Health Insurance Firms paid employees bonuses for cancelling policies!

Parent Cafe
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<p>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.’</p>

<p>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.’</p>

<p>Yeah, no kidding! Quadruple bypass, no big deal!</p>

<p>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.</p>

<p>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. </p>

<p>???</p>

<p>Hey has anyone seen Sicko?</p>

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<p>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.</p>

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<p>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.</p>

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<p>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 ;)</p>

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<p>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.</p>

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<p>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.</p>

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<p>Ok here goes as I am the designated bad guy for this piece…</p>

<p>“I think you’re not paying sufficient attention to the fact that this company broke the law”</p>

<p>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? </p>

<p>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. </p>

<p>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? </p>

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

<p>“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… </p>

<p>“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 -”</p>

<p>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…</p>

<p>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? </p>

<p>“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.”</p>

<p>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… </p>

<p>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. </p>

<p>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.</p>

<p>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? </p>

<p>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?</p>

<p>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. </p>

<p>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.</p>

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

<p>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.</p>

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<p>Should be a high risk pool in every state. Costs more.</p>

<p>It’s just like car insurance - people with clean driving records get a better price than those with tickets and accidents.</p>

<p>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.</p>

<p>Medical costs…#1 cost of bankruptcy in the US.</p>

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<p>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.</p>

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

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<p>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.</p>

<p>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.</p>

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<p>Patsy Bates should also sue the doctor who prescribed her the fen-phen. I remember when that diet drug combo was popular in the mid '90s. It was only available by prescription and doctors claimed it was perfectly safe. Ha. Patsy Bates (and the insurance cos.) are the ones being punished for that bad medicine now. She is uninsurable now and may die of untreated cancer because she trusted her doctor when he gave her the fen-phen years ago.</p>

<p>And she was also probably just earnestly trying to rid herself of those extra 35 pounds!</p>

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<p>Eh, if everyone sued their docs for stuff like that, there would be no docs.</p>

<p><a href=“http://www.mercola.com/2003/jan/15/doctors_drugs.htm[/url]”>http://www.mercola.com/2003/jan/15/doctors_drugs.htm&lt;/a&gt;&lt;/p&gt;

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<p>A few more comments about health insurers:</p>

<p>First of all, the idea of picking patients for health care coverage based on their risk of getting sick, and refusing to cover those who have higher risk is an idea that the “managed care” companies thought up about 15 years ago to make the industry more profitable. It is unethical and wrong. The idea of providing health insurance to large groups is to spread the risk over a big enough group that the company can make a reasonable prediction what it is going to cost them, and charge a fair fee to the group. This ended when the non profit restrictions on these companies were lifted, they became large public companies, and had nothing but CEO and shareholder profit as their goal. Picking only healthy patients for health insurance and rejecting anyone who is overweight or has higher risk of disease is called “cherry picking”. It is illegal in many states. In New Jersey as long as you have continuous coverage, an insurer cannot refuse you for a “preexisting condition”.
If Healthnet was allowed to do whatever they wanted, they would exclude every person with any disease from coverage, and only collect money from healthy people. These companies have perverted the concept of health insurance to the ultimate degree.</p>

<p>Now let me focus on health care fraud. This is a big fraud indeed… the fraud is the concept that it is prevalent, and that it is carried out by health care providers. The true fraud is insurers trying to make patients believe that they have any interest in their health. They do not. The Healthnet story is just a small example… workers told to specifically find records of patients that are costing them money and find some excuse to refuse them care. I know for a fact that before we went to electronic claims, that some insurance companies told their workers to throw claims in the garbage, and deliberately make physicians refile them before they pay anything. Aetna was just fined $9 million dollars in New Jersey for unilaterally reducing payments to out of network physicians by 40%…they just figured they would try to get away with this, and the Dept. of Banking and Insurance told them they couldn’t do it and fined them. So they will just go back to their workroom and figure out some new fraudulent way to steal money.
For those of you who don’t work in the system, believe me, it is much worse than you could possibly imagine. These are totally unethical money grubbing people running these companies, and they wouldn’t think twice about denying payment for your care as you lay on your death bed dying of cancer because you wrote on your application that you weighed 130 pounds instead of 140. Then they give the person who discovered the error and decided to throw you out a bonus. </p>

<p>We have allowed these large corporations to totally take over the health care system with virtually no regulation. This occurred during the Clinton administration where Hillary’s plan failed and they were emboldened to step in and use their clout to gain control of the system. They provide no value. They are not like drug companies that are actually producing a product that is valuable. They have used their market power which is completely stacked in their favor to reduce payments to hospitals and doctors, increase charges to clients, and extract most of the money for profit. This is money that should be going to healthcare and is not. William Mcguire was paid $120 million dollars when he left as CEO of United Healthcare. Horizon of New Jersey (formerly Blue Cross) is sitting on $1 billion dollars in cash. To me this is an obscenity that these companies are making profits like this and denying sick people care, so they can make more. </p>

<p>I am not going to go into my idea for a solution, but suffice it to say, these companies need much more oversight and regulation. Their profits, their fees, the way they deny care all need to be regulated carefully by state or federal agencies. That’s the first step. I’m not sure whether a single payer system would work better. Certainly more of the money contributed would actually go to health care. I’ll leave that for another discussion.</p>

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<p>^^ Couldn’t have said it better!</p>

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<p>Everyone should seriously go see Sicko. Quite an eye-opener. Alot of the cases such as that described in post #33.</p>

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<p>If you think that the health insurance companies are corrupt (many are) but the drug companies are somehow benevolent, then wow, respectfully, either you have put on blinders or you work in the drug industry.</p>

<p>Health insurance companies offer a product, too, but just not as tangible.</p>

