Galeotti's shaken family told the hospital that she was covered by her father's health care plan with Kaiser Permanente. The hospital confirmed her status with Kaiser and proceeded to treat her. Medical bills piled up to more than $4 million.
Then in July 2007, five months into Galeotti's treatment, Kaiser stunned the family with a letter. The Galeottis would have to find another way to pay the bills. Based on informationreceived from her father's employer, Kaiser said that the young woman's coverage had not been in effect when she was hit.
Ten months later, California insurance regulators ordered Kaiser to cover Galeotti's care, saying that Kaiser had no basis for denying payment "other than to achieve a significant financial windfall" at the expense of her family, the hospital and the state's Medicaid program.
Like many insurance disputes, the Galeotti case has its share of miscommunication, bureaucratic wrangling and missing documents. But it remains a stark example of a murky practice by some insurance companies and employers - cutting off coverage retroactively for some patients with expensive medical claims.
The new health care reform bill bans retroactive decisions by insurers in policies sold to individuals, except in cases of fraud. However, as it stands the ban would not apply to group policies, such as the one held by the Galeotti family, which cover some 150 million Americans
.
No comments:
Post a Comment