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Health Insurers' Move to Drop Child Policies Draws Criticism

hazlnut

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Health Insurers' Move to Drop Child Policies Draws Criticism

A move by insurance companies to stop selling child-only policies is drawing criticism ahead of Thursday, when the federal health overhaul will require insurers to cover sick children.

Aetna Inc., Cigna Corp., WellPoint Inc., Humana Inc. and UnitedHealth Group Inc.'s Golden Rule subsidiary say they will no longer sell new child-only policies. The new law requires them to accept applications from sick children on insurance policies that they sell, but doesn't require them to sell a policy individually to children in the first place. Insurers said children with pre-existing conditions will be able to apply for coverage on their parents' plans.

Well they found a loophole. Force parents to wait until their children are sick enough to need health insurance, meaning never take them to a pediatrician for normal check-ups and shots...

At least, the insurance companies are not trying to hide their total lack of ethics. I guess they'll blame big Gov for this.

This watered down highbred b.s. has got to end. Either go one way or the other. A robust public option or go back to the road to insolvency and bankruptcy we were on.

National and available everywhere: A strong public health insurance option will be a national public health insurance program, available in all areas of the country. The insurance industry is made of of conglomerates that have national reach. In order to have the clout to compete with the insurance industry and keep them honest, the public health insurance option must be national as well.

Government appointed and accountable: The entire problem with private health insurance is that they aren’t accountable to you or me. A public health insurance option must have a different incentive. A public health insurance option doesn’t have to be a government entity necessarily, but its decision makers must be appointed by government and must be accountable to government.

Bargaining clout: The whole point of health reform is to lower health care costs. Clearly, the insurance industry has failed to lower costs when left to their own devices. As the President says, we need a strong public health insurance option to lower rates, change the incentives in our health care system, and keep the industry honest.

Ready on day one: The private health insurance industry has utterly failed to control health care costs or provide their customers the quality they’ve paid through the nose for. With one person going bankrupt every 30 seconds due to health care costs, we cannot afford to wait any longer for a real fix. We need the public health insurance option to start lowering prices now. That means no trigger.
 

RightinNYC

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1) Government enacts law that makes a particular type of policy unprofitable for corporation.
2) Corporation stops selling new policies of that type.
3) OMG CORPORATION IS EVIL

The logic seems strained.

edit: Not to mention that if you actually read the article, you can see how dem politicians are scrambling to mischaracterize these actions for political gain and how your OP badly misstates what's actually happening:

"The new federal rules required guaranteed-issue coverage for individuals under 19 without regard to affordability," said Matt Wiggin, an Aetna spokesman. "So folks seeking coverage would be those who need immediate services for high-cost conditions." Mr. Wiggin says the insurer made the decision to protect its existing child-only policyholders from increasing premiums. Aetna has only discontinued the sale of new policies, he said. Golden Rule also recently discontinued the sale of policies to children individually. "Given current health-insurance market dynamics and regulations, it is necessary to require a parent to be on a policy in the same manner as is required on an employer group plan," said Ellen Laden, a spokeswoman.

...

Rep. Pete Stark (D. Calif.) said, "The insurance industry has once again shown their reckless disregard for the well-being of consumers, which is why we need the health reform law that holds them accountable." Robert Zirkelbach, a spokesman for America's Health Insurance Plans, said its pledge in March pertained to concerns at the time about children getting access to their families' policies, not to the "small, niche" market of child-only policies. Mr. Zirkelbach said there is a much greater likelihood that parents will wait until their child gets sick to purchase a child-only plan than a health policy for the whole family, and the industry is worried that the pool of members it is covering will skew increasingly toward the very costly.
 
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1) Government enacts law that makes a particular type of policy unprofitable for corporation.
2) Corporation stops selling new policies of that type.
3) OMG CORPORATION IS EVIL

The logic seems strained.

edit: Not to mention that if you actually read the article, you can see how dem politicians are scrambling to mischaracterize these actions for political gain and how your OP badly misstates what's actually happening:

This is only the second round of blow back because the wildly phony "Obama doesn't Care about your health kill granny plan."

The first shot was the raising of insurance rates just weeks ago and there will be more to come before we can see daylight once the New Congress and Senate begin the work to repeal the damage Obama has done to Health Care and the economy.
 

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Health Care and the Tragedy of the Commons - Adam Wernick - Open Salon
~snip
Again, from Forbes:

"We lost the positive aspects of affiliation health insurance starting in the 1960s and through the 1980s when Wall Street discovered there was money to be made turning nonprofit health insurers, hospitals and nursing homes into investor-owned companies. What we got was a massive conflict-of-interest--profit vs. public good--that has culminated in a dysfunctional health delivery system that has undermined our economy, reduced our national wealth and torn our social fabric."

Health insurance that is driven by profits, not by the needs of its customers, has abandoned the whole idea of mutuality. By denying coverage to their contributors, while reaping profits, they become a type of free-rider - draining the system of money and resources while deriving great benefits from participating in it.

