When Your Insurer Says You're No Longer Covered Firms Defend 'Rescissions' as Fraud Control

[laughingliberal]

Source: Washington Post

LOS ANGELES -- The untimely disappearance of Sally Marrari's medical coverage goes a long way toward explaining why insurance companies are cast as the villain in the health-care reform drama.

"They said I never mentioned I had a back problem," said Marrari, 52, whose coverage with Blue Cross was abruptly canceled in 2006 after a thyroid disorder, fluid in the heart and lupus were diagnosed. That left the Los Angeles woman with $25,000 in medical bills and the stigma of the company's claim that she had committed fraud by not listing on a health questionnaire "preexisting conditions" Marrari said she did not know she had.

By the time she filed a lawsuit in 2008, she also got a diagnosis of pancreatic cancer and her debts had swelled beyond $200,000. She was able to see a specialist by trading office visits for work on the doctor's 1969 Porsche at the garage she owns with her husband.

Read more: http://www.washingtonpost.com/wp-dyn/content/article/2009/09/07/AR2009090702455.html?hpid=topnews

---

Nothing we don't know here but the real kicker comes at the end of the article where a spokesperson for the Rand corporation states that if companies aren't compensated for taking higher risk patients they will continue to look for ways to unload them. She says Washington should subsidize insurers that take on higher risk patients. Why in the hell are we giving these blood suckers a place at the table?

[depakid]

1. "the real kicker comes at the end of the article..."

Which is EXACTLY the sort of propaganda we expect to see from the Post....

Never a straight up article without the RW spin.

[iamjoy]

25. I Thought The Same Thing

"You can ban rescission," Buntin said, "but what we really want is a system under which insurers' incentives are aligned with treating all of their patients well, whether they're sick or healthy."

Insurance companies have no incentive to treat their patients well, and I don't see that they ever will. Insurance companies make money by collecting premiums and lose money by paying claims. The incentive is to find a way to only cover the healthy people and to deny coverage for sick people. I don't see how that would change.

If we make insurance companies cover sick people, I do believe they will make good on their "threat" to make seeking care onerous. Like sure, we'll cover the radiation for your cancer - but only at a hospital a three hour drive away. Oh, I know there's a facility down the block that's in the network, but your coverage agreement says we have the authority to do this in case of a major illness. It's right there on Page 1,235.

Hey, sure, let's have the government subsidize insurance companies for taking on sick people, but then, we're going to penalize them for every covered person that dies. Yeah, their payments should be based on results - right?

[Tangerine LaBamba]

2. We're not giving them a place at the table -

We are not.

They own the table, and the house in which the table sits, and all the food and place settings and crystal and candlesticks and floral arrangements on the table.

They own the property on which the house in which the table sits.

They own the town in which the house sits.

They own the state in which the town exists.

They own the Congressional representatives from the state.

And they can do anything the hell they want to, because no one can tell them they can't..............................

[rambler_american]

15. Well put.

Made me think of George Carlin's rant on corporations controlling everything.

http://www.youtube.com/watch?v=hYIC0eZYEtI

[HEyHEY]

22. That's why we need to use government to take their table away and boot their asses out the door

[laughingliberal]

3. Notice the threat contained in these paragraphs. Bunch of thugs!

"They wouldn't be able to overtly kick you out, but that doesn't mean that they might not put, for example, more onerous preauthorization requirements on services that people who are at risk might need, and that might discourage you from re-enrolling next year," Buntin said.

She said one solution would be for Washington to subsidize insurers that take on higher-risk patients. The government does such "risk adjustment" for the private insurance provided through Medicare Advantage -- though Obama has called for ending those subsidies to finance reform.

"You can ban rescission," Buntin said, "but what we really want is a system under which insurers' incentives are aligned with treating all of their patients well, whether they're sick or healthy."

Why in the hell would anyone support keeping any part of this system. They engage in blatant blackmail and people report they are happy with their healthcare? Who are those people?


edited to correct spelling

[zeemike]

7. That is what I call getting to the heart of the matter.

And if we are to change things we must understand that reality.

oops this was intended as a reply to post #2

[beac]

16. "Who are those people?"

