Health insurer rewards dropping sick policyholders.
By on Nov 9th, 2007 at 3:17 pm
Health insurer rewards dropping sick policyholders.
Woodland Hills-based Health Net Inc., one of the largest health insurers in California, “set goals and paid bonuses” for employees “based in part on how many individual policyholders were dropped and how much money was saved.” Between 2000 and 2006, the company “avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies” while paying “its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies.”
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Gives you a warm feeling inside, doesn’t it?
November 9th, 2007 at 3:18 pmSee? Let the free market do its work! Everything will be all right!
November 9th, 2007 at 3:22 pmFirst rule of insurance…deny all claims. That saves a lot of money for bonuses to CEOs.
Second rule…have a bunch of lawyers draw up contracts that can be only changed by the insurer. Then change the terms in mid-stream.
Third rule…make reimbursement look easy at signing & impossible at collection.
Fourth rule…raise rates for anyone with claims.
Fifth rule…drop anyone who has more than one claim.
Now, on to credit card companies…
November 9th, 2007 at 3:24 pmNope, no need for universal healthcare. The insurance industry just might change the name to healthycare but that’s what free markets do.
November 9th, 2007 at 3:24 pmSup prime and now health insurance and money to come. There is a long list of crimes that have taken place since Bush/Cheney stole the Oval Office. Look for more to come because the list is very long.
November 9th, 2007 at 3:25 pmhow many individual policyholders were dropped and how much money was saved
Efficiency at work.
November 9th, 2007 at 3:29 pmWait a minute, you can not make a profit unless you weed out the sick people. Take the money from people who do not cause increased costs. Does not matter whether they lie or mistakenly fail to disclose relevant information. That way you get their payments. Wait until the the insured starts costing money. Then you can cancel their insurance and deny them future care. Also, you can always find some mistake on the insured’s part that would have caused you to deny a policy had proper disclosure been made.
November 9th, 2007 at 3:29 pmSee Michael Moore has been proved correct, and single-payer health care must be enacted, and health insurance industry cut out of the system entirely. Bravo to Kucinich because he is the only Democrat running for President who advocates single-payer system for everyone. He will get more votes now and Hillary is a dead dog.
November 9th, 2007 at 3:29 pmWelcome to America
You are either a “Winner” or a “Loser”. Plain and simple and get what you deserve.
If you don’t / can’t / or had insurance it’s your own fault. Just die and go away please is what happens.
The Corpratists Congress will never support changing the health care system to a single payer system.
So keep handing out those Bonuses – Heck of a Job Brownie!
November 9th, 2007 at 3:32 pmWelcome to the American Way! Now all that we need to do is keep on making sure that people do their truly patriotic duty of buying bigger cars and idling them in their driveways, as it is way too cold out! (not), or using them to drive 3 blocks.
November 9th, 2007 at 3:36 pmI guess I’m going to have to be the bad guy on this…
As someone that has a LOT of industry experience with Health Insurance, this is not the evil that it initially appears to be.
From the article: “set goals and paid bonuses†for employees “based in part on how many individual policyholders were dropped and how much money was saved.â€
Well, this was for the cancellations department. What better metric can you possible use to assess an employees contribution than their closure rate?
How else are you going to set goals for that department?
November 9th, 2007 at 3:40 pmWell, this was for the cancellations department. What better metric can you possible use to assess an employees contribution than their closure rate?
How else are you going to set goals for that department?
Comment by deebaser — November 9, 2007 @ 3:40 pm
well, you are indeed the bad guy. The cancellation department? How nice.
November 9th, 2007 at 3:43 pmAnd we can always count on TCDon for a completely insipid and useless post.
Apparently, the fact that the current government contracts-out the operation of government health care programs is “proof that government run programs are subject to fraud and abuse”.
That straw man is a little thin, don’t you think? Better stick a few more handfuls of straw in his flannel shirt.
Oh, I see you’ve indicted the CEO for donating to Democratic candidates! That ought to fill out the arms a little.
