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Private Insurance Bureaucracies Abusing the System?

By Greg Webb

A House subcommittee held a hearing last Tuesday regarding private insurance bureaucracies' abuse of the health insurance system. "The hearing was part of a continuing Democratic effort to promote an overhaul of the nation's health care system by focusing on alleged abuses by health insurers" reported The Washington Post in a September 17 article entitled, "House Subcommittee Hearing Focuses on Alleged Insurer Abuses".

The need for the hearing stemmed from "the actions of insurance company bureaucrats in causing needless delays and denials for coverage for prescribed treatment," said Rep. Dennis Kucinich (D-Ohio), chairman of a House subcommittee on domestic policy.

Jim Jordan, the subcommittee's ranking republican, said that he feels insurers cancelling policies on policyholders when they become sick is, naturally, "inexcusable." He also noted that he feels "most Americans instinctively realize that trading some challenges with the insurance companies for the bureaucracy of the federal government is not the solution." Despite the Republican stance that "legislative proposals would put government bureaucrats between patients and doctors," the hearing was effective in showing that "patients now contend with private insurance bureaucracies."

When questioned about how much they were paid, some insurance company executives were expectedly withdrawn. Executives were given the choice to either answer at the hearing or submit their answers in writing.

That didn't stop Colleen Reitan, executive vice president of Health Care Services Corp. from sharing, however. Her company does business as Blue Cross and Blue Shield of Illinois, New Mexico, Oklahoma and Texas, and she confessed that she makes $728,000. Rep. Patrick J. Kennedy (D-R.I.) claims that what he finds so disconcerting about all of this is that Cigna's head earned $11 million last year. Rep. Kennedy also believes that the insurance company earnings are coming from denied claims.

As an example, Kucinich cited the story of cancer patient Esther Dardinger. Esther was successfully undergoing chemotherapy treatment when her insurer, Anthem Blue Cross & Blue Shield, decided to stop paying for it. "The decision was based on a 10-minute review of the case, according to court records" reported The Washington Post. Although she appealed, Anthem maintained its position, eventually leaving her family to cover the cost of the treatment itself. Esther Dardinger died at the age of 49, and "would have lived an additional eight months to two years, ‘maybe longer,' if her chemotherapy had not been interrupted, her doctor testified during the litigation."

Furthermore, Kucinich cited a recent report done by the California Nurses Association that claims "six of the largest insurers operating in California rejected 47.7 million claims – 22 percent of the total" filed from 2002 through the first half of 2009

The executives of these companies testified last Thursday that, in actuality, the rejected population is much smaller than the percentages claimed by the study. Wellpoint, now the parent of Anthem Blue Cross and Blue Shield of Ohio, said "the nurses association used data from a regulatory filing that included claims initially rejected for any reason – for example, if patients had not met their deductibles or the claims lacked supporting information."

Tom Richards, senior vice president of CIGNA, told the subcommittee, "[o]ur mission is to improve the health, well being and sense of security of the customers we serve."

This writer has to respectfully disagree with Tom Richards. I think CIGNA's mission, and the rest of the insurance industry, is to make money, and hold onto the money they have, as long as possible. That is what I see.

Originally posted at InjuryBoard by Greg Webb

Full post as published by Charlottesville Personal Injury Lawyer on September 30, 2009 (boomark / email).