Health care in America is broken!

[tulsascoot]

This is a despicable practice, and it's why our health care "system" is such a poor arrangment for our citizens.

Health insurer's letter seeks to get coverage canceled
The Associated Press
Article Launched: 02/12/2008 01:18:25 AM PST

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
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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."

[we vs us]

quote:Originally posted by tulsascoot

This is a despicable practice, and it's why our health care "system" is such a poor arrangment for our citizens.

Health insurer's letter seeks to get coverage canceled
The Associated Press
Article Launched: 02/12/2008 01:18:25 AM PST

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
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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."

An excellent illustration of the conflict between profit motive and medical ethics.

[cannon_fodder]

Technically this is supposed to already be happening.  If you don't have insurance and have a medical problem or get pregnant, you can not then get medical insurance.  Insurance, by it's very nature, is a group gamble on health - the company is betting that most of its members will have less medical expenses than premiums paid in.  Some will not.  Overall they will come out with a "reasonable" profit (insurance companies are not among the most profitable entities).

However, if you are allowed to hold off of paying for insurance until you NEED it, the insurance company is guaranteed to lose.  As a result, premiums will rise to offset those losses.  So those of us who maintain health insurance inevitably end up paying for the person who fraudulently (recall they ask if you have preexisting conditions, lying would then be fraud) cherry picked coverage.

If this behavior was allowed why would anyone get insurance?  I'd just wait until something went wrong and then get the insurance - instead of wasting hundreds of dollars a month paying for it like an idiot.  Let everyone else pay for it.

So while I agree that the system is broken and that it could be seen as an ethical conflict, it can also be seen as an attempt to keep people from fraudulently forcing other's to cover their medical expenses.

[sgrizzle]

Thought it was interesting that the Government reports around 46 Million uninsured, but local favorites the Kaiser Family Foundation says the actual number of people who are chronically without because they can't afford it is around 8.2 Million. There is a unreasonably high number of people who can afford it, but choose not too. Those people are the ones CF mentioned above who don't pay for insurance until they really NEED it.

[cannon_fodder]

Thanks for clarifying SQ.  On the larger issue I agree that there are people that can not afford it, but I believe MOST choose other priorities (cable, nicer cars, flat screen TV, iPods).  The system's broken and I'd welcome a change for the better.  

Oklahoma is small enough and diverse enough that it would be a great place to try new things.  Hell, even Tulsa with the help of the Kaisers would have a shot at making some simple changes that might help.  I'm open to ideas, but allowing other people to leach off of my insurance premiums is not one of them.

[Wingnut]

Here's some food for thought.....
http://www.humanevents.com/article.php?id=22685
http://www.humanevents.com/article.php?id=22557
http://www.humanevents.com/article.php?id=22467

[Conan71]

Read your enrollment form next time you enroll in health insurance either individually or with your company.  The prospective insurer reserves the right to check your medical records, that's one of the reasons why you sign the damn application.  You sign a release.  You also state and affirm that you are being honest about your medical history on the application.

This story is a very thinly-veiled appeal for UHC.

I was wondering if that story was 20 years old when I read it.  It's hardly earth-shattering news.  Insurers have virtually always excluded pre-existing conditions and pregnancies, with some exceptions in open-enrollment periods for larger employer-sponsored plans.

With individual plans, I do believe PEC has been exclusionary more often than not.  My first child was born with full pre and post-natal care on employer-provided HMO plan.

My second child, we had not planned on for another couple of years, we had declined maternity coverage, and there was a one year exclusion to get on it with the program we had chosen for an individual health insurance plan when we both had gone to work for small businesses w/o employer-sponsored health care.

First child cost me $100 out of pocket, second cost me $5000.

Why should I expect an insurance company to pay out $5000 in maternity benefits after I've only paid them $600 in premiums after two months?  That makes zero business sense.  It would become the target of a lot of people wishing to bilk a private system instead of using their own personal resources or those provided by the state and feds.

Had I not been able to afford the hospital and doctor costs for my second child- there are existing government programs which would have  assured that she recieved proper health care.  Maybe not as great as I get through my GP via my PPO plan I have now, but she would have never gone without.

I'm beginning to see UHC as a total canard.  No one can seem to agree how many don't have coverage who actually do want coverage.

Our company offers a very attractive plan, employee contribution is pretty nominal- about $60 per month, yet there are those who don't take advantage of it.  They'd rather have that $15 per week for smokes.