Documents Reveal Anthem Blue Cross Manipulated Data to Justify Massive Rate Hike

[babylonsister]

Documents Reveal Anthem Blue Cross Manipulated Data to Justify Massive Rate Hike

Wednesday 24 February 2010

by: Jason Leopold, t r u t h o u t | Investigative Report


Internal documents show one of the country's largest for-profit health insurers, in an effort to maintain profits, manipulated data to justify a rate increase on individual premiums in California this year by as much as 39 percent.

At a closely watched Congressional hearing Wednesday, Rep. Henry Waxman, the Democratic chairman of the House Energy and Commerce Committee, blasted WellPoint Inc. executives for publicly stating that the country's economic turmoil and rising health care costs was the reason its Anthem Blue Cross subsidiary intended to move forward with a massive rate increase in California when the company's own documents say otherwise.

Waxman said the company "may have manipulated its actuarial assumptions to keep its medical loss ratio (MLR), a key measure reviewed by California regulators, 'flat.'"

"WellPoint says the rate increases are a result of medical inflation and healthier policyholders dropping coverage," Waxman (D-California) said. "But the thousands of pages of WellPoint documents we have reviewed tell another story ... WellPoint says that its rate increases have nothing to do with increasing company profits. But an internal company e-mail says that its rate increase would 'return CA to target profit of 7 percent.'"

more...

http://www.truthout.org/documents-reveal-anthem-blue-crosss-california-rate-hike-purely-profit-driven57159

[sakabatou]

1. Those BASTARDS.

[hobbit709]

2. The health insurance execs need to be shortened.

[Oceansaway]

3. K&R...n/t

[Vinca]

4. Remind me why single payer is off the table.

[Yurovsky]

16. Large briefcases full of campaign cash???

I imagine that played a part in shifting the debate away from the actual solution to our health care crisis...

[Foo Fighter]

23. No. That has nothing to do with it.

You see, the government has our best interests in mind when negotiating HCR and mandating we shell out money to insurance companies so that they can deny us coverage in any claim we might submit and...oh shit...yeah, I think you're right.

[drm604]

5. This is another argument for single payer.

If we try to solve the problems by regulating private insurers they cook the books. At a minimum they cook them right up to the line (and into any gray areas) of what's legal, and they're as creative about it as possible. That's at a minimum, they'll also go over the line any time they think they can get away with it.

Stemming that requires taxpayer money being spent on auditors to keep them honest. The insurers will spend large amounts of money to either fool or corrupt those auditors. It takes large amounts of tax dollars to attempt to counter that.

All of that money spent on a war of wits between insurers and regulators is money that could have instead gone to health care.

[Nikki Stone1]

15. YES. And notice that Congress is doing NOTHING about this

Did they mention Anthem at the Health Care summit? No....

[glinda]

24. Nothing will happen. No one will have to go to jail or change their ways. Our

biggest Energy Company in the State was found to have ripped off the Public and nothing was done there either.

[Trillo]

26. I beg to differ (or agree, whichever the case may be)

Congress is quite near to mandating we buy insurance from private insurance corporations, of which this company is one. So congress is doing a quite a lot....

[fasttense]

6. The free market at its best, slowly killing people through curable diseases for fun and profits. n/

[ThomWV]

7. Other than perjury, it really doesn't matter. They can charge whatever they want

And if they get a hair up their ass they can charge a surcharge on top of everything else - call it a management entertainment fee or something.

[babylonsister]

8. Is 'cooking the books' legal? Because that's what the committee

is charging.

[ThomWV]

9. Sure, if no books are required to be kept

The company can keep any books it requires for its own purpose. Now nobody is claiming accounting errors on their tax filings - that is a different thing. This is just an account they have thrown together to explain to the outside world why they do whatever it is they do with rates - which they are free to do anything they want with.

You see, if its not regulated then we have no say in what they do.

[elleng]

11. It is regulated by California.

That's how it goes, and that's why there's no anti-trust jeopardy. The States have to do their jobs, but they don't.

[ThomWV]

14. Is the fee structure regulated as a Public Services Commission might do ...

or we would expect a public insurance commission to do. If their fee structure is regulated then of course the books would have to reflect good numbers. But of the fees are not regulated then the company could keep good tabs on the astrological symbols of the CEO as a way to decide on how much they might charge and there's not much we could say about it and it would be immaterial if they had Leo in Aires or the other way around, accuracy just wouldn't matter.

[elleng]

18. Maybe; its hard to tell, which is what the company wants, of course.

'California law requires WellPoint, as well as other health insurers, to spend 70 percent of its premium costs on medical care.

According to the committee's investigation, "to meet this requirement, WellPoint reported to the California Department of Insurance that its anticipated medical loss ratios for each plan as of March 2010 ranged from 72.0% to 78.9%, with one outlier of 144.8%."

"One factor that can have a great impact on medical spending is the number of healthy people, who are relatively inexpensive to insure and chose to leave a particular plan. This is known as 'adverse selection,'" according to the committee's analysis of internal WellPoint documents.
"If a company projects that a large number of healthy people will exit a plan, the estimated spending on medical care for the remaining sicker population is expected to rise and result in a higher medical loss ratio," the committee's analysis concluded. >>>>

http://www.truthout.org/documents-reveal-anthem-blue-crosss-california-rate-hike-purely-profit-driven57159

[elleng]

10. If things work well, States will get off their asses

and do their jobs. I'm not betting on it.

[ThomCat]

12. And yet, Obama is determined to keep them at the core of Heath Care

in the U.S. :(

[bhcodem]

13. BC starting a new "risk Pool"

Visited with my Farm Bureau insurance agent yesterday on how to lower my premium from the anticipated 18% increase. He said that BC/BS was starting a new "risk Pool" and to qualify you need to be mostly problem free. I have surmised that if they move enough "Healthy" people from the current risk pool to the new pool, those left in the old pool will have even higher rate increases in the future because they will be less healthy and cost the company more money. It is really all a racket!

In the meantime, I increased my deductible by $500 for a savings of about $500 a year and have applied for the new risk pool to see if I qualify for the same coverage at a lower premium.

I'm just glad I am licensed as an insurance agent so I have enough background to really understand the various policy offerings. I am also thankful that by next year I will be old enough for Medicare---if it still exists!

[Kablooie]

17. A friend of mine had to decrease her Anthem benefits because of the rate hike but ...

She got the papers for her new more limited policy last week and it was completely wrong.
They mixed the whole thing up.

It starts in effect early next week and she's been calling and calling but there is no option to talk to a human.

She's completely trapped with no options available.



These executives should not just be fined, they should be executed.

[glinda]

25. That is scary because I am thinking about doing the same.

[eridani]

19. Oh, but after "reform" they would never DARE to juggle their medical loss ratios

--in order to hamstring regulators, now would they?

[renate]

20. k&r

I don't get why those stupid teabaggers don't demonstrate against this crap instead. Perhaps it's because they're a bit dim.... :eyes:

[slipslidingaway]

21. "Insurance companies ... provide a legitimate service..."

http://www.whitehouse.gov/the_press_office/remarks-by-the-president-to-a-joint-session-of-congress-on-health-care/

It does not matter that they have been caught with their hands in the cookie jar numerous times.

[donheld]

22. I'm shocked. SHOCKED i tell ya.

[democracy1st]

27. K & R

[Hissyspit]

28. kick nt

[voteearlyvoteoften]

29. Green Cross

Should be the name cause they like money so damn much