WellPoint Counters Reuters Report of Targeting Breast Cancer Patients

By Denise Reynolds

According to a report in this morning’s Reuters News, WellPoint Inc has been using a computer algorithm that targets women recently diagnosed with breast cancer, which triggered a fraud investigation leading to policy cancellation.  The practice, called rescission, is said to be used frequently by insurance companies, and according to a report from a congressional committee last year, WellPoint is said to be one of the worst offenders.

WellPoint Inc has 33.7 million policyholders, more than any other health insurance company in the United States.

Reuters has been investigating insurance companies for other disease states as well.  Recently, Assurant Health was found to similarly target HIV-positive policy holders for rescission.  They were ordered to pay millions of dollars in settlements. 

The healthcare bill signed into law by President Obama was to have contained language that would halt such practices.  The version passed by the House of Representatives would have allowed the women to apply to an “independent external third party” for review before having their insurance coverage dropped.  The final version, passed by the Senate Finance Committee, did not include the provision.

In a statement to Reuters, WellPoint said that it has changed its rescission practices to ensure they are handled appropriately after a 2006 review of its policies prompted by public concern over rescission.  The company notes that it has created a committee that includes a physician for making rescission decisions.

Some insurance carriers go an extra step to ensure that their policyholders are treated fairly.  Aetna, for example, has voluntarily agreed to engage in a third party review of all investigations, which has reduced the number of complaints reported to the Office of Healthcare Advocate in Connecticut.  Victoria Veltri, general counsel of the state agency, says “[The third party review process] is a powerful tool to have a third set of eyes required before someone is rescinded.”

Wellpoint has also issued a public statement this afternoon clarifying some points in the Reuters article.  They state that the computer algorithm that the story claims targets women recently diagnosed with cancer is actually software that looks at a series of diagnostic codes meant to capture pre-existing conditions.  They report that last year, less than one-tenth of 1 percent of their individual members’ policies were rescinded and that one of the women in the Reuters story said to be a WellPoint policyholder actually was under a different carrier’s coverage.

In conclusion, they add “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.