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| -Signs, Portents, and the Weather- |
| CA Blue Cross Tries To Rid Itself Of Sickly Newcomers |
| 2008-02-13 |
| Citing an effort to hold down costs, health insurance giant Blue Cross wants doctors in California to report conditions it could use to cancel new patients' medical coverage, it was reported Tuesday. The state's largest for-profit health insurer is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," the Los Angeles Times reported on its Web site. "Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," according to the letter obtained by the newspaper. One of the conditions noted in the letter that could force a new patient to be dropped by Blue Cross — pre-existing pregnancies. WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said it was sending out the letters in an effort to keep costs at a minimum. "Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members," WellPoint spokeswoman Shannon Troughton said in an e-mail to the newspaper. "Blue Cross feels it is our responsibility to assure all records are accurate and up to date for HMO providers," she said. "We send these letters to identify members early on in the process who may not have been honest in their application." Troughton added doctors are not required, but rather can volunteer, patients' information to Blue Cross. Doctors were unhappy about the letter, warning that some patients might hide any medical history that could affect their prospects of receiving health insurance. "We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Association. This was anticipated long ago, when government tried to force insurers to take on extremely sick patients (notably AIDS), that were guaranteed to never earn those companies a dime. In future, now, insurers will use genetic information to blackball those with any number of serious genetic conditions. They won't be able to ever get coverage, so they will have no HIPPA act protection, either. |
| Posted by:Anonymoose |
| #7 The problem is legislative. Insurance companies assess their risks and price accordingly. If they are required by law to price insurance without reference to pre-existing conditions, then they will do so. Of course, the cost to everyone will be substantially higher. Take your pick? Disclaimer: I know fraud is so rampant in Insurance that buyng lottery tickets gives you better odds than buying insurance. |
| Posted by: phil_b 2008-02-13 23:07 |
| #6 It's fair to cancel coverage if the patient concealed a pre-existing condition - I suspect a lot of cases Blue Cross is trying to dump are patients with previously undiagnosed but pre-existing conditions. "Gee, sir, that's a pretty advanced case of colon cancer you've got there, and you've only been insured a couple of months, so I'm afraid we're going to have to cancel you." I KNOW this happens. |
| Posted by: Glenmore 2008-02-13 19:38 |
| #5 phil_b: unfortunately, there are hundreds of genetic diseases that, even if they only increase your chances of getting a disease by 10%, mean that nobody wants to insure you. One of the big ones is breast cancer, where genetics may be the fourth or fifth most determining factor of whether you get cancer. In truth, probably 80% of people have some known, underlying *excuse* that could be used to deny them insurance, if the insurer *or* their underwriter knew. Why gamble on people with a chance to become sick, if you can do so only with people less likely to become sick? Optimally, a health insurer would want only to insure people who would be very healthy to the age of 65, then die of an acute heart attack before they hit the ground. That way, they would get paid a fortune, with minimal expense. However, a whole life insurer would prefer somebody who is sickly but long-lived, so they don't have to pay a dime until they've had the premiums for years. |
| Posted by: Anonymoose 2008-02-13 19:36 |
| #4 I don't see the issue here. Insurers try to get information to access their risk. Not revealing that info is fraud. Try getting life insurance after you have disclosed you have a terminal illness. Fraud is a huge problem for insurers. No one knows how big it really is, fraud raises insurance costs for everyone. |
| Posted by: phil_b 2008-02-13 17:38 |
| #3 Well, yeah p2k, if you want to get rid of the pregnancy. If you want to bring it to term, apparently, that's another matter. |
| Posted by: Swamp Blondie 2008-02-13 16:15 |
| #2 Sent by Blues last night "Blue Cross of California highly values the trust of its members and understands the personal relationship members have with their physicians and medical groups. It is our responsibility to assure all member records are accurate and up to date, both for the benefit of our members and the providers in our HMO network. One of the ways we do this is to send the member's application for medical coverage to the physicians to ensure that it mirrors what is reflected in the physician's notes for that member. We believe the sending of the application satisfies this obligation. This notification process has been in place for several years, and to date we have not received any calls or letters of concern. However, we are now aware that the CMA has some concerns regarding a cover letter that accompanies the applications. We greatly value our relationship with the CMA and look forward to working with them to address any questions or concerns they may have regarding this letter. It is important to note that of the approximately 300,000 new individual Blue Cross members each year, this letter pertains to less than 1,000 HMO members per month." |
| Posted by: Beavis 2008-02-13 16:03 |
| #1 We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information.. Wait a second. Wasn't Roe vs Wade predicated upon the sacredness of the private communication between a patient and their doctor? |
| Posted by: Procopius2k 2008-02-13 15:56 |