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| Subject: "bureaucracy accounts for at least 31 percent of total U.S. health spending compared to 16.7 percent in Canada" | |
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Author: Mo' Green |
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Date Posted: 12:45:09 11/12/07 Mon In reply to: Oropan 's message, "YES!, lets put them all on the umemployment line!!" on 10:43:07 11/12/07 Mon You're a walking ignorance advertisement. http://www.consumeraffairs.com/news04/health_plan.html >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-insure9no >v >>0 >>>9,0,3065397,full.story?coll=la-home-center">http://ww >w >>. >>>latimes.com/business/la-fi-insure9nov09,0,3065397,ful >l >>. >>>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Health Net after her coverage was rescinded while she 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 ] |
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| Canadians come here becuase it is convenient | Stephen | 19:00:20 11/26/07 Mon |