Skip to main content

View Diary: Health insurers look for new (and old) ways to make more money (47 comments)

Comment Preferences

  •  I have two friends whose wives work in the health (8+ / 0-)

    care insurance industry.  I can't believe some of the things that go on there.  The incidents below are from pre-ACA days, but doubtless the process continues.

    One is a senior VP in a major Texas-based plan.  They were routinely denying some preventive care that they should have covered under their agreement with some of their patients.  The patients who got denied, were ones with multiple health problems.  The insurance company had been paying out benefits for them (i.e. they were costing the insco more than the insco wanted to pay).  The reason for denial was so that these patients would get pissed off and switch to another insco.  Many did.  Problem was minimized.

    The other woman is not as highly placed in the insco food chain but still privy to some of the executive decisions.  The health insurance company she works for is located in NY.  She says that every year about three months before the end of the company's fiscal year, they get the annual "Deny Everything" memo.   It's more subtly worded, but essentially says that, if there's even the most remote reason to deny, do it.  It will take months for the patient or doctor to appeal.  Frequently, they'll just give up in disgust or frustration.  Then the insco won't have to pay for that MRI, PET scan, etc.  

    And there are more incidents, many more.

    Additionally, the inscos tend to delay payments to providers.  One that I know of sent out a memo several years ago to doctors in network in Pennsylvania.  It essentially said, "Don't even THINK of getting reimbursement for a charge for a patient visit in less than 90 days."  It took a concerted effort by most of the participating physicians, who threatened to just drop the insurance, before the insco relented - relented in that sometimes payments are now received in about 45-60 days-not 90.  

    This is a sad and painful state of affairs whether someone is sick or well.

    A word to the wise is sufficient. Republicans need at least a paragraph.

    by d3clark on Mon Jul 21, 2014 at 01:53:03 PM PDT

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site