Nope… still too thin. Got any more straw there, TCD?
November 9th, 2007 at 3:50 pmAlso, you can always find some mistake on the insured’s part that would have caused you to deny a policy had proper disclosure been made.
Comment by JMOHR — November 9, 2007 @ 3:29 pm
—-
No, you really can’t. There are guidelines. I’m not familiar with California’s Dept of Insurance, but in NY, those guys are scary as hell. The company will put its toe up to the line, but will NEVER break the rules outright.
This allows for some pretty (i can’t even think of an adjective that will pass the language filter) behavoir on the part of the insurance company, but 99 times out of 100 they comply completely with the law as written.
CA appears to be one of those messed up states that allows Medical underwriting. If you’re sick and you need health insurance there is a very compelling reason to lie to lower your rate or even qualify. This department appears to be the one charged with weeding out the liars.
Yeah, it’s totally messed up that you can’t get individual coverage if you’re sick, but place the blame where it belongs. Insurance Companies aren’t charities. They’re at best amoral companies. If they’re paying $3000 out a month on a $100 premium, they’re going to have SOMEONE look into whether this policy should have been written in the first place.
November 9th, 2007 at 3:50 pmSay TeensypeensyDon – how many big donors to the ReTHUGlic Party are under indictment – or in JAIL…?
My my.
November 9th, 2007 at 3:50 pmEvery movie Michael Moore makes and gets trashed for gets proven to be correct over time. Granted, the health issues are easily shown to be correct as this story shows. Still, when the right wing screams about a Michael Moore film, the more we should pay attention to it.
November 9th, 2007 at 3:51 pmDon’t need to extend SCHIP though. Free market will provide all the affordable insurance people need.
Isn’t there some special prison we can send these people to. Preferably something right outof Dickens.
November 9th, 2007 at 3:53 pmYou have to understand. Private insurance companies aren’t in the business of insuring people, they’re in the business of making money. That’s a fiduciary obligation to their stockholders. Finding out new ways to not pay settlements, and getting rid of people that might cost them money, is good bidness practise.
That’s why public insurance that actually is set up to evaluate proper risks and rates (rather than finagle the “risks” by tossing out the “bad bets”), provide coverage to avoid people getting ruined by catastrophic expenses, and afford coverage to all as a public service (and to do so as efficiently and with as little overhead, much less profit, as possible), is such a threat. If we had that, rather than big corporations trying to make as much money for as little as they can, then these companies would be out of business and that’s bad for the stockholders … and bad for Amur’kah.
Cheers,
November 9th, 2007 at 3:53 pmI said:
If we had that, rather than big corporations trying to make as much money for as little as they can, then these companies would be out of business and that’s bad for the stockholders … and bad for Amur’kah.
Put another way, the more money insurance companies make, the poorer deal we the “customers” are getting.
Cheers,
November 9th, 2007 at 3:55 pmBest medical care in the world? Sure, as long as you’re rich enough to pay for it after your insurance company declines to keep covering you because you actually need health care.
November 9th, 2007 at 3:57 pmHealthNet manages Medicare, Medicaid and TRICARE and Veterans Affairs programs. If anything, this is proof that government run programs are subject to fraud and abuse.
——-
Actually, these are PRIVATIZED versions of government run programs. So the point could be made that privitization doesn’t work and is often subject to fraud.
Although, that is still inaccurate because the Medicare Advantage plans are given to these companies on a Cost + basis.
November 9th, 2007 at 3:59 pmBack in the late eighties and very early nineties–some large banks would have these elaborate incentive programs to have tellers steer their customers to use the ATMs–Then they fired half the tellers once people got into the habit of doing most of their banking through the machines. Basically, the people ‘incentived’ themselves out of jobs. What will become of the insurance agent after a few years of getting bonuses for screwing over his customers? Exactly–he’ll be downsized because there won’t be as many policies to handle. Go to town boys–just don’t cry when the axe falls and you find yourself out of work– with no insurance, to boot.
