To be fair, that sounds bad, but if they are a fraud investigation team what else would you bonus them for? For every x number of fraud cases you expose we will give you a bonus. It's not like what's being said is that they rescinded policies that shouldn't have been rescinded.
Certainly true - I haven't been able to find too much on it, except that they have been fined $1MM so far by California for the practice. http://www.naturalnews.com/023313_health_health_insurance_health_care.html (NaturalNews) Health insurance company Health Net Inc. rewarded employees for finding ways to drop customer policies and not pay for their medical expenses, according to an investigation by the California Department of Managed Health Care (DMHC). Since 2005, the DMHC has been investigating five of the seven insurance companies that provide health care plans to individuals in California. The department is attempting to crack down on the practice among insurers of dropping people's coverage based on often accidental errors in their enrollment applications. In many cases, people's policies have been dropped after they submitted medical claims. The DMHC has fined Health Net $1 million for failure to disclose a program in which employees received bonuses for meeting or exceeding quotas for health insurance policies to be dropped. The department continues to investigate Health Net and has yet to determine if the dropping of policies or the bonus program are illegal. The DMHC describes itself as the only stand-alone watchdog agency for managed health care in the country. Since 2005, it has fined Blue Cross $1 million for rescinding its members' health plans and $200,000 for rescinding one person's plan in particular. It has also fined Kaiser Permanente's Kaiser Foundation Health Plans $325,000 for illegally rescinding two policies. "None of the plans that we are investigating thus far have had an adequately fair process" for dropping policies based on application errors, said DMHC Director Cindy Ehnes. Health Net's employee bonus program was revealed in the course of a lawsuit by a breast cancer patient who had her health insurance policy dropped by the company after she became sick. The company dropped 1,600 policies between 2000 and 2006, avoiding paying $35.5 million in medical fees. Ehnes and California Insurance Commissioner Steve Poizner have proposed new regulations that would require health care providers to find that customers deliberately misrepresented information on their applications before dropping their coverage.
Two things from that article, on opposite sides of the case: 1. It hasn't been determined if the program or the bonuses are illegal, and the fine isn't terribly substantial as of yet. 2. It mentions that the program involved quotas, which suggests that they may create reasons to cancel a policy if people need to meet their quotas. Having a quota assumes you have a certain number of policies you're trying to cancel, which is f-ed up.
Fraud cases are one thing. Otherwise, it's kind of like paying a college professor by the number of students he fails. (Because then they have to stay in college longer and pay more tuition.) It's a model that makes (very) short-term financial sense, but no moral sense, and no sense of making money while honoring the spirit of your contract with customers. I say short-term, because if a college does that, eventually people get wise to their 4 and 6-year graduation rates and kids stop going there. (or fewer go there.) By analogy, the medical industry and the health insurance industry have had it pretty good, but by over-reaching for profit, it's now topic #1 in America, and things will eventually change (even if not this year), because we can't have 100% of GDP be healthcare costs.
I don't know if what they were doing was bogus or not. I think at least some of it had to be, but it's not clear how much. However, if you reword what they were doing to say "The insurance company paid bonuses to its rescission team based on the number of applicants they discovered who had fraudulently completed their application" it no longer sounds evil. Also, I think Healthnet insures nearly 7 million people. They rescinded 1600 in 6 years? So over 6 years they rescinded less than a tenth of a percent of their insured base? That hardly seems egregious.
If they were creating phony reasons to drop a policy it is a terrible thing. But I don't know that to be the case and I haven't seen an article yet that says it. The one in particular is a case I'm familiar with. Her policy wasn't rescinded for a bogus reason, it was rescinded because she lied about heart trouble (don't remember the exact nature) and her weight. Those are material misrepresentations and an insurer should be able to rescind your policy is a non-guarantee issue system based on that.
You make a good point and I would rep you for it if I could. However, the counterpoint is that given the average US health insurer, she might have found it impossible to get coverage without lying. See: Thadeus, the.
Absolutely which is why I support reform that mandates coverage and forces carriers to offer coverage to all.
Fair enough - I'd extend such rationale as a basis to find health care provider policy that currently rewards rescinding policies grossly heartless. You've effectively damned people to either lie or die. Not acceptable. And it's not the patient's fault - thus the ire.
Fair enough, and not knowing much about California's insurance laws I can't really respond to that. I know in Texas there are options (albeit not good ones.) 1) If you are an employer plan in Texas your coverage cannot be rescinded for any reason. 2) Employer plans cannot be denied due to any medical conditions 3) There are individual plans like BCBS that will rider out conditions (such as the heart in this lady's case) and then there are ones like Aetna that don't enforce riders and just raise the rate based on conditions 4) If you are declined by carries in Texas and do not have access to employer sponsored insurance, Texas offers the Risk Pool. It's not a good solution, but it is available.
