If you guess the co-owners of junk insurance are Goldman Sachs and Credit Suisse, then you are right..
WASHINGTON — April Capil has mixed feelings about the national outcry over canceled health insurance policies.
Five years free of the stage III breast cancer that nearly claimed her life, the Boulder, Colo., resident is once again healthy, but she’s still struggling to put her life back together.
Like millions of Americans, Capil thought she had solid individual health insurance. Then she got sick and found that her coverage was woefully inadequate.
The financial problems that followed would aggravate Capil’s health struggles, force her into bankruptcy and trigger a fraud lawsuit over $230,000 in unpaid medical bills against HealthMarkets Inc., the parent company of her former insurer.
The litigation is nothing new for HealthMarkets. The North Richland Hills, Texas, insurer, formerly known as UICI, has a long history of battles with state regulators trying to root out “junk insurance” in the individual market. But numerous sanctions and a host of consumer protections in the Affordable Care Act have put a financial squeeze on the company and forced it to change its business model.
If you exclude the fly-by-night insurers that set up bank accounts, collect premiums and skip with the cash, HealthMarkets and its subsidiary insurance companies hold a rare distinction, said Capil’s attorney, Antony Stuart of Los Angeles.
“They’re the worst health insurance company that is actually trying to operate within the law,” Stuart said. “I can’t imagine that there has ever been any worse.”
Along with improperly denying benefits, Capil and Adams accuse HealthMarkets and its agents of deceptive marketing by misrepresenting the terms of their policies and obscuring the policies’ coverage limitations in confusing contract language.
“Their claim is ‘Oh, you should have read all of the fine print and understood it,’” Adams said. “I’m supposed to understand that? You have to be a doctor and an attorney to understand it. And by the way, you have to be an insurance underwriter also because you can’t understand the legalese. You can’t understand the medical terminology. And you can’t understand the insurance industry. And that’s what they expect you to do.”
“These junk policies have been crafted pretty carefully,” he said. “When I talked to people and they shared their contracts with me, the language can be very confusing, even for somebody like me.”
The complaints are a familiar refrain for HealthMarkets, which is owned by three prominent Wall Street private equity firms: Goldman Sachs Capital Partners, The Blackstone Group and Credit-Suisse-DLJ Merchant Banking Partners.