Kaiser Told to Reinstate Coverage

The woman first appealed to Kaiser. But when the HMO denied her appeal, she joined a class-action lawsuit filed in January 2005 in Alameda County Superior Court, one of about 10 suits filed every year contesting cancellations by the HMO. That suit was settled confidentially last September. Anderson said the accord set up a process for expediting arbitrations of individual complaints. That process was underway in the woman's case when she complained to regulators in late September.

Anderson said he could not guarantee that another member would not be canceled for failing to disclose conditions treated by Kaiser physicians. But he said it was less likely because the HMO was working harder to scrutinize applications before issuing coverage.

Kaiser now allows people declined for individual coverage to return to group or other plans in which they cannot be denied coverage. Also, an application question about untreated symptoms, which was challenged as vague, now is more precise.

Consumer lawyers and patient advocates say changes implemented by health plans in response to lawsuits and other criticism do not go far enough.

"Decisions about when insurance can be denied or revoked must be taken out of the hands of insurers who have a financial incentive to refuse to pay when we get sick and need it most," said Jerry Flanagan, a healthcare advocate with the Foundation for Taxpayer and Consumer Rights.

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lisa.girion@latimes.com