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As the Health Care Vote Passes

Another Troubling Insurance Story

By Marian Wang, ProPublica – March 17, 2010 2:03 pm EDT

[picapp align=”none” wrap=”false” link=”term=health+insurance&iid=8337843″ src=”c/e/5/3/President_Obama_signs_baf7.JPG?adImageId=11734822&imageId=8337843″ width=”380″ height=”484″ /]

Reuters filed a stunning report [1] recently about a health insurance company that targeted policyholders with HIV to drop their coverage. It opens with the case of Jerome Mitchell:

Patient Jerome Mitchell

Previously undisclosed records from Mitchell’s case reveal that [health insurance company Fortis [now known as Assurant Health] had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators ….

Insurance companies have long engaged in the practice of “rescission,” whereby they investigate policyholders shortly after they’ve been diagnosed with life-threatening illnesses. But, government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.

The Three Minute Rule

A South Carolina judge who ruled on the case noted that in the meeting in which the rescission committee [2] reviewed Mitchell’s case and decided to cancel his policy, there were more than 40 other customers whose cases were up for review, and “an average of three minutes or less” was spent per customer. Assurant Health told Reuters [1] it doesn’t comment on individual customer claims, while a spokesman added the company disagreed with “certain of the court’s characterizations of Assurant Health’s policies and procedures.” 

Link: http://www.propublica.org/ion/blog/item/as-health-care-vote-nears-another-troubling-insurance-story

Assessment

As the story notes, it’s not just this one insurance company that has been engaging in aggressive rescission. In California, state regulators fined five major health insurance providers—Health Net, Anthem Blue Cross, Blue Shield of California, PacifiCare and Kaiser Permanente—for dropping more than 6,000 sick policyholders. The terms of those settlements, reached in 2008 and 2009 [3], have yet to be implemented in most cases, according to news reports [3] from last week.

Industry Indignation Index: 39

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5 Responses

  1. Unhappy Doctors

    Recently, Athenahealth and Sermo released their Physician Sentiment Index (PSI). With over 1,000 physicians polled, the national survey is thought to be the largest of its kind. While many of the findings come as no surprise to physicians in practice, and ME-P readers, the message is nevertheless alarming; doctors are currently not happy campers.

    http://www.thehealthcareblog.com/the_health_care_blog/2010/03/the-numbers-tell-the-story.html

    Read full PSI survey results (PDF): http://www.sermo.com/sites/www.sermo.com/files/images/product/Athenahealth_PSI_Condensed_Complete_Sermo.pdf

    Gary

    Like

  2. Economics of Provider – Health Insurance Interactions

    The cost of interacting with insurance plans averages a whopping $68,274 per year per physician in America’s clinics according to a study funded by the Robert Woods Johnson Foundation and the Commonwealth Fund, and published in Health Affairs.

    Administrative costs in general — and particularly those related to dealing with insurance — have been the subject of much attention in the current debate on health care reform.

    http://blog.clarityhealth.com/2009/11/06/how-big-is-the-problem-68000-per-year-per-doc/

    Clyde

    Like

  3. More on Voting Politicians

    House Democrats just asked health insurers to immediately stop canceling plans because a patient gets sick, even though that provision of the federal health overhaul that doesn’t take effect until September.

    The request comes on the heels of news that WellPoint Inc. was targeting breast cancer patients with the intent of canceling their coverage – a practice called “rescission” that the reform law will ban except in cases of fraud.

    http://www.politico.com/news/stories/0410/36423.html

    Jackie

    Like

  4. More on the Patient Protection and Affordable Care Act

    Here is the latest Kaiser Health News column on The Patient Protection and Affordable Care Act [Obama Care] by Austin Frakt PhD.

    It continues the American tradition of privately provided, publicly subsidized health insurance. And, is how most Americans’ health insurance is financed today.

    But, despite its advantages, there is a hidden cost to this arrangement: insurers have more information about health care coverage, spending and utilization than the taxpayers that help fund them. And, the system’s opacity gives insurers the upper hand in debates over government payment rates.

    http://theincidentaleconomist.com/hidden-cost-of-publicly-subsidized-private-health-insurance/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+TheIncidentalEconomist+%28The+Incidental+Economist+%28Posts%29%29

    Jane

    Like

  5. Forget the Health Insurance Compliance Police – Use Some Common Sense Instead

    Dr Marcinko, and the ME-P, did you know that Cobb County Georgia was the first law enforcement agency in Georgia, and one of a few nationwide, to be accepted into the federal 287(g) program?

    The program is an agreement with immigration officials to check the status of everyone taken into the jail. Three other Georgia law enforcement agencies and the Georgia State Patrol also participate in the program. Cobb just renewed its contract with the federal government last October.

    So, when someone shows up at an [expensive] hospital emergency room for treatment – uninsured – why not just check the patient’s immigration status?

    Then, the Obama administration wouldn’t have to hire the proposed 18,000 health insurance “police” – mandated in the new law – as part of a national employment plan.

    Makes some sense, doesn’t it.

    Mary

    Like

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