jclay2

opie ofMaybery2: Just so you know I through out the question, just because I thought that's where the convo was going to end up.

Hanna

"Ha ha. What a joke. A million dollar fine. The scumbags at Healthnet couldn't wait to write that check. They probably were high fiving each other."

That's just what I thought when I saw the headline. This fine isn't even a slap on the wrist; it's a minor cost of doing business, like paying the Culligan man who refills the water cooler.

Opie, I think you're not paying sufficient attention to the fact that this company broke the law. When it comes to this type of fine, it doesn't matter if the insured's application was covered with lies from beginning to end. State law says that insurance companies can't reward their employees for catching those lies, period. Compensation has to be independent of claims decisions. That law should either be enforced with real teeth or it should be repealed.

kluge

No, the problem is we have a system which rewards and encourages being a bad guy. If a person figures they'll save a few bucks by lying on their application, they're a bad guy. If a mom knows that her kids will not be able to get medical insurance for anything which happens to them if she notifies the new company about a condition which may or may not ever cause a problem, and she omits that information - is she a "bad guy?" If a person doesn't tell the insurer about a heart problem, and they deny her medical coverage for injuries sustained in a car accident which has nothing to do with her heart - who is the "bad guy?"

Well, it would solve the problem highlighted in this story, wouldn't it?

calmom

First of all, the plaintiff's health insurance was canceled when she was diagnosed with breast cancer - which has absolutely nothing to do with heart condition and very little to do with her weight. (At most, excess weight might be a risk factor for cancer - not a direct cause).

So there's not much "fraud" -- it is not as if she signed up for health insurance knowing she wanted gastric bypass surgery. Insurance policies routinely deny care for "pre-existing conditions", but in this case the purported nondisclosure is an unrelated condition.

But that gets to another issue entirely-- and why we need universal health care. The whole idea of denying someone medical care because they were sick before they got insurance is ridiculous -- is this person any less entitled to treatment for her breast cancer because she had a heart condition? For that matter, should she go without medical care for her lifetime for her heart condition (whatever it is) because she can't buy insurance for a "pre-existing condition"? If your kid has asthma do you want him or her to grow up to be uninsurable -- or only able to get medical care by paying monthly premiums that are unaffordable for any young person?

Obviously issues like excess weight and smoking are partly within the control of the patient, and it makes sense for insurance companies to offer incentives such as reduced premiums for those who work to stay healthy -- but it is unconscionable to let people go untreated for serious conditions like cancer simply because they can't afford the treatments -- and who can afford the cost of cancer treatment?

If we had universal health care --whether through a single-payer system or a regulated, hybrid system like the one that John Edwards & Hillary Clinton propose -- then this wouldn't be an issue. Health Net could play by the rules, or if they don't want to pay to treat sick people, they could opt out of the market.

A private system where only healthy people with few risks can be approved for insurance that they can afford is no system at all. It is simply a ripoff.

somemom

Is there a time limit on health insurance and for how long after your application they can go back to find "fraud?" With life insurance, the company has two years to determine fraud, if it has not surfaced in two years, you got away with it.

Seems like it ought to be the same in health insurance, if the mis-stated illness has not caused a problem for 2 years, then how big a problem is it? Ah, but then if I forgot to mention I had breast cancer 5 years ago and it recurs i 5 more years, I should have been paying higher premiums all along the way, so that is tough.

I have an extremely high deductible and avoid doctors whenever I can, but am floored by the rampant waste in CYA testing done by doctors. My FIL has a cancer that was daignosed, had scans & biopsys & it is slow growing, treatment is ONLY for symptoms, if they develop, yet his doc is still doing scans and repeat biopsys, though there is no treatment. The only reason I can come up with for this is to cover himself in case of litigation???? Otherwise, why does it matter? What a waste of money & time & health risks.

Our system is crazy and I hate paying so much for which I receive (and hope to continue to receive) nothing- we are healthy, but we avoid treatment for small things. I hate to pay $100 for a visit for a sore throat!

lealdragon

I sell health insurance. We have to ask the applicant a series of VERY specific questions. It is to be expected that weight may fluctuate a bit, within reason, but if someone leaves out something like a heart condition, that is considered a 'material' omission and fraudalent. There's really no way they could unintentionally leave that out, since we very specifically ask for any sort of 'heart ailments or conditions.'

I once had a man tell me how healthy he was: he exercised, had low cholesterol, never got sick, etc. It was only when I specifically asked him if he'd had any surgeries that he nonchalantly replied 'Oh, just a quadruple heart bypass surgery, but I'm fine now, so it's no big deal.'

Yeah, no kidding! Quadruple bypass, no big deal!

It's true that the health insurance companies often try to wiggle out of payng claims. But they're not always the bad guys everyone thinks they are (though some certainly are!). People need to realize that they are in it for the $$ and have to be able to make $$ just like any other business.

I tend to blame society's view of healthcare, oops, make that disease management, as a whole, than I do of the insurance companies per se. Society has this mentality that they can do whatever they want, eat crap, don't exercise, and then expect a doc to fix whatever goes wrong, and not have to pay anything. It always boggles my mind when people tell me they want a policy to cover 100% of their costs, for a family of 4, for $50 a month.

???

Hey has anyone seen Sicko?

Well, you might consider alternative therapies. I have not gone to a doc for a sore throat/cold/flu for over 25 years. Herbs and other natural supplements work wonderfully for stuff like that.