<p>You think drug companies care about people? About cures? No way. They are all about profit. All the big businesses are about profit, don’t kid yourself. Drug companies have denied people access to info, they try to shut down harmless alternative treatments, their drugs are responsible for hundreds of thousands of deaths & serious side effects, which they downplay…oh don’t get me started!</p>

<p>What about the obscenity of drugs costing $100 here and those same drugs costing $1 in other countries? (see Sicko)</p>

<p>from <a href=“http://www.mercola.com/2007/mar/13/accidental-deaths-due-to-prescription-drugs-on-the-rise.htm[/url]”>http://www.mercola.com/2007/mar/13/accidental-deaths-due-to-prescription-drugs-on-the-rise.htm&lt;/a&gt;&lt;/p&gt;

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<p>Even though I sell health insurance, I recognize that there is a lot of corruption in the industry. But to think that the drug companies are any better…is just naive.</p>

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<p>This is the time I can say I’m glad CC allows us to post anonymously, because otherwise I couldn’t tell this story.</p>

<p>Eight to ten years ago, I was working for a friend, very, very part-time, who sells financial products, including life and health insurance. I knew this friend from church, so it occurred from time to time that his clients would be other people we knew from church. I remember one middle-aged woman in particular, who I’d heard had a history of pretty serious depression. She applied for life insurance, and since I was the one to complete some parts of the application, I noticed under the section that related to depression, she denied ever having it. She got her life insurance, no problem, no higher rates, etc.</p>

<p>Fast forward a couple of years later (this woman was no longer a member at our church and I was no longer working for my friend), while I’m completing a clinical position in a hospital, this woman was admitted for adverse reactions to chemo from breast cancer. When I was reviewing her chart, I saw that she did admit to her depression history, and it included time prior to the date she applied for the life insurance. I was so incredibly p*ssed!.. because -
a couple of years before I worked for my friend, I had applied for life insurance through State Farm, and was denied based on my honesty of some mental health issues I’d had earlier in my life. When I answered these questions a certain way, they made me sign a release of information form for a doctor I’d seen, who had charted just enough to affirm my past. It didn’t help when our agent said, “I’ve never known our company to deny someone based on your history.” Soon after that (before I was working for him), I approached my friend, who was able to insure me (term only, not whole life), at an increased rate. At least I got the insurance, but when I think back to the woman who lied, and had no problem getting the whole life policy at standard rate, it infuriates me. I was honest, and got screwed for it.</p>

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<p>“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.”</p>

<p>Nope no herring, not even trout. Why is one acceptable and the other not? because today it’s something you support? Me? I’ve got dog in this fight, but I know both parties did something wrong. I could understand if it came down to choosing food and shelter before medical care, but do “we” know that is her case? Maybe she wanted to travel and didn’t see the value of owning health care. Maybe her rates went up because of her condition (treatments) with her old plan and there wasn’t a provision for portability in arnold land? So she pulled a fast one by not disclosing information. Evidently they found her out so somebody treated her previously. </p>

<p>Would it be OK to lie on auto insurance about DWI’s? I mean I only got one and I don’t drink that often…</p>

<p>Should I disclose 3 tickets? </p>

<p>Call it a red herring if you wish but simply calling it a red herring doesn’t dismiss which actions are acceptable and which aren’t.</p>

<p>I feel sorry for the lady if an agent sat there with her and walked her through an app and caused this, but then again I wasn’t there and don’t know, but usually I finish my applications at signature reading the fine print (yes, that’s why I’m poor) and the statement “and to the best of your knowledge, everything here in this application is truthful and honest.” But she wasn’t one of my clients.</p>

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<p>Agents can lose their licenses for helping people lie or misrepresent their health histories. I doubt many agents would be willing to risk their licenses for a sale.</p>

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<p>“doubt many agents would be willing to risk their licenses for a sale.”</p>

<p>There always will be some. But ya gotta figure if it’s worth it or not personally. </p>

<p>I’d be alot wealthier and in a different voting block if I would have said yes rather than no a few years back. Kicking back a few thousand dollars on a deal would have netted an additional 50-60k a year for years, but I said NO. My ethics are good, but my wallet is thin… lost a major account cause a week later he found somebody who would. </p>

<p>Maybe that why the kids got all that scholarship money, god pays you back in funny ways.</p>

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<p>According to Medicare, the top 20% healthcare users use up 80% of total costs, and the top half use 97% of costs.
Most private policies once accepted will not cancel you as long as you make the payments.<br>
Government, once you combine all the programs, is the largest payer of healthcare. Healthcare providers are being squeezed by the government. It costs $10 to fill a prescription, the government only gives them $3.50. So, pharmacies are reviewing plans to remove counseling services from being included in prescription price and add an extra fee for them. A number of doctors refuse or limit medicare/medicade patients. The average reimbursement time for medicare/medicare is 3-4 months compared to 1 month for private insurance. The government is a major cause in the disappearance of independent pharmacies.
The drug companies and PBMs make the biggest profit. The major issue according to Pharma is that the cost of creating a new drug is in the hundreds of millions. I am willing to believe that. I am also willing to believe that most of their drugs fail and don’t make it to market. I also know the cost of ingredients for most drugs is less than $1 per tablet, and also, some companies spend more on marketing than R&D. They have a right to make back their investment and make a profit, the issue is the amount.
FDA states if any alternative drug claims cure, they have to go through trials to prove it. If you read any claim by a supplement, they do not claim to cure a disease. Most alternatives do not survive the trial process. As a class, some of the Chinese herbals have the highest percentage of drug causing liver disease. If you claim a handful of dirt cures heart disease, then it comes under FDA jurisdiction.</p>