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As his badly injured wife writhed in pain in University Hospital's intensive care unit, Keith Bleazard was stricken with anxiety.

A mountain bike ride up the Stump Hollow trail in Wasatch-Cache National Forest a day earlier had turned disastrous when she rode off a berm and flew over her handle bars.

With each successive X-ray, the news kept getting worse: Heidi Bleazard's neck and back were broken, as were some of her ribs. This on top of a bruised lung and significant head injuries.

"It just kept going on and on," Keith Bleazard said. "It was like, when is this going to stop?"

The couple's one comforting thought during Heidi Bleazard's three-week stay at the hospital was at least they had health insurance. Or so they thought.

On Jan. 17, 2006 - nearly five months to the day after Heidi Bleazard's accident - the letter came. Regence BlueCross BlueShield of Utah, their insurer, was retroactively rescinding their policy.

The Bleazard's health insurance had evaporated. Worse yet, Heidi Bleazard's more than $100,000 in medical bills would not be covered - because they failed to disclose on their insurance application that Keith Bleazard was seeing a doctor and taking prescription drugs for treatment of an old back injury.

"My wife was just worried to death about what was going to happen to us," Keith Bleazard said. "We were going to lose everything. We were going to have to sell everything we own."

Couples like the Bleazards represent about 145,000 Utahns who are individually insured, meaning they don't get coverage through an employer. It's a group, consumer advocates say, that is particularly vulnerable to being charged exorbitant premiums and having their policies yanked away without warning.

With state lawmakers and presumed Republican presidential nominee John McCain pushing individual health insurance as a cornerstone of health care reform, the ranks of the individually insured are only poised to grow.

"We may see, depending on how things go politically . . . that the opportunity of insurers to rescind and the threat of rescission become more widespread simply because there are a lot more individual insurance policies," said Salt Lake City attorney Brian King, who is representing the Bleazards in a lawsuit against Regence.

Unfair practices? Filed in October, the Bleazard's lawsuit alleges the company has for many years rescinded individual insurance policies without complying with Utah insurance codes.

King has since filed a motion to have the Bleazards' case certified as a class-action lawsuit, representing the 197 individuals and families whose Regence plans were retroactively revoked in Utah between 2003 and 2006.

Regence, the lawsuit contends, fails to investigate applicants' reasoning about information they include or omit. The suit also asserts that when companies issue policies, state law requires them to provide customers a copy of their application, and that Regence does not do so.

The lawsuit claims the company's rescission investigations are triggered when it receives claims over a certain dollar threshold within the first few months after a policy has been issued. This kind of "post-claims underwriting" - scrutinizing a person's information after he or she has already been approved for coverage - is sometimes used by Regence as a way to avoid paying large claims on new policies, the lawsuit states.

Regence spokeswoman Tauni Everett declined to comment on the litigation but said the company does not "rescind policies to get out of paying any claims or to make money. Regence is a not-for-profit organization. We don't answer to a bunch of shareholders."

But other major health plans in Utah do. How many policies these companies collectively revoke each year is unknown because the Utah Insurance Department neither requires them to report it nor does it keep track of rescission complaints filed by consumers - in large part because it receives so few.

Suzette Green-Wright, director of the department's Health Insurance Division and Office of Consumer Health Assistance, said during her 14 years there, "I'm thinking twice I've seen complaints come in on someone being rescinded."

'Material misrepresentation' Federal law prohibits insurance companies from dropping someone's coverage just because his or her health takes a turn for the worse.

But companies can revoke a policy if they can prove a person made a "material misrepresentation" on his or her application - something that's not difficult to unintentionally do, King said, because the applications are "so broad that you can have individuals who say, 'I don't think I really have to answer "yes" to that question or check "yes" to that box.' "

Insurance companies defend the practice, saying it's an important way to root out people who lie about health history in order to get insurance, and such winnowing helps keep subscribers' premiums low. And, they say, they rarely do it.

Regence, which offers insurance to about half of the 10,000 or so people and families who apply for insurance each year, revokes only a tiny fraction of those policies - between 45 and 48 a year, said Ann Ibrahim, the company's director of underwriting.

Taking away a person's insurance coverage, the company recognizes, is "pretty serious," she said. "It's a pretty significant step . . . for us to take rescission action, we have to feel confident there has been some serious misrepresentation or omission."

