BillCosby

Title
Health insurer's letter seeks to get coverage canceled

Link
AP State News - Health insurer's letter seeks to get coverage canceled - sacbee.com
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Excerpt

LOS ANGELES -- Citing an effort to hold down costs, health insurance giant Blue Cross wants doctors in California to report conditions it could use to cancel new patients' medical coverage, it was reported Tuesday.

The state's largest for-profit health insurer is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," the Los Angeles Times reported on its Web site.

"Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," according to the letter obtained by the newspaper.

One of the conditions noted in the letter that could force a new patient to be dropped by Blue Cross - pre-existing pregnancies.

WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said it was sending out the letters in an effort to keep costs at a minimum.

"Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members," WellPoint spokeswoman Shannon Troughton said in an e-mail to the newspaper.

"Blue Cross feels it is our responsibility to assure all records are accurate and up to date for HMO providers," she said. "We send these letters to identify members early on in the process who may not have been honest in their application."

Troughton added doctors are not required, but rather can volunteer, patients' information to Blue Cross.

Doctors were unhappy about the letter, warning that some patients might hide any medical history that could affect their prospects of receiving health insurance.

"We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Association.

Blue Cross is one of several California insurers that have been criticized for issuing policies without checking applications and then canceling coverage after individuals incur major medical costs. The practice of canceling coverage is under scrutiny by state regulators, lawmakers and the courts.

Troughton said the request of doctors has been in place for several years and Blue Cross has not received any complaints about it. The health insurance company doesn't always cancel the policies of patients with discrepancies in their applications and occasionally offers them another plan, she said.

Lynne Randolph, a spokeswoman for the state Department of Managed Health Care, said the agency would review the letter. Blue Cross is fighting a $1 million fine the department imposed in March over alleged systemic problems the agency identified in the way the company rescinds coverage.

"They are playing a game of 'gotcha' where they are trying to use their doctors against their patients' health interests," said Anthony Wright, executive director of HealthAccess California, a healthcare advocacy organization. "That's about as ugly as it gets."

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Comment:

HERES YOU BEST HEATHCARE MONEY CAN BUY.....

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Preventive war is not war!!!!Counter-terror is not terror

W.M.DEEEZ

The laws regarding health ins. have changed over the years. Now, as long as you have less than a 30 day gap in your insurance coverage, pre-existing conditions are covered.



Part of the reason that coverage is unaffordable, is because of those who sign up for insurance, only after finding out they have an expensive procedure coming up.


I'm disgusted by most of what I see in the industry, but I can understand why they want to crack down on some of these fraudulent practices.

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Don't it always seem to go, that you don't know what you've got til it's gone

BillCosby

When I read the paper I actually over looked that article..

I was talking w/ a neighbor & she pointed it out & was pissed....

She is paying over $1200 a month for coverage as they said he daughter that is 9 years old had a preexisting condition because she went to the hospital over three times (I don't know for what).....

The kid is in good health & no known ailments but now @ 9 years old she is considered eligible unless she/they pay this exorbenant amount to cover her...........

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Preventive war is not war!!!!Counter-terror is not terror

Richterscale

Single payer health care would eliminate these 'fraudulent' practices on its first day. How is getting sick committing fraud?

This is insurance company psychobabble nonsense. For years, HMOs have blamed doctors for rising insurance costs. HMOs have the money to create the public sentiment they desire and lobby for what they want - and have done so very successfully to all our detriment.

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Google Sibel Edmonds

"How many people died from the Kama Sutra as opposed to the Bible? Who wins?" - Frank Zappa

itsmeeeeeee

this is typical of an morally bankrupt industry...

the industry of providing insurance only to people who don't NEED insurance.

they want to rake it in, without ever having to pay it out.
the health care industry has turned into nothing more than a racket that should be abolished - and i have no doubt that sooner or later, it will be.

it's ruining not only our health, but our entire economy and ability to compete in global market.

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BillCosby

I hope you are right & it is gone one day...........

As a corporation it has it's first responsibility to it's shareholders......

