Anyone who thinks private insurers can be part of the solution needs to read this report.

[PA Democrat]

http://hcfan.3cdn.net/48b73f19dac6bc9fa7_vzm6iijoh.pdf

The 41 page report documents thousands of cases of obscene abuse by health insurance companies. They regularly cheat people out of coverage to which they are contractually entitled because they often get away with it and at worst pay an inconsequential fine. Individuals are losing their lives and being forced into bankruptcy because of the corrupt behavior of these companies. We as taxpayers foot the bill for the governmental agencies and courts trying to keep these crooks honest.

Just a few excerpts from the report by Health Care for America Now (HCAN):

• It would be hard for PacifiCare, a subsidiary of UnitedHealth Group Inc., to argue that 133,000 mishandled claims were just a mistake. For the violations, California regulators hit the company with a record $3.5 million fine – a penalty that may ultimately reach $1.3 billion when an investigation is completed. The laundry list of alleged health insurance misdeeds: wrongfully denying covered claims, failing to properly manage provider networks, making incorrect payments, making multiple requests for previously provided documentation, and so on. Here’s some of the damage, courtesy of the Sacramento Bee: A surgeon was blocked from scheduling surgeries for six months; more than 200 patients of a pediatrician were told he wasn’t in the insurer’s network anymore; a father fought for 11 months to get claims paid for his autistic child while his wife put off heart-stress tests.
o "PacifiCare fined record $3.5 million," by Gilbert Chan, Sacramento Bee, January 30, 2008 (www.sacbee.com/103/story/672192.html)

• An Oregon woman who complained to the state after PacifiCare Life Assurance Company, a subsidiary of UnitedHealth Group Inc., denied six of her seven medical claims, helped launch a state investigation that overturned nearly 5,000 other claim denials. Regulators fined PacifiCare $46,000 for failing to conduct reasonable investigations before denying claims, making policyholders with pre-existing conditions wait more than six months for coverage of those conditions, and for failing to act promptly on a claim. As a result of the investigation, PacifiCare reviewed more than 10,000 denied claims and determined it should have paid 4,928 of them. It also discovered that it erred in denying some claims involving pre-existing conditions.
o “Insurer fined for improperly denying health claims,” Press Release, Insurance Division, Department of Consumer & Business Services of Oregon, December 30, 2008 (www.oregon.gov/DCBS/docs/news_releases/2008/nr_ins_12_30_08.pdf)

• According to the Los Angeles Times, California’s Health Net Inc. “avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006.” This secret came out when a hairdresser fought back after Health Net dropped her during her chemotherapy. Now, California is investigating the state’s top health plans – and finding that Health Net wasn’t the only one ripping up people’s policies.
o “Health insurer tied bonuses to dropping sick policyholders," Los Angeles Times, Lisa Girion, November 9, 2007 (www.latimes.com/business/la-fi-insure9nov09,0,4409342.story?track= mostviewed-storylevel)

• On March 25, 2009 a class action lawsuit was filed in the federal court in California alleging that WellPoint Inc., owner of Blue Cross Blue Shield franchises in 14 states, engaged in a conspiracy with other health insurers to underpay physicians for out-of-network services, with financial consequences to both physicians and their patients. Similar lawsuits were filed against Aetna Inc. and Cigna Corp. in February 2009. The three lawsuits allege a conspiracy with Ingenix, a division of UnitedHealth Group Inc., to fix prices and set artificially low prices to be paid to non-participating physicians. The lawsuits followed an investigation by New York Attorney General Andrew Cuomo demonstrating intentional rigging of the Ingenix database to shortchange reimbursements. The American Medical Association, California Medical Association, Connecticut State Medical Society and Medical Association of Georgia have joined the WellPoint actions.

• Anthem Blue Cross, California’s largest for-profit health insurer, agreed to pay a $1-million fine and offer new coverage—no questions asked—to 2,330 people it dropped after they submitted bills for expensive medical care. As part of a deal that the California Department of Insurance, Anthem also offered to reimburse those people for medical expenses that they paid out of pocket after they were dropped. The company, a subsidiary of Indianapolis-based WellPoint Inc., estimated that those reimbursements could reach $14 million.
o “Anthem Blue Cross agrees to take back clients, pay $1-million fine,” Lisa Girion, Los Angeles Times, February 11, 2009 (www.latimes.com/news/local/la-fi-bluecross11-2009feb11,0,5806275.story)

• California insurance regulators reached an agreement with insurer Blue Shield to provide new health coverage to 678 consumers whose policies were improperly canceled. The settlement resolved a 2007 lawsuit filed by the state insurance commissioner after Blue Shield rescinded policies over a five-year period that ended in May 2008. The deal requires Blue Shield to reimburse the consumers for medical expenses incurred because of the cancellations. The insurer also was required to change its underwriting and claims practices and set up a third-party review process to rule on future policy rescissions.
o “Calif. reaches settlement with Blue Shield,” Samantha Young, The Associated Press State & Local Wire, January 7, 2009 (http://cbs5.com/business/blue.shield.settlement.2.901688.html)