Bay

To clear up some facts in the Patsy Bates case: She had underreported her weight on her application by 35 pounds, and "she had been screened for a heart condition tied to her use of the diet drug combination fen-phen." (per L.A. Times) Health Net said it would not have covered her in the first place if it had know her weight/heart condition.

somemom

Leal- I have not found any herbs that work for strep, which seems to hit my D waaay too often. Believe me, we do all sorts of alternative methods to avoid paying the big bucks- including going to other countries to see docs & buy meds

bookworm

Having just gone thru the process of applying for health insurance, I don't understand how these untruths could go undetected. The companies asked for names of my physicians and obtained records. Things like weight and surgeries are in the file.

gbesq

Absolutely disgusting. A million dollar fine? How about putting the HealthNet executives who came up with this idea in jail for starters? I don't have a problem with an insurer cancelling a contract for an individual who made a materially fraudulent statement about their health on the application. I DO have a problem with an insurer that gives its employees a financial incentive of this kind. I guess that's the fundamental problem -- if you're going to view equal access to healthcare as a right that all should have, then a system of coverage based upon private insurers with a profit motive simply won't do. The candidate who can offer America a real plan for national healthcare that takes for-profit insurers out of the equation has my vote. It can't happen soon enough.

Opie ofMaybery2

Ok here goes as I am the designated bad guy for this piece...

"I think you're not paying sufficient attention to the fact that this company broke the law"

Nope caught that.. but does their wrong dupe hers? My point, is she a victim or did she get caught? Is senator Craig a victim or did he get caught?
depends..don't it?

Kluge we live in a country that will imprison a man for shoplifting bread or smoking some dope, but allow a man who robs a pension plan of millions a free pass? I didn't make the rules, nor am I really trying to defend them, just live with em, ya know? in this particular case is there not a high risk pool available? In WA state we have a high risk pool.

As far as the ommission didn't fit the need? Didn't norte dame fire a coach who padded his college education experience? He lost his job because his degree wasn't quite right, but he coaches football, so why cut him loose? We make big deals over people whom emblish resumes or leave things off... that have nothing to do with their jobs, yet they lose their jobs..why?

Was she fudging on the app to save dollars, she took a risk got caught.

"Well, it would solve the problem highlighted in this story, wouldn't it?"
yes, because she would have been paying for insurance already, just as if she had prior coverage, she could have wingwalked. couldn't she? In either senario she would have had coverage and been paying for it either by taxes or premium..


"and why we need universal health care. The whole idea of denying someone medical care because they were sick before they got insurance is ridiculous -"

because she will have been paying into the system from the day she was born so yes, she would not have the problem of pre-ex because she would be paying for it already..

Or is universal health care "free"? refresh my memmorary on how we will pay hospitals, doctors and nurses for services after UHC takes effect. I am sure those folks and the people who will still be needed to process claims (private will simply switch over as you will still have claims) will live on sunshine and never want a raise again?

"A private system where only healthy people with few risks can be approved for insurance that they can afford is no system at all. It is simply a ripoff."

I'm a hypertensive diabetic and I have insurance. it is affordable because I make it a priority in my life. I passed on the ipod, bmw and xbox.. Since I am in the system I deal with alot of people that spend more for those things above every month and would never consider healthcare because it doesn't float their boat...

the one thing that might help with UHC is it will force everyone to own insurance... as you see, not everybody who lacks insurance wants it or wants to pay for it... Not all of the 44miilion are poor desparates, some are making more money than you or I and see no need...yet.


The two aspects of UHC that are fluffed over always seem to be cost and access... It will cost and you'll still hear "no". It's not everybody gets a pony.


sorry the only thing you get rid of in healthcare are the ceos and agents. I make 2% for my services, CEO make alot and gawd I don't like that either. but everything else involved in the nuts and bolts of delievering hc will still need to be there. Claims will still need to be processed at a much greater rate (because hc will become free) professional compensation issues will still be there.. who pays for it? the good fairy?

Most of the dollar collected for hc passes through..to the same people who will still be there under single payor.. did we fix it or make it a monopoly that will cost more?

Actually if you want to know one of the things I would do is I would breakup the United healthcares out there. For the last couple decades (since 83) the bigs have been swallowing the small, in preperation for national healthcare. Your single payor (actually regional payors) is creating itself out there right now, as was planned in 83.

Since then the choices I can offer have gone from around 20, to three or four. How much competition is there when 20 are competing for business than 3 or 4? Some of your UHC folks are getting what you want, no competition already..me? Let's go back 20years and make em all lean and mean and scrappy. Choice.. what a simple concept.

kluge

We already have universal health care. We just deliver it by the most inefficient and expensive means possible.

Opie - Your argument about the football coach is a red herring. Lying about your diploma is generally grounds for termination of employment because the punishment fits the "crime." Would understating your weight by 35 pounds be grounds for firing you from a desk job? I don't think so.

lealdragon

Should be a high risk pool in every state. Costs more.

It's just like car insurance - people with clean driving records get a better price than those with tickets and accidents.

Opie, I agree. I can't tell you how often I come across people in expensive houses who quibble over a few hundred bucks a month to insure their families.

Medical costs...#1 cost of bankruptcy in the US.

lealdragon

No, but it would be grounds for either raising the rate for insurance coverage, or refusing coverage altogether. These rates are very strictly calculated. It's all about calculating the risk for that particular person. An overweight person has a higher risk than an average-weight person.

We sell our insurance in person so that eliminates the issue of missing something obvious like obesity.

lealdragon

I have mixed feelings about UHC. I support Ron Paul, and he is against it. He did bring up a good point though: that disease management keeps going UP in price, whereas technology usually goes DOWN. He also pointed out that a lot of problems started with HMOs back 25 or so years ago.

Come to think of it, my parents were very poor and yet they did occasionally take us to the doctor. It wasn't so prohibitively expensive back then.