But families suing Regence say it did little to verify their applications before issuing them coverage. Only after they racked up expensive medical bills, these families say, did the company's underwriters take the time to evaluate their applications for omissions.

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'The world was crumbling' A case filed against Regence by Salt Lake City couple Daniel and Melissa Clyne, also represented by King, went to trial in 3rd District Court last week. The Clynes lost their coverage in February 2004 - two months after Daniel's first surgery to remove a benign brain tumor.

The company claims he failed to disclose information about pre-existing medical conditions, including asthma, sarcoidosis and an esophageal ulcer.

"[It] felt like the world was crumbling down on us," said Melissa Clyne, who at the time was worried Daniel might have another brain tumor. "I felt like it was me against the world because how in the world am I going to get my husband well if he has this [second] brain tumor?"

Once previously denied by Regence for insurance, Daniel Clyne was added to his wife and son's policy in September 2003. That time around, his insurance agent said his asthma was so mild it wasn't worth mentioning; likewise, his doctor said his sarcoidosis hadn't been active in 15 years so it wasn't necessary to include it on his application.

It was bad advice. The Clynes' policy was retroactively rescinded, saddling them with more than $200,000 in unpaid medical bills - a predicament that could have been avoided had Regence's underwriters taken the time to thoroughly review Daniel Clyne's application to begin with, they assert.

Had the company done so, it would have discovered Daniel Clyne had previously been denied coverage, they say - and that at one point, he had even placed calls to Regence's customer service department to discuss it.

A judge will rule on the Clynes' claim later this summer, after closing arguments are filed in writing.

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Settlements in California The Clynes' claims are similar to those made in a string of lawsuits filed against health insurance companies in California. Those lawsuits have drawn attention to the controversial practice.

Last week, the California Department of Managed Health Care announced a settlement with PacifiCare, which will offer coverage to about 60 members whose plans were rescinded. Any medical charges the members incurred while they went uncovered, meanwhile, will be offered expedited dispute resolution.

It's the state's third settlement with a major California health plan; in April, it struck similar deals with both Kaiser Permanente and Health Net Inc. to extend coverage to 1,200 people whose plans were rescinded after they incurred high medical expenses.

The settlements followed an arbitrator's February decision to award $9 million to a breast cancer patient whose coverage was dropped in the middle of her chemotherapy treatment, The Los Angeles Times reported.

Health Net claimed it would have never issued a policy to the woman had she disclosed her true weight and a pre-existing heart condition. In his ruling, however, the arbitrator wrote that the company had broken state laws and given "little, if any, consideration and concern for the interests of the insured."

The Clynes feel similarly slighted. They hope their lawsuit will expose what they say are unfair practices and trigger changes to both state laws and the companies' overly broad applications.

Left physically impaired by his two brain surgeries, Daniel Clyne is now on disability - which qualified him for Medicare. Melissa Clyne and son Christopher, meanwhile, remain on Regence's policy.

They don't dare apply for a new one somewhere else.

How to get - or lose - coverage

Regence BlueCross BlueShield's steps for issuing or rescinding a policy:


The company strives to ensure applications are thorough and accurate, said Ann Ibrahim, director of underwriting:

* If a person has previously been enrolled in a Regence plan, the underwriter will compare the application to prior claims.

* The underwriter may request an additional health questionnaire or ask for medical records.

* The underwriter may investigate customer service calls.

* Once information is complete, the underwriter will use industry guidelines to assign points for pre-existing medical conditions.

Until June 1, applicants exceeding 44 points were denied insurance; the state has since raised the bar to 100 points.


In a monthly audit, Regence computers scan claims for diagnostic codes of chronic illnesses, such as cancer, diabetes and asthma. Such illnesses are more likely to have been diagnosed or treated before coverage began.

* An auditor looks at the policy's start date and the person's application. If the illness was disclosed, Regence honors the claim.

* If there is a discrepancy, however, Regence will request medical records, the auditor may talk to the underwriter, and the customer is invited to provide clarifying information. A committee of representatives from Regence's departments - such as marketing, customer service and legal - then votes on whether to rescind.

* If a policy is rescinded, the person has 60 days to appeal. If the customer appeals, a second committee of different members reviews the case. Ibrahim said a second computer program also identifies high-dollar claims, but she said such tags do not trigger audits.