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| Subject: YES!, lets put them all on the umemployment line!! | |
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Author: Oropan |
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Date Posted: 10:43:07 11/12/07 Mon In reply to: Mo' Green 's message, "Heard that more people are employed by Bluecross in Mass. than entire Healthcare Canada system" on 10:30:54 11/12/07 Mon BTW, how many people work for medicare and medicaid? Annd why do people from Canada and the UK come here for advanced medical treatment? >United Health paid it CEO $1.5 Billion! These >insurers provide no value and actually hinder care. >Just wait for the ads to come out next election cycle. > Unfortunately the rubes will probabaly fall for the >same scare tactics. > >> >>href="http://www.latimes.com/business/la-fi-insure9nov >0 >>9,0,3065397,full.story?coll=la-home-center">http://www >. >>latimes.com/business/la-fi-insure9nov09,0,3065397,full >. >>story?coll=la-home-center >> >>Health insurer tied bonuses to dropping sick >>policyholders >> >>Ken Hively / Los Angeles Times >>DROPPED: Patsy Bates, 51, a Gardena hairdresser, is >>seeking $6 million plus damages in a suit against >>Health Net after her coverage was rescinded while she >>was in the middle of chemotherapy treatments. >>By Lisa Girion, Los Angeles Times Staff Writer >>November 9, 2007 >>One of the state's largest health insurers set goals >>and paid bonuses based in part on how many individual >>policyholders were dropped and how much money was >>saved. >> >>Woodland Hills-based Health Net Inc. avoided paying >>$35.5 million in medical expenses by rescinding about >>1,600 policies between 2000 and 2006. During that >>period, it paid 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, documents disclosed Thursday >showed. >>The revelation that the health plan had cancellation >>goals and bonuses comes amid a storm of controversy >>over the industry-wide but long-hidden practice of >>rescinding coverage after expensive medical treatments >>have been authorized. >> >>These cancellations have been the recent focus of >>intense scrutiny by lawmakers, state regulators and >>consumer advocates. Although these "rescissions" are >>only a small portion of the companies' overall >>business, they typically leave sick patients with >>crushing medical bills and no way to obtain needed >>treatment. >> >>Most of the state's major insurers have cancellation >>departments or individuals assigned to review coverage >>applications. They typically pull a policyholder's >>records after major medical claims are made to ensure >>that the client qualified for coverage at the outset. >> >>The companies' internal procedures for reviewing and >>canceling coverage have not been publicly disclosed. >>Health Net's disclosures Thursday provided an >>unprecedented peek at a company's internal operations >>and marked the first time an insurer had revealed how >>it linked cancellations to employee performance goals >>and to its bottom line. >> >>The bonuses were disclosed at an arbitration hearing >>in a lawsuit brought by Patsy Bates, a Gardena >>hairdresser whose coverage was rescinded by Health Net >>in the middle of chemotherapy treatments for breast >>cancer. She is seeking $6 million in compensation, >>plus damages. >> >>Insurers maintain that cancellations are necessary to >>root out fraud and keep premiums affordable. >>Individual coverage is issued to only the healthiest >>applicants, who must disclose preexisting conditions. >> >>Other suits have been settled out of court or through >>arbitration, out of public view. Until now, none had >>gone to a public trial. >> >>Health Net had sought to keep the documents secret >>even after it was forced to produce them for the >>hearing, arguing that they contained proprietary >>information and could embarrass the company. But the >>arbitrator in the case, former Los Angeles County >>Superior Court Judge Sam Cianchetti, granted a motion >>by lawyers for The Times, opening the hearing to >>reporters and making public all documents produced for >>it. >> >>At a hearing on the motion, the judge said, "This >>clearly involves very significant public interest, and >>my view is the arbitration proceedings should not be >>confidential." >> >>The documents show that in 2002, the company's goal >>for Barbara Fowler, Health Net's senior analyst in >>charge of rescission reviews, was 15 cancellations a >>month. She exceeded that, rescinding 275 policies that >>year -- a monthly average of 22.9. >> >>More recently, her goals were expressed in financial >>terms. Her supervisor described 2003 as a "banner >>year" for Fowler because the company avoided about "$6 >>million in unnecessary health care expenses" through >>her rescission of 301 policies -- one more than her >>performance goal. >> >>In 2005, her goal was to save Health Net at least $6.5 >>million. Through nearly 300 rescissions, Fowler ended >>up saving an estimated $7 million, prompting her >>supervisor to write: "Barbara's successful execution >>of her job responsibilities have been vital to the >>profitability" of individual and family policies. >> >>State law forbids insurance companies from tying any >>compensation for claims reviewers to their claims >>decisions. >> >>But Health Net's lawyer, William Helvestine, told the >>arbitrator in his opening argument Thursday that the >>law did not apply to the insurer in the case because >>Fowler was an underwriter -- not a claims reviewer. >> >>Helvestine acknowledged that the company tied some of >>Fowler's compensation to policy cancellations, >>including Bates'. But he maintained that the bonuses >>were based on the overall performance of Fowler