California insurers accused of denying benefits

[question everything]

Thursday, March 31, 2005

California insurers accused of denying benefits

Proposed class-action suit names several major health plans and says they withheld payments for emergency-room care.

Reuters

Major insurers in California face a proposed class action from policyholders who say the insurers "systematically" refused to pay for emergency- room treatment covered in their policies.

The lawsuit, filed Monday in Los Angeles Superior Court, also says the insurance companies let hospitals overbill subscribers for services they illegally failed to cover.

The suit centers on when and how much insurers must pay in cases in which third- party insurance, such as automobile or homeowner policies, are used to cover emergency medical bills.

(snip)

The lawsuit, filed by Burlingame law firm Cotchett, Pitre, Simon & McCarthy, names WellPoint Health Networks Inc., Blue Cross of California, Blue Shield of California, Cigna Healthcare of California Inc., PacifiCare of California Inc., AET Healthcare Plan of California Inc., Aetna Health of California Inc., Health Net of California Inc. and Kaiser Foundation Health Plan.

More..
http://www.ocregister.com/ocr/2005/03/31/sections/business/oc_region/article_463056.php

[havocmom]

1. Even those paying for health insurance are finding they really don't have

health insurance. Let the revolt against insurance begin.

edited to add: And some states are now considering making health insurance MANDITORY!?! Wow, gotta pay for those campaign contributions, huh? They won't insist on a living minimum wage but some will consider INSISTING people buy insurance they can't afford and which really will not help them in too many cases.

[bemildred]

2. I stopped giving these dishonest swine money.

You can too. Nothing much happens except you pay as you go.

[depakid]

5. Unfortunately, when you do that

you end up having to pay what are called "charges."

Charges are the rates that hospitals would like everyone to pay- and they're set by beancounters who look at all sorts of financial statistics.

Large third party payers don't pay "charges." Because they "buy" in volume, they get a significant discount.

You can see the same thing at work with collective bargaining. Members of labor unions get better wages and benefits through pooling their resources. One individual has little 'clout.'

Your insurer is, in essense, your collective bargainer. Whether its a good deal or not to be part of their pool depends very much on your individual circumstances- and how much you're willing to bet that you get sick or injured.

[bemildred]

7. There are plans that get you negotiated rates, I have one.

They are much cheaper than "insurance".

[solinvictus]

3. No great surprise..

I used to work in health insurance and it was common knowledge that many claims were intentionally denied during either system problems or due to institutional incompentence. I agree with the lawsuit, you shouldn't have so many problems with insurers after paying these huge premiums. But, as I've always said, insurance companies get rich from CASHING checks, not writing them.

[DBoon]

4. Health care should be a social benefit

Using insurance in lieu of what should be a universal benefit program is idiotic.

Insurance is all about manging risks. Insurance is a miserable vehicle for providing universal benefits.

[Commie Pinko Dirtbag]

6. Why did the movoe "The Incredibles" suddenly pop in my mind? (nt)