That is the same for all corporations...........

Seems that there is something worse than government ran........

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Preventive war is not war!!!!Counter-terror is not terror

W.M.DEEEZ

A long time ago, I remember that changing health insurance was a problem, if you had a preexisting condition. Then, they changed the law/regulation, and as long as you had coverage with no gaps, all ailments would be covered.

Of course, this coincided with a rate hike, if memory serves.


Are you saying that you think an uninsured person who gets a bad diagnosis,should be allowed to run out and sign up for insurance, and expect to be covered?



Unless I'm mistaken, and the rules I stated are statewide, instead of nationwide, I think preexisting conditions are covered, as long as you had no lapse in coverage.


In Cosby's neighbor's case, I wonder what her situation was before the first diagnosis.

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Don't it always seem to go, that you don't know what you've got til it's gone

itsmeeeeeee

Health insurers probed over reimbursement

Health insurers probed over reimbursement - Yahoo! News

By Paritosh Bansal and Lewis Krauskopf Wed Feb 13, 6:33 PM ET

NEW YORK (Reuters) - New York Attorney General Andrew Cuomo said on Wednesday he is conducting an industry-wide probe of health insurers into an alleged scheme to defraud consumers by manipulating reimbursement rates.

Cuomo said he intends to sue UnitedHealth Group Inc (UNH.N) and four of its subsidiaries, including Ingenix Inc, the nation's largest provider of health care billing information.

The attorney general also issued 16 subpoenas to the largest U.S. health insurance companies, including Aetna Inc (AET.N), Cigna Corp (CI.N) and Empire Blue Cross Blue Shield, a unit of WellPoint Inc (WLP.N)....

The alleged scheme centers on Ingenix, which serves as a conduit for rate data to the largest insurers in the country, Cuomo said in a statement.

A six-month probe found that Ingenix operates a "defective and manipulative" database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses, Cuomo said.

The probe found that two other UnitedHealth subsidiaries used data provided by Ingenix to keep reimbursement rates artificially low and thereby force patients to assume more of the costs, the AG's office said.

The subpoenas to insurers request documents on how they compute reasonable and customary rates, as well as communications between Ingenix and the insurers on the issue, among other information, Cuomo said.

"Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is," Cuomo said. "But when insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need."

According to Cuomo's office, Ingenix used insurers' billing information to calculate a "reasonable and customary" rate for individual claims, generally taking into account the type of service, physician, and geographical location.

But the investigation found such rates produced by Ingenix were lower than the actual cost of typical medical expenses, it said.

UnitedHealth's insurance plans also hid their connection to Ingenix from plan members, Cuomo said.

Several physician and patient advocacy groups applauded the attorney general's probe.

The investigation "calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members," Nancy Nielsen, president elect of the American Medical Association, said in a statement.

Historically large-scale managed care industry probes have taken years to play out and any resulting fines have tended to be minor, Wachovia analyst Matt Perry said.



the whole damn industry stinks to high heaven!

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Heretic

Another reason why Hillary's use of Romney-Care will only make the problem worse. With the amount of money I make a year I'd not only spend the bulk of my paycheck on insurance [or the fine after the bastards garnish my wages] but still not get the coverage I need.

And I know Hillary's plan involves a government subsedy to make insurance "affordable" but what criteria would allow me not to pay the whole costs aren't defined, and I'm certain I'd have to be near bankrupcy before I'd be eligable for government augmentation of premiums.

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"Enough!!" -so rang Barack Obama's voice off the walls of Mile High Stadium

W.M.DEEEZ

Now THAT, sums it up rather nicely.


This info doesn't surprise me. I've never understood how they come up with what they call "reasonable" charges.

They're really good at taking your money, but seem to drag their feet when they have to pay out.

Every 3 months that they can hold on to your money, that's another quarter's interest.


I've always been bothered by the fact that they get to choose what is considered "customary" treatment. We have no choice to pursue natural methods for certain ailments. Often, these methods work better than these "approved" methods.

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Don't it always seem to go, that you don't know what you've got til it's gone