• One of California’s largest health insurers reached a $25 million agreement with regulators in an effort to right the wrong of canceling coverage for nearly 1,000 policyholders when they tried to make use of their policies. Health Net Inc. agreed to offer new coverage to 926 customers who were illegally dropped from individual or family policies since 2004.
o “Health Net, state reach $25M settlement,” Long Beach Press-Telegram, September 13, 2008 (http://nl.newsbank.com/nl-search/we/Archives?p_product=LB&p_theme=lb&p_action=search&p_maxdocs=200&p_topdoc=1&p_text_direct-0=1232F15675B23358&p_field_direct-0=document_id&p_perpage=10&p_sort=YMD_date:D&s_trackval=GooglePM)

[MrModerate]

1. They are wicked and incompetent shits, no question. However . . .

Private insurance -- for "extras" -- exists in most if not all countries with single-payer systems. And that's perfectly OK. No system is going to cover all medical procedures that people might ask for, and funding such procedures through insurance works pretty well in such countries.

Perhaps if all of America's health care CEOs and their legions of toadies were banned from the industry, it could be effective in the US.

[PA Democrat]

7. There is such a widespread culture of corruption in the US insurance industry.

I don't think it is tolerated in other countries like it is here. In almost every country with universal health care, it is non-profit. I believe the Netherlands a few years ago starting allowing for-profit health insurance and I have heard that it is not working out too well.

[MrModerate]

17. In Australia, where I am now, it's a mix of for-profit and non-profit insurors . . .

And the system works fairly well. However, since Medicare was introduced in 1984 (looooong before I got here), the private insurance industry has not grown to the size and influence of such companies in the US. Also, Aussie culture would probably be opposed to the creation of platinum-plated healthcare CEOs in short order.

[RandomThoughts]

2. There should be more then monetary penalties.

When the only penalty is money it is just another business equation. When their is manslaughter charges in cases of gross negligence, then their are societal consequences.

[hobbit709]

3. Instead of fining them, they should lock up a few CEO's.

I bet most of this crap would cease if a couple of those bean counter types spend a little time in a cross-bar hilton.

[PA Democrat]

4. Many of the people who are supposed to regulate the insurance companies

are former insurance company executives or lobbyists. The State Attorney General of Connecticut got involved in insurance fraud after the state's insurance commissioner failed to take any type of meaningful action to punish blatant wrongdoing.

... And then there was the state of CT (Connecticut) Department Of Insurance Commissioner Susan Cogswell who defiantly refused to investigate and refused all cooperation indicating that there was no such insurance companies frauds or corruption in her agency or state. She was obviously proven repeatedly upon repeatedly to be dead wrong. In spite of the fact that investigations by the Connecticut State Attorney General proved her wrong in this regard on many fronts and in spite of her misplaced arrogance when her agency holds the responsibility to protect Connecticut’s citizens from just such Insurance companies practices, now more than 1 year later, It is truly unbelievable that Cogswell is still CT's Insurance Commissioner. This speaks volumes for the ethics and disgraceful state of Connecticut's top political government officials ... not only for Insurance Commissioner Cogswell, who if she did not resign, should have been fired, but also for the former Lieutenant Governor M. Jodi Rell who replaced CT Governor John Rowland (Rell took over the Governor's post when Rowland had to resign in mid 2004 amid scandal facing charges of corruption and impeachment). Rell indicated upon temporarily filling the office that she would clean up the corruption in CT's government and her office ... appears to be nothing more than political rhetoric as no action appears to have been taken to clean up the corruption. With what appears to be corruption as usual in Connecticut, guess there's good reason for it being the insurance capital of the world? (Note: On April 18, 2007 Thomas R Sullivan was newly appointed as the CT Insurance Commissioner replacing Susan F Cogswell who was previously asked by Governor Jodi Rell to resign on December 12, 2006 ... and assumed the post of Deputy Insurance Commissioner).

http://www.badfaithinsurance.org/9000a.htm`

Cogswell's former employer? The Traveler's Indemnity Co.

[havocmom]

24. EXACTLY!

When it is just $$ at risk, they will play the odds against getting caught/fined. If they were likely to end up in a cell with a violent offender, they might think twice

[PA Democrat]

25. Yep, the fines certainly don't come out of their pockets either.

They still get their obscene salaries and bonuses and golden parachutes regardless of their actions. This guy's photo should be his mugshot:




Details: An Stephen Hemsley - UnitedHealth Group

Total Compensation: $3,241,042

An $895 million class-action lawsuit over stock-option back dating aside, Hemsley still manages to make the cut for this list at No. 10. The UHG CEO's base salary was $1.3 million in 2008, to go along with a non-equity incentive plan compensation worth just over $1.8 million and "other compensation" amounting to slightly more than $119,000.