Healthy (and selfish and stupid) people who think it's dandy that they only pay $30 for checkup once a year.

Wait until they get sick and actually need health CARE...

[jeffbr]

4. Fucking leeches, thieves, and murderers

Get rid of them.

[strategery blunder]

5. If they want to deny care and allege fraud,

they had damn well PROVE fraud in a court of law.

Nothing like having your healthcare yanked because your insurance is accusing you of fraud, and you don't get a chance to defend yourself. :grr:

[laughingliberal]

9. In the current system, they hold all the cards

And THIS is the system the people fighting reform want to defend and protect. Just bizarre.

[strategery blunder]

10. I am well aware of that.

In the current system they just cancel the policy and leave you holding the bag--they don't even need to pay their attorneys for that. :grr:

I agree with you that courts are too friendly with insurance companies. It's perfectly possible for someone to not KNOW they have a medical condition when they apply for insurance, because they're untreated. How can there be fraud without that knowledge?

It will be interesting to watch the insurance companies come up with new excuses to defend recission if pre-existing conditions are eliminated. They would have no reason to rescind a policy because someone didn't disclose they had a condition they didn't know about if the insurer can't discriminate based on pre-existing conditions anyway--but I am sure that won't stop insurers from finding other excuses.

[ejpoeta]

21. here's the thing that gets me.... these people who are fighting reform....

in a few years when they end up without insurance due to costs increasing or getting sick... when more people are without insurance... who will they blame??? they will blame the GOVERNMENT for not doing something about the insurance companies. they will totally forget that THEY had an integral part in stopping anything getting done. they will blame obama and the democrats for not fixing it.

[naaman fletcher]

6. I don't get it..

IF she lied about a back problem and then made a claim for medical care on her back I could see her point. But.. one would think that her failure to list a back probelm (assuming that's even the case) would have nothing to do with the claims in question.

[laughingliberal]

8. It's a racket

There was that one woman on television who had her insurance cancelled the day before surgery for breast cancer because years earlier a dermatologist had noted some possible precancerous lesions on her face. Nothing that could possible be related to breast cancer and no proof he actually mentioned them to her. Took her 4 months of fighting which is a serious delay in cancer treatment. But there you have it. The best health care in the world-if you don't lose it the day before you're scheduled for surgery.

[tclambert]

11. The whole point of group medical insurance way back when

was that a group of people pooled their resources to make sure whichever members of the group lost the health lottery and got expensively sick would not go broke paying for medical care, and would not die because they couldn't afford the care they needed. That was inherently socialist. Private insurance companies thought of a way to make money off this socialist idea.

But in recent decades some things went wrong with this system.

Something like 60% of all personal bankruptcies result from medical costs, most of those for people WITH insurance. Studies found 18,000 Americans die every year because they can't get coverage, and another 80,000 die because their coverage doesn't cover enough.

This has happened because:

1) Employers actually pay for most group medical plans. And decades ago they started asking, "How can we save on these costs?" Well, that's simple. Create plans that don't cover as much. Higher deductibles, co-pays, managed health care (which exists solely to say no to treatments your doctor recommends), and lifetime caps on benefits came about to make EMPLOYERS happy.

2) Clever insurers figured out they could make more money by paying fewer claims. To cut their costs and increase profits, they devote significant mental resources to inventing reasons to NOT pay for medical treatments. Death and disability resulting from their perfectly legal activities get paid for by Social Security or life insurance. They are somebody else's costly problem,.

3) Clever insurers figured out that they could make more money if they didn't provide any coverage at all to people who were likely to become expensively ill. Bad health isn't always just bad luck. Insurance companies try hard to identify and exclude the higher risk people, like those with pre-existing conditions, or poor people who can't afford preventive care that the insurance doesn't cover anyway. Cut them off and you never face the flood of claims they would have produced.

[Aragorn]

18. what you left out

is that truly, under this system, too many people kicked costs way way up. Sometimes intentionally as with unneeded medical care. I'm not talking about the patients either - I mean most hospitals and some doctors. Insurance companies are greedy yes, but so are other people. And those who don't do this are often scapegoated for charging less!

