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California woman denied health insurance for condition she doesn't have

By Anita Creamer | The Sacramento Bee

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Consumer advocates consider their story emblematic in many ways of complaints that plague the entire health insurance industry.

"We've seen people denied for things as minor as heartburn," said Anthony Wright, executive director of Health Access California, a statewide health advocacy coalition. "It gets to the point where living is a pre-existing condition.

"The system is fundamentally broken if insurance can be denied to anyone who actually needs coverage."

The Scagliones moved a decade ago from Los Angeles to Lake of the Pines, a community of wooded lots and winding roads. Michael, now 51, established a fishing tackle manufacturing business, while Valerie set up an online marketing company. Their 13-year-old daughter, Samantha, attends Magnolia Intermediate School. Twins Nikki and Kylie are 6.

"Our health insurance costs three times our mortgage," Valerie Scaglione said. "That's crazy."

The Scagliones were shocked when Blue Shield approved Michael and the twins for coverage, but not Valerie and Samantha. Letters from the insurer pointed to Samantha's bronchitis last year and a suggestion that Valerie had been treated for rosacea as reasons for disqualification.

"I've never had that a day in my life," Scaglione said of the blotchy skin condition. "They say Sam has a cherry-colored birthmark. It's not there. They're listing things that aren't even correct."

When Scaglione tried to see that their medical records with UC Davis Medical Group reflected accurate information, Blue Shield refused her requests to appeal its decision.

"There are no rules," said Wright, the health advocate. "Insurers can deny coverage for any reason. The industry isn't standardized."

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