November 9th, 2007 at 4:02 pmWhy does RHF hate facts?
Comment by TCDon — November 9, 2007 @ 3:58 pm
When did you post any that were actaully relevant to the discussion? All I saw was your usual deflection and bullshit. If the government ran the program, no greedy CEO, Dem or Repig, could get his hooks into it. How did you get to be so stupid? Do you practice?
November 9th, 2007 at 4:02 pmDeebaser (comment #10),
You are indeed playing the bad guy. The very existence of a “cancellations department” at a health insurer is the nature of the problem.
Providing health insurance and making a profit are mutually exclusive – you cannot maximize both. Health insurance is differenent than any other type of insurance as it is required for “life, liberty and the pursuit of happiness.” Health insurance is a public necessity, much like the police, the military and the fire deparment. We don’t leave those necessities to “the market” for obvious reasons. Stories like this one show why we can’t leave health insurance to “the market” to sort out either.
This is why any health insurance reform that leaves the private, profit driven insurance industry in tact will never solve the problems the industry has (cancellations, refusal to cover, declining of benefits, out of control premiums, etc.).
The best and only workable solution (from a public policy AND economic sense) is a not-for-profit single payer system where private insurers are heavily regulated or (even better) eliminated.
November 9th, 2007 at 4:02 pmTampon Don is a little self-absorbed today, please excuse him; he’s administrating.
November 9th, 2007 at 4:03 pmAgain, TeensyPeensyDon – when has it become a crime to donate money to a political candidate…?
*DO* tell.
November 9th, 2007 at 4:10 pmPerhaps we should have a little chat with Frankenfreddie about the drug lord who was running *his* campaign, eh…?
November 9th, 2007 at 4:11 pmFor Profit.
November 9th, 2007 at 4:14 pmOh, you mean because there are SO MANY Republican scandals…?
Well, alrighty then.
November 9th, 2007 at 4:15 pmDeebaser (comment #10),
You are indeed playing the bad guy. The very existence of a “cancellations department†at a health insurer is the nature of the problem.
—-
Agreed, but point the finger at the right target. The insurance company is only using a legal tool at its disposal “medical underwriting”. If you lie and cheat, they are allowed to kick you to the curb. If they didn’t have a cancellations department, only the stupid would actually be honest on their medical histories and the premiums for everyone would go up significantly.
Medical underwriting for individual policies is abhorrent. Blame Sacramento. They let these companies do it. Don’t blame HealthNet for tracking fraud.
November 9th, 2007 at 4:15 pmNo RHF, you have the facts wrong again. Jay Gellert began giving money to Democrats long before 2006. The link I gave you only showed some from 2006 forward. You can find the rest elsewhere.
How many hours a day do they give you to blog in your penitentiary RHF? Or are you on house arrest now?
Comment by TCDon — November 9, 2007 @ 4:06 pm
You’re one lazy liar, donny, and this is not a Democratic scandal by any means. this is a capitalistic scandal, ascandal of greed and selfishness, thus a Republican scandal. You are willfully stupid today (like every other day).
November 9th, 2007 at 4:16 pmEvery time TCDon posts, I’m tempted to declare him the supidest troll on this forum.
Fortunately for him, someone else like michael or sh!ts or O. Bigmouth will come along and challenge him for the title again, thus keeping his stupidity reflexes sharp.
For sheer obstuseness and missing the point, however, you can’t beat TCDon.
November 9th, 2007 at 4:21 pmThat’s the thing you seem to keep missing, TeensyPeensy – we here would be pissed off by ANY scandal like this, no matter *who* was in charge.
Unlike you Rethuglicans, who excuse anything, up to and including murder, done by other Rethuglicans, we don’t excuse Democratic scandals.
And frankly, Donnyboy, it’s going to take a whole lot more than just YOUR word to convince me that this is indeed a “Democrat scandal.” You see, you have NO cred here.
Furthermore, I’d be willing to stake a large sum that this particular CEO has ALSO donated to Rethugs. They all do.