Hemsley's other compensation was a combination of the company matching his contributions under the 401(k) plan and the company matching contributions under his executive savings plan. According to the SEC, "in May 2006, the amount of Hemsley's supplemental retirement benefit was frozen based on his current age and average base salary and converted into a lump sum of $10,703,229." Because of this, "there was no increase in the benefit payable to Mr. Hemsley under his supplemental retirement benefit" in 2008.



Read more: http://www.fiercehealthcare.com/story/unitedhealth-groups-stephen-hemsley-ceo-compensation/2009-05-14#ixzz0PwebhQQQ

[OHdem10]

5. The economy is in such bad shape, no party including Democratic

Party is willing to do anything that would cause some Insurance
Companies to go out of business. This is the only rational
explanation I can come up with at this time.

Furthermore, from the time of Regan until now, the Conservative
Economic Fundamentalism has dominated our government and our
party has been right there voting the Conservative Policies.

A serious result of all this is the governing of the country
really lies in the hands of Business and Wall Street. Now we
are trying to do something about Health Care. Our Party finds
itself with only one choice. Simply try to do something about
Insurance. The Insurance Companies have to be protected--
therefore Obama has tried to come up with something that is
a little better than what we now have. The Democrats and Obama
cannot it seems say Conservatism is wrongheaded and that
is what drove us over the cliff. This is the only way to make
serious change. We will continue to support and give way to
the Insurance Companies and I fear we will end up with something
worse than we have now. Big Business is in charge in this
country. Get ready for another bigger meltdown.

[Jackpine Radical]

9. I have another rational explanation for you.

Bribery.

[PA Democrat]

11. Other businesses are going under and laying people off because of the crushing cost of health

insurance. Consumers have less disposable income to spend elsewhere because of health care costs. Health care reform with a strong public option is not going to result in massive layoffs overnight in the insurance industry. But it would spur other portions of the economy. It's a net win.

[rucky]

6. K&R Times a thousand.

Thanks for the download. This is scathing.

[Laelth]

8. k&r for the ugly truth. n/t

:dem:

-Laelth

[Jackpine Radical]

10. Private health insurance is most definitely part of the solution.

Just like dinosaurs were part of the solution for the rise of the mammals. By going extinct.

[redqueen]

12. K&R

The fines won't stop them... they just chalk it up as the cost of doing business. "Doing business" meaning screwing people over for profit, of course.

[musette_sf]

13. the fines are piddling and inconsequential

and simply considered "the cost of doing business"

:mad:

[debbierlus]

14. They are LEECHES...End of story.

[Bozita]

15. death panels for sure

[sicksicksick_N_tired]

19. INSURANCE COMPANIES HAVE HAD THE PATENT/TRADEMARK/COPYRIGHT ON DEATH PANELS,....

,...since the day they were created as profiteering marketeers.

NOW,...THAT IS THE DAMNED TRUTH AS THEY ARE DAMNED FOR MAKING MONEY OFF HUMAN SICKNESS AND DEATH!!!

[renate]

16. how the CEOs of insurance companies must have laughed and laughed and laughed...

... to see the deathers at those town halls doing their bidding without even knowing it.

Of all the industries for rabid zealots to defend with threats of terrorism and violence... health insurance? Waving the flag and spewing spittle in defense of companies who would cut them off with a dime and without a second thought?

It'd be funny--just like the CEOs must see it--if it weren't so tragic.

[sicksicksick_N_tired]

18. Imagine, a country whose people CLAIM moral ground, advocate PROFIT OFF PEOPLE'S DEATH!!!

The prospect of bargaining people's lives for profit would NORMALLY BE MORALLY REPULSIVE!!! DIGUSTING!!! BARBARIC!!! DEVIL/DEMON-LIKE.

Yet, here we are, with the most morally repulsive, disgusting, barbaric demons among human beings DICTATING health care for our own citizens.

What does that fact SAY about this nation? SAY IT!!!!

[meow2u3]

20. I wonder if the mob is behind these shady insurance practices

This report reads as if the Mafia were running the insurance industry from behind the scenes. It has been reported that the mob has its hand in many white-collar crimes, since they're more difficult to prosecute than the traditional strong-arm extortion of unions and small business.

It would make sense that either the mob is making the rules regarding health insurance, as well as corrupting boardrooms in other industries, because that's where the big money is.

If there's one industry the FBI ought to investigate for crimes ranging from fraud to price fixing to antitrust violations, it's the insurance industry.

[PA Democrat]

21. They certainly don't think that any laws apply to them.

They will do whatever they can get away with as long as it is profitable.

[Lugnut]

22. K&R n/t

[liberalhistorian]

23. Oh, but..but..but... the private sector can do it SO much

better than teh eeeeeeeevil gubmint!!!! :sarcasm: :sarcasm: :puke: :puke: