INSIDE AN INSURANCE INDUSTRY DENIAL MACHINE

The first concept you need to understand is the Medical loss ratio. You and I are losses in insurance industry lingo.

The medical loss ratio refers to the percentage of dollars actually spent on medical care versus administrative costs or profit. The higher the ratio, the more money is being spent on actual delivery of care. Components of the medical loss ratio include payments to physicians, hospitals, pharmacists and other providers of health care.  Read more 

According to Market Watch, Aetna CEO Ronald Williams “earned” nearly $43 million in total compensation in 2007. The census bureau set the 2007 poverty line for a single person at $9944 (over 65) or $10,787 (under 65); let’s just call it a nice round $10,000.

Meanwhile, this painter/sculptor might dispute the use of the word “earned” in the Market Watch story:  Read more 

They Know What’s in Your Medicine Cabinet
How insurance companies dig up applicants’ prescriptions—and use them to deny coverage

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.  Read more 

HealthMarkets Inc., fined $20M for lax practices

The three-year examination involved 29 states and was helmed by Washington State insurance commissioner Mike Kreidler and Alaska insurance director Linda Hall.

The companies targeted sales to self-employed individuals and sold health plans through associations.

Often, the agent or company did not adequately explain the health benefits.

UnitedHealth income off 73%

On July 2, the company said it would pay $895 million to settle a class-action lawsuit led by the California Public Employees Retirement System. It also said it was cutting 4,000 jobs nationally, or just under 6 percent of its workforce, and reduced its forecast 2008 profit for the second time.

The legal problems will just keep growing:
CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS’ FRAUDULENT REIMBURSEMENT SCHEME

My very own corporate parasite, Aetna, is losing the battle for public opinion in the pages of New Jersey’s Bridgeton News. In a story on the reaction to Aetna’s decision to drop The Center for Diagnostic Imaging (CDI) of Cumberland County from its network, Andrea Scapellato, whose husband has been depending on CDI for regular ultrasounds, is quoted:

“First you have to pay for insurance, and then you can’t even go where you want to go,” she said. “We live in the United States, not communist China or Russia.”  Read more 

Stock prices of Aetna and other health insurers are up. How nice for them and their shareholders.

Meanwhile, the lowly life-forms who actually need health care abandon all hope in the health (couldn’t) care (less) system:  Read more 

Insurance Cancellation Questions Could Spread Beyond California

Today’s Health Blog jargon of the day is rescission, the insurance industry’s practice of revoking individual insurance policies because of health-related mistakes or omissions on the application for coverage. …

… Now it looks like the push-back against rescission may be spreading. Henry Waxman, a Democratic California Congressman, held a hearing on the subject yesterday and said his oversight committee plans to investigate the issue nationally.  Read more 

Adopt-a-parasite? The whole health (couldn’t) care (less) system is a parasite on the body politic. At Salon, a doctor lays out the obscenity: (via Suburban Guerilla)

As a resident in a Los Angeles hospital, he tries to get the on-call orthopedic surgeon to come in the middle of the night to treat a five-year-old with a severe broken leg.  Read more 

Tragedy!

Poor William L. Jews. His compensation package for leaving his position as CareFirst CEO has been cut by more than half. This means Mr. Jews will not get the $18 million severance he was expecting, but will receive less than 9 million bucks. Can you imagine having to get by on just shy of 9 million bucks? I mean, you can’t even buy a decent Santa Barbara estate for that kind of money anymore.

Why was this outrage perpetrated? Well, it seems CareFirst is a nonprofit health provider

How much health care does $9 million buy in California?

Why was Caitlin White’s $113,000 brain surgery delayed for more than two months? Would she ever have had the surgery without the intervention of TV news?

It’s really not clear from the linked story, but this much is clear: Caitlin’s mother believes the “claim came in too late” for her to have the surgery scheduled for May. She also believes that the insurer denied coverage altogether when she rescheduled the surgery. The insurer, Aetna, disputes the circumstances, but according to the story it took pressure from a local TV station and a four-day investigation to get Aetna to “change its tune” and “partner” with Tampa General Hospital to fully cover the costs.  Read more 

I was going to write a great post about this idea, but readers will have to make do with slap dash. In order to pass single payer we need to completely discredit the health insurance companies. In order to achieve this we will need their help. Fortunately they are willing to cooperate.

Thus today’s disgrace: Blue Shield sued for allegedly canceling policies

The Los Angeles city attorney is suing Blue Shield of California for allegedly bilking policyholders when they tried to make claims.  Read more 

Tom Skilling of WGN-TV Chicago is the best TV weatherman in America, all classes and probably all-time. He has the misfortune to be the brother of Jeff Skilling, of Enron infamy, who has just been convicted of everything but aggravated sidewalk-spitting and a count or two of insider trading. It’s an interesting morality play of two brothers, products of the same genetics and environment and all that, both very talented guys, one of whom used his abilities for Good and the other…not so much. Story, breaking, here at the Chicago Tribune. Who also own WGN TV, the Cubs, and a lot of other things, but that’s a rant for another time.  Read more