Health Insurers Consider A Caesarean-Section Pregnancy A Pre-Existing Condition Earlier this week, the Huffington Post’s Ryan Grim reported on the fact that in seven states plus the District of Columbia, “getting beaten up by your spouse is a pre-existing condition.” The insurance industry figures that if “you are in a marriage with someone who has beaten you in the past, you’re more likely to get beaten again than the average person and are therefore more expensive to insure,” but what it really does is punish these victims for something that wasn’t their fault. But that isn’t the only policy that health insurers have that primarily discriminate against women. First of all, most individual health insurance markets don’t cover maternity care. In fact, according to the Kaiser Family Foundation, only 14 states have a requirement for such coverage, and the number of plans without maternity coverage continues to rise dramatically. Why? Anthem Blue Cross — which has been actively fighting health care reform — considers pregnancy optional and therefore not necessary to insure: When a woman isn’t currently pregnant, she often still cannot get coverage. Many insurers consider a Caesarean-section pregnancy a pre-existing condition and refuse to cover women who have had the procedure. From a 2008 New York Times story about a Colorado woman who had Golden Rule Insurance:
That is absolutely disgusting and it is not true in Texas. Unbelievable. Covering maternity care on an individual policy in our current system is a terrible idea anyway. Pregnancy is incredibly expensive and they want to drop their plans after birth. It is mandated for employer sponsored plans however.
What's wrong with healthcare? For those of you still living in the city I spent over half my life in, Houston, ponder this... 1 in 3 adults who live in Harris County are uninsured. That is simply unacceptable. There is no excuse for it. None. Nada. Zilch. How anyone can claim our current system is the world standard of healthcare is beyond me. One would have to be delusional. Seriously delusional. Here is Houston, home of one of the, heck, arguably the best heathcare center in the world, the Houston Medical Center, where countless people from all over the planet come for care, those who can afford it or have help, and one third of adults have no insurance. Read it and weep. One in three Harris Co. adults uninsured, Census report says By MIKE SNYDER One in three adults in Harris County lacked health insurance in 2008 while Texas continued to have the highest rate of uninsured residents in the nation, the Census Bureau reported today. Harris County's overall uninsured rate of 27 percent was the seventh-highest among Texas' 50 most populous counties, according to data from the American Community Survey. The state uninsured rate was 24 percent. Other results from the survey, which covers a broad range of social, economic and demographic characteristics, showed continuing racial and ethnic diversity in the Houston area. Latinos represented a plurality of the population in Houston (43 percent) and Harris County (39 percent) while whites remained the majority in Montgomery County (74 percent) and Galveston County (60 percent.) Fort Bend County, one of the fastest-growing in the nation, had the highest percentage of Asian residents among Houston area counties at 15 percent. Questions about health insurance coverage were included in the survey for the first time last year. Previous estimates were based on other data that were less reliable, particularly at the county level, said Karl Eschbach, the state demographer. The new figures were released in the midst of an intense national debate over the first comprehensive health care reform effort in the United States in 16 years. Advocates for aggressive reform said the new figures demonstrate the need for health care legislation to include a public option or even a single-payer, “Medicare for all” system. They pointed out that uninsured rates for the elderly, most of whom are covered by Medicare, were just 2.7 percent in Texas and 3.8 percent in Harris County. “If we expanded Medicare to everybody, it would solve this problem,” said Ana M. Malinow, a Ben Taub Hospital pediatrician who is active in health care reform advocacy groups. But William Fleming, a Houston neurologist who is the president of the Texas Medical Association, said coverage doesn't necessarily equate to access to good care. Many doctors don't accept new patients covered by Medicare or Medicaid, the government system for the poor, he said. And the federal government projects that without changes in the Medicare system, its reimbursement rate to doctors will decline by 21 percent in January, Fleming said. “That's just not sustainable,” Fleming said. “I think we need to fix Medicare before we start any new government health care programs.” http://www.chron.com/disp/story.mpl/metropolitan/6629893.html
YO MAMA!!! Madame senator with the smackdown! via TPM -- Just before the Senate Finance Committee wrapped up for the long weekend, members debated one of Sen. Jon Kyl's (R-AZ) amendments, which would strike language defining which benefits employers are required to cover. Sen. Debbie Stabenow (D-MI) argued that insurers must be required to cover basic maternity care. (In several states there are no such requirements.) "I don't need maternity care," Kyl said. "So requiring that on my insurance policy is something that I don't need and will make the policy more expensive." Stabenow interrupted: "I think your mom probably did." The amendment was defeated, nine to 14.
Keep the government out of my bedroom! Well, unless I catch a cold, then it's my right for the government come on in and fondle my every orifice.
