2 posts tagged “insurance rape”
I have hated insurance since as far back as I can remember. To me, it seemed like a legitimized mafia practice. Pay me in case something bad happens. Oh, and if something bad does happen, good luck getting us to do anything about it! I hate insurance because it has changed the medical industry as well. Medicine is now practiced based upon the bottom line rather than the care of patients. Costs have skyrocketed because hospitals know that they can get the money from insurance companies rather than patients. If you are a patient and you have a severe illness, you can't expect to be treated unless you demonstrate the ability to pay. Do you know what really hammers this idea home? Should you get really sick, insurance companies will ACTIVELY seek to remove you so that they don't have to pay out! This practice is acknowledged by our government:
The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.
“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals' policies if any condition was not disclosed when the policy was obtained, "even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”
“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said.
The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims.
“Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage," HHS said.
Do you want to know the lengths to which they will go? I will offer you two examples, one which would seem obvious given what these corrupt assholes are doing, and the other that should terrify any clear-thinking person.
WellPoint and Assurant told the committee that they automatically investigate the medical records of every policyholder with certain conditions, including leukemia, ovarian cancer, brain cancer, and becoming pregnant with twins, the committee staff wrote.
In November 2006, after a Texas resident was found to have a lump in her breast, Wellpoint investigated her medical history and concluded that she had been diagnosed previously with osteoporosis. The insurer rescinded her policy and refused to pay for treatment of the lump, the committee staff wrote.
Under the current system, something as relatively simple as seasonal sneezing can jeopardize your financial security, HHS argues, citing a 2001 study for the Kaiser Family Foundation.
“Even when offering coverage, insurers can exclude whole categories of illnesses related to a preexisting condition. For example, someone with a preexisting condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage,” HHS said.
In a truly disgusting practice, it was revealed that Blue Cross REWARDS their employees for dropping policy holders who become ill with anything serious:
But documents obtained by the House Committee on Energy and Commerce and released today show that the company's employee performance evaluation program did include a review of rescission activity.
The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.
WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.
What is the bottom line on all this? The bottom line is that it is all about the bottom line for insurance companies. They will gladly take your premiums, but when it comes time to honor their obligations, they will find a way out of them. It is a truly disgusting practice, but I believe it to be systematic of how things in our country operate in our modern age. It becomes increasingly difficult to believe that the rich and powerful don't run this country in a manner that only fosters their own interests. I firmly believe that the average citizen has no say in our government anymore.
Talking about health issues is tough for anyone. It is especially tough for me, for personal reasons. I won't espouse about any recent goings-on, but I will lament the experience afterward. I think that by and large, the medical community has changed from an entity that's purpose was to provide the best possible care to its patients, to a business that is more concerned with maintaining relationships with insurance companies, the government agencies that pay out claims, and the bottom line. (Jesus, this is horrible. But it's 3:30 A.M...)
I am not an idiot, and I am perfectly aware that hospitals have to make a profit. I am with them on that front. I contend that the real problem is the insurance industry. With the advent of medical insurance, costs have risen at a very healthy rate for many, many years. While I find the entire concept flawed, I will play devil's advocate here for a second. In theory, you pay an insurance premium every month as protection against some catastrophic illness or accident. Should such a thing occur, you pay a deductible, and the insurance company pays the remainder. In practice, it NEVER works this way. In practice, you pay a premium that rises astronomically if you have ever been very ill/hurt, your deductible is an enormous amount, and the insurance company pays only X% of the costs. The problem is that if you have to have heart surgery, and the cost of the operation is $225,000 and your deductible is $1000 (if you are lucky), your insurance will likely pay either 70/80% of the cost. So what does that translate to? How about $46,000 out of your pocket not accounting for any costs post-op. I know that there are some people who can afford this, but the reality is that the vast majority of Americans cannot afford such things. At this point, the person or family is left facing an unpayable medical debt either way. What is the way out? Bankruptcy. Over 60% of U.S bankruptcies are attributable to medical debt. Ask yourself what the real difference is between a $225,000 debt and a $45,000 one. It's likely that you wouldn't be able to afford either one.
It gets worse too. The people whom are all-too-happy to take our money are rather stingy when it comes time to pay out. Consider the recent discovery that health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.
At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
The star witness at the hearing was a former public relations executive for major health insurers whose testimony boiled down to this: Don't trust the insurers.
"The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable -- publicly accountable -- health-care option," said Wendell Potter, who until early last year was vice president for corporate communications at the big insurer Cigna.
Potter said he worries "that the industry's charm offensive, which is the most visible part of duplicitous and well-financed PR and lobbying campaigns, may well shape reform in a way that benefits Wall Street far more than average Americans."
Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged, Potter said.
The report released yesterday alleges that insurers have systematically underpaid for out-of-network care. The issue had been brought to light previously in litigation, committee hearings and other investigations, including a probe by New York Attorney General Andrew M. Cuomo. But as politicians and interests groups clash over the current effort to overhaul the nation's health-care system, it took on new relevance.
Cuomo described it last year as "a scheme by health insurers to defraud consumers by manipulating reimbursement rates."
Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said.
Wash Post: Senate Hears of a Raw Deal
In an upcoming post, I will discuss Obama's health care initiative and see what it does-and doesn't-do to solve some of these issues. And in a follow-up post, I will analyze how the organ transplant process works as it pertains to patients and those with significant financial means.
