findings to pilot programs in our Blue states to identify better communications methods for members and clinicians, to diminish disparities.
- Also, WellPoint's preventive health guidelines include recommendations that women over the age of 40 receive a clinical breast exam by their health care provider and a mammogram every year. The majority of our health plans include this as a preventive care benefit, even after the US Task Force recently changed mammography screening guidelines to begin at age 50.
- Additionally, in an effort to motivate women to get recommended preventive health screenings (breast, cervical, colorectal cancer), and encourage women to talk with their doctors about preventive screenings and good health, WellPoint conducts automated calls to women that include messaging about mammography. Specifically, for breast screenings, the calls are targeted toward women ages 40-69 non-compliant with recommended breast cancer screening (mammogram).
- We are deeply disappointed that these various allegations would be made without regard for the facts. We are proud of our record in improving care for women with breast cancer in this country.
Kristin Binns, 917-697-7802
Jon Mills, 317-370-4029
/PRNewswire-April 22/ --
SOURCE WellPoint, Inc.