The Story Behind the Ad

Here is the Coakley campaign’s description of the story behind the new “Jane” ad:

Jane Gilman lost her job in 2003 and exhausted her COBRA benefits in 2005. After searching for affordable health insurance on the internet, a MEGA Life and Health Insurance agent met with Jane at her home and promised her that a MEGA policy would be comparable to the insurance she previously had. MEGA Life and Health Insurance is a subsidiary of HealthMarkets, Inc. Because of a history of cancer in her family, Jane was particularly concerned about coverage for mammograms and also sought an affordable deductable.

The MEGA agent told Jane the policy would meet all her needs and had an affordable $2,000 deductible. However, Jane soon experienced problems with claim denials for a mammogram and doctor’s visits. Despite many calls to MEGA, Jane never received clear information about her coverage, and she learned that the $2,000 deductible was applied per diagnosis – so Jane was never able to meet the deductible and stop paying out of pocket for services.

In 2007, Jane contacted the Attorney General’s Health Care Division to ask for help with the MEGA claim denials. A health care mediator with the Attorney General’s Office worked with Jane and a HealthMarkets representative to review and reprocess the claims that had been denied. As a consequence, HealthMarkets agreed to pay many of the claims.

Because of complaints like Jane’s and many others’, the Attorney General’s Office began an extensive investigation into the practices of HealthMarkets and its subsidiaries. Coakley filed a lawsuit against HealthMarkets and its subsidiaries, MEGA Life and Health Insurance and Mid-West National Life Insurance, resulting in a $17 million settlement for unfair and deceptive marketing and administration practices and a five-year ban on selling health plans in Massachusetts. The settlement came after the Health Care Division of the Attorney General’s Office alleged that Health Markets deceived consumers into buying low-cost health insurance policies and then denied them coverage after they became ill. The $17 million settlement became the largest consumer protection settlement against a health insurer in Massachusetts history.