and >>the company. He also said that meeting the >>cancellation target was only a small factor. >> >>The documents showed that Fowler's annual bonuses >>ranged from $1,654 to $6,310. But Helvestine said that >>no more than $276 in any year was connected to >>cancellations. >> >>He said Fowler's supervisor, Mark Ludwig, set goals >>that were reasonable based on the prior year's >>experience. >> >>"I think it is insulting to those individuals to make >>this the focal point of this case," Helvestine said. >> >>Bates' lawyer, William Shernoff, said Health Net's >>behavior was "reprehensible." >> >>He said the cancellation goals and financial rewards >>showed that the company canceled policies in bad faith >>and just to save money. After all, he told the >>arbitrator, canceling policies was Fowler's primary >>job. >> >>"For management to set goals in advance to achieve a >>certain number of rescissions and target savings in >>the millions of dollars at the expense of seriously >>ill patients is cruel and reprehensible by any >>standards of law or decency," Shernoff said. >> >>The company declined requests to make Fowler available >>to discuss the reviews. >> >>Cianchetti, the arbitrator, earlier ruled the >>rescission invalid because Health Net had mishandled >>the way it sent Bates the policy when it issued >>coverage. At the end of the hearing, it will be up to >>Cianchetti to determine whether Health Net acted in >>bad faith and owes Bates any damages. >> >>The disclosures surprised regulators. A spokesman said >>state Insurance Commissioner Steve Poizner was >>troubled by the allegations. >> >>"Commissioner Poizner has made it clear he will not >>tolerate illegal rescissions," spokesman Byron Tucker >>said. "We are going to take a hard and close look at >>this case." >> >>In recent months, the state's health and insurance >>regulators have teamed to develop rules aimed at >>curbing rescissions and to more closely monitor the >>industry's cancellation policies. >> >>Other insurers that have rescission operations, >>including Blue Cross of California and Blue Shield of >>California, said they had no similar policies linking >>employee performance reviews to rescission levels. >>Blue Cross said it conducted audits to ensure that >>claims reviewers were not given any "carrots" for >>canceling coverage. >> >>Bates, who filed the suit against Health Net, owns a >>hair salon in a Gardena mini-mall between a liquor >>store and a doughnut shop. She said she was left with >>nearly $200,000 in medical bills and stranded in the >>midst of chemotherapy when Health Net canceled her >>coverage in January 2004. >> >>Bates, 51, said the first notice she had that >>something was awry with her coverage came while she >>was in the hospital preparing for lump-removal >surgery. >> >>She said an administrator came to her room and told >>her the surgery, scheduled for early the next day, had >>been canceled because the hospital learned she had >>insurance problems. Health Net allowed the surgery to >>go forward only after Bates' daughter authorized the >>insurance company to charge three months of premiums >>in advance to her debit card, Bates alleged. Her >>coverage was canceled after she began post-surgical >>chemotherapy threatments. >> >>"I've got cancer, and I could die," she said in a >>recent interview. Health Net "walked away from the >>agreement. They don't care." >> >>Health Net contended that Bates failed to disclose a >>heart problem and shaved about 35 pounds off her >>weight on her application. Had it known her true >>weight or that she had been screened for a heart >>condition related to her use of the diet drug >>combination known as fen-phen, it would not have >>covered her in the first place, the company said. >> >>"The case was rescinded based on inaccurate >>information on the individual's application," Health >>Net spokesman Brad Kieffer said. >> >>Bates said she already had insurance when a broker >>came by her shop in the summer of 2003, and said she >>now regretted letting him in the door. She agreed to >>apply to Health Net when the broker told her he could >>save her money, Bates said. >> >>She added that she never intended to mislead the >>company. Bates said the broker filled out the >>application, asking questions about her medical >>history as she styled a client's hair in her busy shop >>and he talked to another client waiting for an >>appointment at the counter. She maintained that she >>answered his questions as best she could and did not >>know whether he asked every question on the >>application. >> >>Bates' chemotherapy was delayed for four months until >>it was funded through a program for charity cases. >>Three years later, she can't afford the tests she >>needs to determine whether the cancer is gone. >> >>So she is left to worry. She is also left with a >>catheter embedded in her chest where the chemotherapy >>drugs were injected into her bloodstream. Bates said >>she found a physician willing to remove it without >>charge, but he won't do it without a clear prognosis. >>That remains uncertain. >> >>Shernoff, Bates' lawyer, claimed that the performance >>goals for Fowler showed that Health Net was bent on >>finding any excuse to cancel the coverage of people >>like Bates to save money. >> >>"I haven't seen this kind of thing for years," >>Shernoff said. "It doesn't get much worse." >> >>lisa.girion@latimes.com [ Next Thread | Previous Thread | Next Message | Previous Message ] |
| Subject | Author | Date |
| "bureaucracy accounts for at least 31 percent of total U.S. health spending compared to 16.7 percent in Canada" | Mo' Green | 12:45:09 11/12/07 Mon |
| Canadians come here becuase it is convenient | Stephen | 19:00:20 11/26/07 Mon |