Category: Private Health Insurance

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com:

“‘People who are underinsured end up facing almost identical problems as the uninsured,’ said Karen L. Pollitz, director of the Health Policy Institute at Georgetown University. ‘The difference is, they paid for the privilege.’

“Medical debt is likely to figure prominently in the looming national debate over reforming health care.

“Jim Eyler, 57, of Westminster, Md., says he needs help. The cement company manager said he spends about 33 percent of his take-home pay on unreimbursed medical bills, many connected with the advanced breast cancer his wife has been battling since 2005. ‘I keep wondering, where’s the money going to come from?’ he asked.”

More anecdotes here, of course, but the larger point is that our current cost structure is unsustainable.

Blue Shield to restore coverage for dropped Californians – Los Angeles Times

Blue Shield to restore coverage for dropped Californians – Los Angeles Times:

“In an attempt to settle investigations prompted by articles in The Times, the insurer agrees to reissue plans to almost 700 Californians and reimburse them for expenses that would have been covered.
By Lisa Girion [January 7, 2009 ]

“Blue Shield has agreed to reissue medical coverage to nearly 700 Californians whose policies were canceled after they got sick and to make changes in the way it handles insurance bought by individuals, officials said Tuesday.

“Blue Shield of California’s Life & Health Insurance Co. also agreed to reimburse consumers whose coverage was canceled for medical expenses they paid out of pocket.”
…
“Most of the state’s health insurers remain mired in litigation over the practice that has led to the cancellation of thousands of policies of sick patients, as well as financial losses for them, physicians and hospitals. In addition, Los Angeles City Atty. Rocky Delgadillo has sued Anthem Blue Cross, Blue Shield and Health Net, accusing all three of improperly dropping customers.”
…
“When the state’s charges were initially filed, Ross called them “grossly unfair.” Blue Shield and other insurers have maintained that state law allows them to review a patient’s old medical records after they get sick and rescind coverage if it finds something the policyholder failed to disclose on his application — whether intentionally or by mistake.

“Consumer advocates and lawyers have accused Blue Shield and other insurers of using purposefully confusing applications designed to trick people into making mistakes that can later be used against them and of failing to properly vet the applications before issuing coverage.”

God bless the American Businessman! Or woman. (Sorry, Loretta!)

AMNews: June 23/30, 2008. What’s in their wallets? Health plan executives bring home the bucks … American Medical News

AMNews: June 23/30, 2008. What’s in their wallets? Health plan executives bring home the bucks … American Medical News:

“In its analysis of S&P 500 companies, Equilar found median total compensation for the CEOs was $8.8 million. The six publicly traded health plans that are a part of the S&P 500 index all paid their CEOs more than that median: from $9.1 million for WellPoint’s Angela Braly to $25.8 million for Cigna’s H. Edward Hanway. The highest-paid executive in the S&P 500 2007 was John Thain, CEO of Merrill Lynch, who took home $83.8 million, most of it in stock options and stock awards granted at his hiring last year, Cwirko-Godycki said.

Of the largest publicly traded health plans, only Health Net’s Jay M. Gellert was below the median, at $3.7 million. His company is not part of the S&P 500.

Heidi Toppel, JD, senior executive compensation consultant for human resources consulting firm Watson Wyatt, said health plan CEOs’ pay isn’t out of line by Wall Street standards. ‘I would not consider the levels of pay to be stratospheric,’ she said.

But she and other experts acknowledge that pay is a thorny issue for health plans, particularly as physicians question why their reimbursement should be under pressure and why they need to jump through hoops to get care paid for while health plan executives take home large paychecks.”

So what is the usual, customary and reasonable compensation for limiting healthcare access and reimbursement?

They Know What’s in Your Medicine Cabinet

They Know What’s in Your Medicine Cabinet:
“That prescription you just picked up at the drugstore could hurt your chances of getting health insurance.

An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.

Privacy and consumer advocates warn that the information can easily be misinterpreted or knowingly misused. At a minimum, the practice is adding another layer of anxiety to a marketplace that many consumers already find baffling. ‘It’s making it harder to find insurance for people,’ says Jay Horowitz, an independent insurance agent in Overland Park, Kan.”

This would be funny if it weren’t so disturbing.

We’ve been having a running joke at our house that our pharmacist is going to think I’m the most diseased man on the planet because I keep getting medications from my local grocer’s $4 drug list for my dog!

I’ve been getting him antibiotics, oral and ophthalmic and topical, in a wide variety, steroids, and other stuff in my name because paying for these is far cheaper than at the vet’s! Now none of these have been charged to my insurer, I strictly pay cash, but clearly my name will be in the databases with all these drugs. So next time I have to switch plans….