But I guess that’s different, eh? IOKIYAR.
November 9th, 2007 at 4:22 pmCompassionate Conservative thinking at it’s lowest, this is exactly why we need to put these insurance companies out of business, the for profit in Healthcare is a BAD idea, very BAD.
Now for something really stupid -
“ANY comment by TCDonkeyass” – you always suck, it’s your style.
Buck Fush
November 9th, 2007 at 4:26 pmExcellent idea, buckie, piut those legalized thieves out of business. they’re as bad as the tobacco murderers. they’re not as bad as Bushco, but only because they haven’t tried hard enough.
November 9th, 2007 at 4:29 pmThey are trying to kill us aren’t they?
November 9th, 2007 at 4:34 pmSo what, Teensypeensy?
What would you like me to do about it? Call him a scumbag?
OK. He’s a scumbag.
There. Happy now, asswipe?
November 9th, 2007 at 4:36 pmTell ya what, Teensypeensy – now it’s your turn.
Howsabout you post a list of all the big Rethuglic donors who are under indictment – or in jail…?
I’ll wait.
November 9th, 2007 at 4:37 pmhttp://www.newsmeat.com/ fec/ bystate_detail.php?st=CA&last=Gellert&first=Jay
Comment by TCDon — November 9, 2007 @ 4:31 pm
and the whole thing proves our point, dumbdonny: privatization of health insurance is bad. anything else to offer, you socialist lefty, you?
November 9th, 2007 at 4:38 pmI feel like an automobile thats had too many crashes…
November 9th, 2007 at 4:38 pmBut then, I understand that they cannot report on one of their own big funders. Comment by TCDon
”You mean this?:
Richard M. Scrushy, the ousted former chairman and chief executive of HealthSouth Corp., repeatedly invoked his Fifth Amendment right to silence as he made his first public appearance since a $2.5 billion accounting scandal engulfed the health-care company he founded.
Soros appears to have turned it around:
November 9th, 2007 at 4:48 pm
Nice try TCDon, it was Scrushy that pulled an Enron on the company he founded.
November 9th, 2007 at 4:49 pmWell for the Record, the FAKE ATTORNEY is one stupid little girl! That explains why Aphrodite is now pretending to be a man this time.
Comment by republicans hate facts
Our nutty nut nut is back?
November 9th, 2007 at 4:55 pmdeebaser: “As someone that has a LOT of industry experience with Health Insurance, this is not the evil that it initially appears to be.”
As Upton Sinclair said, “it’s hard to get someone to agree with something when their paycheck depends upon disagreeing.”
November 9th, 2007 at 5:04 pmWhile the debate over the health care crisis in America remains focused on the expansion of S-CHIP and the competing proposals of the 2008 presidential candidates, a new study revealed the continuing and steady decline of employer-based health coverage in the United States. Once the lynchpin of the U.S. health care system, workplace health insurance now covers only 59.7% of Americans, down from 64.2% in 2000. And making matters worse, surging health care costs, insurance premiums and employees’ own contributions continue to exceed inflation and the growth in wages.
For details, see:
November 9th, 2007 at 5:08 pm“Employer-Provided Health Coverage Continues to Decline.”
If anybody died then she and the corporation should, must, face murder charges!
November 9th, 2007 at 5:18 pmShe an dthe corporation should and must face MURDER CHARGES if anybody died!
November 9th, 2007 at 5:20 pmDeebaser: Stop trying to defend the insurance industry. My background is a little different. Defending insurance companies like Anthem for its little regulatory problems.
The insurance companies pay for and receive value for the lobbying exerted on state legislatures and the federal government, I have testified before legislative and administrative bodies to influence statutes and regulations on belhalf of my clients. I can assure you that we had excellent access due to the amount of campaign contributions provided to the people’s representatives through our various trade associations. Consumer groups did not have nearly the same access. They also generally had little hearing time as compared to the health care business interests.
