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Name: Scott Janis
Home: Streamwood, Ill.
Problem: Insurer retroactively canceled his coverage after he suffered a stroke.
How law will help: A provision barring insurers from rescinding policies comes too late for Janis, but he may get coverage through another provision of the law.
Out of the blue, Scott Janis suffered a massive stroke in November. As his medical bills reached $175,000 a few months later, his insurance company canceled his policy.
"It's despicable to leave a man who's recovering from a stroke with no insurance," said Scott's father, Ray Janis. His parents told his story because Janis has trouble communicating following the stroke.
The company said Janis had failed to disclose an unrelated problem, low testosterone, when he applied for coverage on the individual market.
"He did fail to put down he had been seeing this urologist," said Scott's mother, Connie Janis. "Sometimes you can't remember everybody you've seen. It was inadvertent."
The new law prohibits the practice of insurers searching for small misstatements and using them as an excuse to cancel individual policies for people with high medical bills. Most states, including Illinois, now allow these types of cancellations, called rescissions, for reasons other than fraud.
Psychiatric problems were the No. 1 reason for rescissions in a study by the National Association of Insurance Commissioners, which also found Illinois has one of the highest rates of rescission in the nation. Nationally, there were about 4 such cancellations per 1,000 policies written on the individual market, NAIC found.
The new federal law comes too late for Scott and his parents, who are in their 60s. They've been fighting the insurance company as they struggle to take care of their son and find coverage for him.
Even though the new law hasn't directly helped them, the Janises think it offers important protections for consumers. And they've applied for coverage of their son for people with pre-existing conditions, a new program funded by the federal law.
Blue Cross and Blue Shield of Illinois issued a statement saying the company can't comment on Scott Janis' case because of privacy laws.
"We recognize that rescissions are difficult for everyone involved," the statement said. "We have a long-standing policy not to rescind coverage for members unless we learn that they intentionally omitted material information or provided false information at the time of their membership application."
Illinois Department of Insurance Director Michael McRaith said the new protection in the national law is "a big step forward," but the state Legislature also needs to strengthen the Illinois law. McRaith would like to require insurers to get approval from the state insurance department before they rescind policies.
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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