Essay – Fed Up With the Frustrations, More Doctors Change Course – NYTimes.com

Essay – Fed Up With the Frustrations, More Doctors Change Course – NYTimes.com:
“Not long ago, fed up with what he perceived as a loss of professional autonomy, Dr. Bhupinder Singh, 42, a general internist in New York, sold his practice and went to work part time at a hospital in Queens.

“I’d write a prescription,” he told me, “and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.”

When he decided to work in a hospital, he figured that there would be more freedom to practice his specialty.

“But managed care is like a magnet attached to you,” he said.

He continues to be frustrated by payment denials. “Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ””

But if they were Government Bureaucrats, now that would be intolerable…

BTW, I included this post with the category of Rationing Healthcare because it does become rationing by attrition. Physicians often are so frustrated by the battles they fight hourly with Private Insurers, they cave in and provide less than optimal care.

Melani followed circuitous journey from Allegheny Valley to Highmark

Melani followed circuitous journey from Allegheny Valley to Highmark:

“Some peoples’ lives are framed by the gravity of their forebears’ legacy; others by a singular, undeniable talent. The life of Dr. Melani, now 54, was not so much framed as it was forged, by his own personality and skills as a diplomat.

Those skills have him on the cusp of becoming one of the most powerful business leaders in Pennsylvania, and one of the most important health insurance executives in the United States. Highmark is seeking a merger with Philadelphia’s Independence Blue Cross, and combined, the two nonprofits will have up to 26,000 employees, 7 million policyholders, a $24 billion organization — physicians’ practices, dental, vision, casualty and life, and of course health insurance.

If the merger is completed, he’d head the entire company as its CEO.

‘It’s a very serious responsibility,’ says Dr. Melani, who in his current job makes more than $3 million a year and occupies a radiant, 31st-floor office. ‘I step back and look at it and say, Oh my God, how did little me from Cheswick, a little kid from Arnold, end up in this position? I was just going to practice medicine, and that was overwhelming to me.'”

My point in posting this is not to pick on Dr. Melani nor Highmark, per se, just to point out the obvious: These things are huge, money making machines.

Doctors demand action on private health insurance

CNW Group CANADIAN DOCTORS FOR MEDICARE Doctors demand action on private health insurance:

“TORONTO, March 12 /CNW Telbec/ – Canadian Doctors for Medicare today called on the federal and provincial governments to immediately take all necessary steps to stop the spread of private health insurance for medically necessary services in British Columbia.

‘The recent exposé that Acure Health Corp is selling ‘Medical Access Insurance’ for services already covered under Medicare undermines the public health care system to the detriment of the vast majority of Canadians, and contravenes the Canada Health Act’, said Dr. Danielle Martin, Chair of Canadian Doctors for Medicare.
…
“Those who think private health insurance is a panacea for our system should take a look at the Australian experience. The major beneficiaries there have been higher income Australians, private insurance companies, private hospitals and medical specialists – and not the wider Australian community,” said Dr. Martin.
…
“In its 2006, in its discussion paper “It’s About Access”, the Canadian Medical Association reviewed all the evidence and found: – Private insurance for medically necessary physician and hospital services does not improve access to publicly insured services
– Does not lower costs or improve quality of care
– Can increase wait times for those who are not privately insured; and
– Could exacerbate human resource shortages in the public system.”

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times:

“Calling Woodland Hills-based Health Net’s actions ‘egregious,’ Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.

‘Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured,’ Cianchetti wrote in a 21-page ruling.

Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.

Then, ‘I thanked God,’ she said. ‘I praised the Lord.’

Bates called the arbitration judge ‘an angel . . . a real stand-up kind of judge.’

When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.

Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.

At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.”It’s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive,” the judge wrote.”

Of course, this will get reduced substantially on appeal, but at least this tort case got the attention of the insurer to improve policy (for the time being, anyway).

NEJM — Market-Based Failure — A Second Opinion on U.S. Health Care Costs

NEJM — Market-Based Failure — A Second Opinion on U.S. Health Care Costs:

“Relentless medical inflation has been attributed to many factors — the aging population, the proliferation of new technologies, poor diet and lack of exercise, the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand, excessive litigation and defensive medicine, and tax-favored insurance coverage.

Here is a second opinion. Changing demographics and medical technology pose a cost challenge for every nation’s system, but ours is the outlier. The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system.

Markets are said to optimize efficiencies. But despite widespread belief that competition is the key to cost containment, medicine — with its third-party payers and its partly social mission — does not lend itself to market discipline. Why not?”

Read on…