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October 06, 2009 07:04 PM UTC
30 Comments
First things, first!
God, I hate this “system.”
I’m calling the indigent care clinic today because of worsening pain in my knee and hands. But our “system” of Medicare and AFLACK will pay $300,000 to keep my father alive two years……
Is this any worse than what we hear about in Canada or the UK for non-urgent matters?
I think not.
for insurers to deny claims they know they will have to pay if challenged. The attitude is that they will get away with it often enough or be able to hang on to the money long enough to squeeze more profit out of their customers.
They see absolutely nothing wrong with forcing people at their sickest and most stressed to spend hours arguing with various bureaucrats just to get what even the companies agree they have coming. This barbarism won’t end without a public option. The slap on the wrist fines are nothing compared to the profits. It’s all part of the insurance companies’ misery and death for profit culture.
that health insurers pay their claims examiners bonuses for denying claims.
Several years ago I sued my health insurer, Fortis, for failure to pay a relatively small claim. I did it pro se, and they were shocked a policy holder would hold them accountable for failing to pay a relatively small claim.
Fortis (based in Wis.) had to hire an attorney at Holland and Hart to handle the case, as well as an attorney in their home office involved. I negotiated a very favorable settlement, and in the course of those negotiations I asked them point blank why they had failed to pay a legitimate claim in over 6 months. They had absolutely no answer. A $96 claim landed up costing Fortis thousands of dollars (settlement, costs, and their attorney fees).
Anybody who runs a business and has a basic understanding of accounting realizes that in many cases, cash flow can be more important than profit. Insurers have the ideal cash flow system – they get their premium revenue right on time (because you have no coverage and they cancel you if they don’t), but they string out payments of claims as long as they can. Sweet (for them).
I think it is important to remember that this current situation is not the “fault” of the insurance industry. They are just finding ways to profit in the current regulatory climate that exists. I would do it too! Ask ANY business owner. They play as hard as they can in the rules provided. Sometimes that even includes playing hard in the gray areas of law and regulation.
The fault lies at the foot of us- the United States Congress (I say “us” because, well, the government IS US!). We have allowed these conditions to exist and now it is up to us to change it.
Send your letters and e-mails to your representatives so they will hear our voice over the din of the lobbyists! If you don’t like the results, vote the bums out and try again!
They broke the laws, and now they have to pay the fines that the regulator hands down.
Yes, if you break those laws or regulations then you are in trouble- just like any other business caught with their hands in the cookie jar.
Overall, the conditions that the insurance industry works within are caused by us.
As well, PLEASE don’t think I’m a fan or defender of insurance companies- I’m not. I am, however, a STRONG proponent of realizing this is OUR government and WE need to play our role…
For context the average compensation of a health insurer CEO is $12 million a year, or about $230k a week.
Puts these fines in to context.
These claims are not being denied because of fear of drop in the bucket penalties. Ask anyone who works for these companies. It’s the employees’ job to deny as much as possible. They routinely deny for no good reason at all except that they might get away with it. If not, so they’ll pay. Big deal. They’re profits have gone up well over 400% while our average income has increased by somewhere in the twenty % range so they can afford to get caught. No biggie.
It’s nothing to do with fear of government regulation. They consider the piddling price of any fines just part of the cost of doing their obscenely profitable, death and misery business.
At the expense of financially damaging someone?
In my case (not atypical I’m sure ) I was getting letters from the health care provider demanding payment, and the next step was forwarding the bill to a collection agency which then immediately downgrades your credit. My business, and therefore my livelihood, depend on maintaining my good credit.
You talk about playing hard and fast with the rules and the law, but the law provides for legal action against someone who financially damages you. And that law was well established before we even had health insurance.
United Health didn’t play by the rules or the law, that’s why they got fined.
This should be compensated when they act in bad faith.
The deep pocketed insurer, shit storms you with a blizzard of paper, threatens your credit, and eventually you give in and either pay the bill yourself, declare bankruptcy or deny yourself the treatment.
Heath insurance companies are NOT benevolent. They are profit-driven entities that treat our healthcare like a commidity.
Change the rules of the game AND put some money towards enforcement.
I’m as curious as everyone else to see if the Congress has the guts to do these two things. Unfortunately, we have the ear of Congress from a distance. The lobby has their ear 24/7/365 and sweeten in with campaign money.
My insurance company got in an argument with my doctor over $90. I got letters from a collection agency too…
It sucks….
because when she went to the doctor, they had to do a pregnancy test before they could prescribe her a medication. We knew she wasn’t pregnant, but the doctor was required to perform the test.
A few months later we get a bill for $75 from the doctor, with a note saying her insurance refused to pay because her policy doesn’t cover “anything related to pregnancy or childbirth.” She wasn’t even there for anything remotely related to pregnancy.
The system is totally broken, and the people who are suffering the most are middle class consumers.
Many doctors offices know that coding certain things in certain ways begs for denial of coverage. When I took my nutritional education after being diagnosed diabetic, the hospital very specifically coded the class away from the standard “nutritional education” coding and into a specific diabetic coding.