[NJCher]

23. and, from another direction

The system prevents itself from a lot of good income--take young people, for example. They often won't spend for health insurance because they think their risk is so low. And in fact, it is. And then there are people like me. I come from a healthy family and have never had any health problems. About 13-14 years ago, when my coverage ended when I quit my job, I didn't take on health insurance because it was so expensive.

I have it now--but think of all the money I'd have contributed to the pool if it had been more reasonably priced. And I'd never have used it, either.

Cher

[subterranean]

29. It's not just the cost -- it's also the perceived value.

People read about practices like this and think, Why should I spend my money on something that may not be there when I need it?

[Vinca]

12. This, in a nutshell, is why we need single payer.

Big insurance only wants people who don't file claims. They dump high risk people off on the government or let them fend for themselves. Virtually everyone would have something in their background that big insurance might point to in order to avoid paying the bill. Take, for example, poison ivy. When I was a little kid I got a severe case and spent a summer getting injections to reduce the swelling. In a million years I wouldn't think to put that on an application, but that would be an orgasmic find for big insurance.

[Hassin Bin Sober]

27. A co-worker of mine was kicked off while his wife was preagnant....

Blue Cross dumped the whole family because the parents failed to mention a visit to a dermatologist for a minor skin birth defect on one of their other children - it was a mild blemish on the kid's arm the doctor recommended leaving alone because the child would grow out of it. It was one of those things you have looked at just to be safe.

[ScottLand]

13. This is sick.

[MannyGoldstein]

14. Obama Should Discuss This Case in His Speech

And bring Ms. Marrari up to the podium.

[customerserviceguy]

17. Nina Totenberg said something like that this weekend

on "Inside Washington". She said that if we do some sort of partial healthcare reform that requires private insurers to take people without pre-existing conditions, etc., in a year, they'll come back to Congress begging for a public option. It fits in with what I've said all along, public option is going to end up as a dumping ground for everybody the private insurers find too expensive.

Now, it's even worse if we have a "trigger" option. The private insurance companies are then in the driver's seat as to whether or not we get one, and you can bet that if they've penciled it out, they will do whatever is necessary to pull that trigger. Of course, that means one last feeding frenzy on the premiums, and the public will link their jacked up premiums with a crappy law that did this to them.

Anything less that a full public option, or better yet, single payer, is a legislative disaster for us. In fact, if we do nothing this year, we simply make sure there are more Sally Marari's out there who will be willing to back single payer when we can bring it up again in 2011 or 2013.

I'm not into letting the perfect be the enemy of the good, but I am in favor of letting the good be the enemy of the seriously flawed.

[demwing]

19. So its fine for the Government to subsidize Insurers

or any variety of business or corporation, but when the Government subsidizes the insured, or any private citizen through any given support system, it's suddenly demonized and called Socialism.

We live in a fucked up world run by insane sociopaths, and ultimately we live to serve their needs. We might as well be farm animals.

[Cass]

20. We owe this slimeball industry NOTHING.

Now they want government compensation for high risk patients so they can max out their already obscene profits...that's chutzpah. Screw them. They had the chance to do the right thing but they blew it. We owe them nothing.

[tabatha]

28. Yep, advocating against government healthcare

yet, wanting government compensation.

Sick beyond sick.

[tjwash]

24. Fucking blue cross...

Sleaziest piece of shit company there is, and in an industry dominated by sleazy pieces of shit, that's no easy task to accomplish.

They fucked me more than once on the exact same stuff that article is talking about. :argh:

[Piewhacket]

26. Dear Health Ins Companies: You are soooo &*^$%#### RESCINDED!!!

[MountainLaurel]

30. Saw that in the Post

And was screaming "Horseshit, fraud control my ass" at the computer monitor.

[Zorra]

31. They're gonna see some real fraud control when we pass a plan with a public option.

They'll actually have to become honest businesses providing quality services in order to compete.

[bemildred]

32. What is fraud is taking the money and not providing the coverage. nt