The lobbying and legal talent usually meant that the frontiers would be pushed in terms of the conduct that the insurance companies could get away with. The idea was to push the limits as far as possible before there would be a public backlash because the rules were being stretched too far. It is also an incremental process so that the companies push a little further each year.
Do not say its the legislatures fault. It is a systemic problem caused because the health care industry has so much money that it can buy far too much influence. The insurance companies, in large part wrote the laws and know exactly what they can get away with without violating the law. The money needs to be removed from the system.
Yes, I do fault the metric used for the departmenet. It should not be the number of policies revoked, it should be the quality of review and the number policies reviewed. The emphasis on the number of policies revoked and the amount of money saved indicates that the process is being used as a money making center.
By the way, I bet that there is no feed back mechanism to judge the quality of initial underwriting .
In either event, special interest money plays far too important a role. I dislike insurance and other industry insiders who always blame it on the legislature while placing a heavy thumb on the scales.
November 9th, 2007 at 5:31 pmAll those 80’s MBAs had to do something to make a buck. Stealing from the sick and the elderly was a natural choice.
November 9th, 2007 at 5:52 pmJMOHR, spot-on.
Public funding of all federal elections and mandated TV time for candidates and issues would neuter the political power of these corporations overnight.
The biggest challenge is that every four years the corporations running our media make about $40 billion off of political advertising.
November 9th, 2007 at 5:57 pmWhadda ya expect in Facist America????!!! Corp’s are running the show people!!! Get a clue!!! It’s FACISM!!!!
November 9th, 2007 at 8:32 pmInsurance Companies aren’t charities. They’re at best amoral companies. If they’re paying $3000 out a month on a $100 premium, they’re going to have SOMEONE look into whether this policy should have been written in the first place.
Comment by deebaser — November 9, 2007 @ 3:50 pm
—————
One big reason why “health insurance” is a sham. You only keep it if you don’t need it. In order to get it, you must be healthy as a horse. As soon as you get sick, you lose it; and yet, Americans pay twice as much per capita for healthcare than other industrialized nations.
It has to change!
November 9th, 2007 at 8:48 pmwhat happened to “TCDon”?
donnie – quitters never win and winners never quit!
November 9th, 2007 at 9:22 pmIsn’t there some special prison we can send these people to. Preferably something right outof Dickens.
Comment by crick — November 9, 2007 @ 3:53 pm
The joke about the three people who came to St. Peter at the Pearly Gates:
A doctor, a nurse, and an HMO CEO allarrived at the same time at the Pearly Gates. St. Peter informed them that due to a rule change, each would be required to step forward and say why he/she was worthy of admission to Heaven.
The Nurse stepped forward first. “I saved thousands of lives over my career. I also volunteered at my kids’ school at taught CPR at the community center in the evenings.”
“You may enter,” replied St. Pete, “Next?”
The Doctor stepped forward next. “After 15 yeard of working in an inner-city ER, I joined Doctors Without Borders. I served in Dharfur and Somalia and helped save lives among those who needed it most.”
“You may enter,” replied the Saint, “And you, sir?”
The HMO CEO stepped forward. “I helped develop the concept of Managed Care in America, which helps distribute health care in the most efficient way possible, and allows my stockholders to make a great profit on their investment, thus improving the quality of their lives. I helped save billions of dollars that would have toerwise been spent on unnecessary procedures.”
“You, too may enter,” replied St. Peter, “But you may only stay one night.”
November 9th, 2007 at 10:00 pmShameless, and sick.
November 10th, 2007 at 2:51 pmWow, only $20,000 in bonuses, when they save the company over $35 million? The adjusters are the ones dealing with the angry public when they have to face them and screw them over and they only get $20,000, whereas the fat cats on the Board who sit back and make money with money are even screwing the screwers.
November 10th, 2007 at 6:37 pmWell, hey, that’s capitalized medicine for ya!
November 11th, 2007 at 5:39 amOnly in Bushworld ….
November 11th, 2007 at 3:52 pm