I suspect that if your doctor’s office had coded the pregnancy test as some kind of contra-indication test instead of as a pregnancy test, the insurance company would have had no problem paying it.
It’s a lousy system, such as it is. Doctors shouldn’t have to pay a huge staff to be competent in the ins and outs of each individual policy, and insurers shouldn’t be wasting so much money paying people to screen out payments for the slightest, most inane reasons.
According to the CO Division of insurance, for health insurer complaints investigated by the DOI in 2007-2008 FY 75% were found to be confirmed. Confirmed means the company failed to comply with the the law, regulation or the policy provision.
75%
Just so you don’t think that is an anomaly, it has ranged between 69-77% over the last few years.
(As an FYI health insurance isn’t the worst on complaints, Annuities top the DOI list at 90% confirmed)
In the past, insurers could simply deny in bad faith and there was no penalty. If they got caught either through the regulatory or civil law process they just had to pay what they would have had to pay if they hadn’t acted in bad faith. Since you don’t get caught every time this created incentives for insurers to cheat.
Democrats got a very good law passed a couple of years ago that punishes insures who deny coverage in bad faith, hopefully this will start to effect their behavior by changing the incentives to cheat policy holders who have been paying their premiums in good faith.
Why are we paying premiums to companies who would rather pay fines to the government than pay for our care? If anything, this is an incentive for healthy people to remain uninsured.
My insurance broker suggested (with a straight face) that I self insure for EVERYTHING except catastrophic.
I asked her how she slept at night working in that industry. Her response? “I make GREAT money!”
just self insure…..
I’m sure that would work for Bill Gates and Warren Buffet, but for the other 99.99998 % of us……..
when they drop you as soon as that catastrophe comes along. We think we’re paying for protection from that catastrophe but its really just Russian Roulette. You can pay for years, make them lots of money, have a brain tumor and get dropped for whatever reason they can dig up. It’s more like paying protection in the Mafia sense of the word.
And her advice may have been accurate.
Our present system is so bad and the deck so stacked against the consumer that it may not be worth buying insurance for the little stuff.
In a commercial context we used to say, insure for the risks that you can’t afford to pay. Meaning insure anything that would kill you, not merely hurt you.
Insurance is just a contract and in business everyone knows that if its worth enough money corporations will just ignore the contract and force the other party to litigate against them.
This gives the defendant insurance company the dominant position in negotiations.
was her response, except, not the other way around. This would seem to imply that insurance for catastrophic isn’t at all reliable since it can so easily be pulled out from under you. You know, like the nurse with aggressive breast cancer facing rescission because of past acne treatrment? She won after months in court but it may have been months too late to save her life. She had catastrophic. The fact that the people who did this to her can sleep at night is why we need, as a bare minimum, a strong public option.
I read that wrong.
I feel foolish, but I don’t think the DOI allows for everything but Cat insurance (the insurance companies tried to get a law passed last session that would have allowed it, but it didn’t pass)
from the sound sleeping agent wasn’t even a possibility? Heartless and incompetent? Don’t you just love health insurers?
It’s called an HSA with high-deductible health insurance. The only difference is that the HSA is tax deductible.
I pay a $6k into an HSA every year to cover the deductible. This money mostly gets spent on routine health care. So we’re essentially self-insured.
So far, it’s actually worked really well and cost less than a policy with low deductibles (but not by much).
Self insuring (HSAs) work if you actually can afford the deductible and consume your healthcare in a normal manner.
The problem is that some people in HSAs can’t afford the deductible, so they delay treatment and self ration until a medical need grows into something very expensive.
IMO the problem with healthcare is not “overconsumption”, it is too much consumption when it is profitable, and not enough consumption when it is not. HSAs reinforce this behavior.
I’ve heard that docs hate patients with HSA/HDHPs, precisely because so many patients can’t cover the deductible with their HSA. Just because you have an HSA doesn’t mean that it has enough in it to cover the deductible.
When we switched to an HSA/HDHP, our docs all insisted on credit card imprints.
Mayor Hickenlooper “announced today that a $60,000 sponsorship from UnitedHealthcare of Colorado will help Denver Parks and Recreation significantly expand the availability of its recreation center programming guides to 75,000 guides per year — up from 20,000 copies in… previous years — reaching thousands more city residents and promoting the use of affordable health and exercise programs.” (This copied from the Mayor’s Facebook posting.)
Sounds like the UnitedHealthcare PR folks were behind that contribution.”
Everyone goes to a doctor or hospital, sooner or later. Not everyone gets into a car accident. Sometimes never.
So, on the one hand we have pooled resources to “make whole” a ship owner that sees a loss, a car owner that has an accident, or a life that ends prematurely.
OTOH, we (alone among advanced nations)expect companies to essentially become monetary conduits for what is an expected part of life, health care. It’s like paying a middle man to cover the cost of your food or rent. Why on earth would you do that? Said middleman would start telling you that organic produce isn’t covered, etc.
Health insurance isn’t insurance. It’s that simple and it’s that simple why said “insurance” companies have no place in the health care of Americans.