HMO-Cancellation: Legal? Yes, but is it Ethical?

Sometimes life is not fair. Everyone who is breathing knows this fact is more than a truism. A young couple whom are very close to me have been going through quite a time lately. Through no fault of their own, both she and her husband are out of work. And they're pregnant. The industry they work in took a nosedive and they, unfortunately were just a small part of the casualties. Finding another job when you are six months pregnant is simply a task, for all intense purposes, a futile exertion of energy. Her husband is having just about as much luck. Hard to find a job in your field when everyone is getting either laid off or the business shuts it doors.

What makes this worse is that they obviously cannot go without medical coverage. They tried to get medical coverage from the same company their former employers provided privately but were turned down because of a "pre-existing condition"-that being the pregnancy! So they signed up for Cobra. Extremely expensive, especially since all the money they have coming in is unemployment.

As if things couldn't go any further down, the health plan called her up to inform her that the company they used to work for had gone out of business and were no longer paying their minute part of the cobra payment, so as of the end of the month they were cutting her off! If she wanted to keep the HMO, they would grant her a "special" plan (instead of turning her down, again) that would cost $200 more a month, her appointment fees would quadruple, and when her delivery time came, they would have to pay $2,500.00 at the hospital and then $200.00 a day until she went home! The supervisor she asked to speak to told her that this was more than legal and referred her to the book she received when she signed up to read what rights she had and what rights they had.

After reading the brochure, it was indeed legal for the company to treat her in this way, but does that make it ethical?

First: why would they want this type of publicity? There have been more than a few HMO's lately in the news that have been getting quite the trouncing for cutting their clientele's benefits off as soon as they had a health problem. This, in fact, was one of the companies.

At this point, instead of doing the "legal" thing, this company should be bending over backward to try and gain some good graces back with the public! Let alone do the right thing by this young couple and their baby-to-be.

Some other points to include in this situation: The young, pregnant woman has been with this particular company since her inception, she's never been with any other health agency. They have seen her through her entire 24+ years. Do they not think they have some moral obligation to see her through what is more than her hour of need?

How does a company that is supposed to care for you medically decide to put you under such stress during what should be a wonderful time of your life? Are they even thinking what the publicity would be like if she miscarries due to this extra stress?

Yes, legally health agencies have the right to terminate your coverage, raise your rates and change the benefits they provide-they are a business and they are not non-profit. However, they are in the medical field-doesn't that mean they should have to follow the rules of the profession?

One of the major points of the hippocratic oath is: Do no harm.

This HMO should remember this point.