We need to embrace preventative medicine, nutritional counseling, local free gyms. we need to think out of the box and change how we think of healthcare. Everything we do should not be seen as a means to make a fekin' buck. :2no4:
 

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buck

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Bargaining clout: The whole point of health reform is to lower health care costs. Clearly, the insurance industry has failed to lower costs when left to their own devices. As the President says, we need a strong public health insurance option to lower rates, change the incentives in our health care system, and keep the industry honest.

Ready on day one: The private health insurance industry has utterly failed to control health care costs or provide their customers the quality they’ve paid through the nose for. With one person going bankrupt every 30 seconds due to health care costs, we cannot afford to wait any longer for a real fix. We need the public health insurance option to start lowering prices now. That means no trigger.

You mention it quite a bit, but can you tell me how insurance companies can really lower the cost of helath care? Nearly 90 percent of the premium health insurance companies take in go toward health care. Only about 3% is for proft.
 

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way to go liberal government...You pass a law that forces insurance companies to cover sick kids, how stupid, then insurance companies say to hell with it and stop selling child-only policies. Blame it on Obama for actually trying to get sick children health care coverage.
 

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way to go liberal government...You pass a law that forces insurance companies to cover sick kids, how stupid, then insurance companies say to hell with it and stop selling child-only policies. Blame it on Obama for actually trying to get sick children health care coverage.

No ones mad he tried to "help". Everyones going "DUH, of course this would happen.
 

RightinNYC

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way to go liberal government...You pass a law that forces insurance companies to cover sick kids, how stupid, then insurance companies say to hell with it and stop selling child-only policies. Blame it on Obama for actually trying to get sick children health care coverage.

This is a pretty ridiculous mischaracterization of what's actually happening. The law passed by congress creates terrible incentives that would result in substantial losses to the insurers if they continued to offer these policies. That would cause the insurers to have to raise their other rates. Instead, the insurers will no longer offer the child-only policies, but will continue to allow people to add children to their other policies.

Insurers said they were acting because the new federal requirement could create huge and unexpected costs for covering children. They said the rule might prompt parents to buy policies only after their kids became sick, producing a glut of ill youngsters to insure. As a result, they said, many companies would flee the marketplace, leaving behind a handful to shoulder a huge financial burden.

The insurers said they now sell relatively few child-only policies, and thus the changes will have a small effect on families.

Big health insurers to stop selling new child-only policies - latimes.com
 

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I don't understand why you would think it is strained or that somehow insurance companies weren't already making ridiculous amounts of profit. You want to know how to make insurance companies play nicer? Break them apart, and force them to play nice. The government pussied out and put these loopholes in here so they could get some more lobbying money. Hooray for Democrats! Thanks for ****ing children over and blaming Republicans, oh but hey also thanks for raising every pack of cigarettes up the past 2 years to pay for childerns health and doing it again soon, because ****ing me over and not the insurance company makes even more sense.
 

RightinNYC

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I don't understand why you would think it is strained or that somehow insurance companies weren't already making ridiculous amounts of profit.

What's the profit margin for the insurance industry?
Who do you think should be in charge of deciding how much profit each industry is allowed to make?

You want to know how to mae insurance companies play nicer? Break them apart, and force them to play nice.

Great idea! Let's do the same thing with airlines, auto companies, movie studios, retailers, energy companies, food companies, and everyone else. I mean, how could such a simplistic idea not work wonders?

The government pussied out and put these loopholes in here so they could get some more lobbying money. Hooray for Democrats! Thanks for ****ing children over and blaming Republicans, oh but hey also thanks for raising every pack of cigarettes up the past 2 years to pay for childerns health and doing it again soon, because ****ing me over and not the insurance company makes even more sense

It sounds like your position is based more on "I can't believe I have to pay more for my cigs" and less on "this is a sound economic proposal."
 

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What's the profit margin for the insurance industry?
Who do you think should be in charge of deciding how much profit each industry is allowed to make?



Great idea! Let's do the same thing with airlines, auto companies, movie studios, retailers, energy companies, food companies, and everyone else. I mean, how could such a simplistic idea not work wonders?



It sounds like your position is based more on "I can't believe I have to pay more for my cigs" and less on "this is a sound economic proposal."

The government actually did decide how much insurance companies made quite a few years ago with Nixon scheming on how to make more money within the industry, so just as fast as they made it more profitable for the fortunate, they could make it as beneficial for the less fortunate. Also breaking them up is a good idea when their is a monopoly shared by 3 main companies, and yeah I am bitching about my cigarettes being more while at the same time pointing out the irony of it.
 

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apologies for popping you palliatives, but obama has thoroughly SHOT america's health care WAD for at least a generation

there will be NO movement forward on this impossible issue in most of your lifetimes

i'm astonished anyone, let alone people who spend so much time in political chatrooms, could be so egregiously outta touch with america's mood

live it, libs, love it

it's YOURS!

MEANINGFUL talk about health care begins only AFTER november, there will be much remediation required

have fun, tho

chat
 

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The government actually did decide how much insurance companies made quite a few years ago with Nixon scheming on how to make more money within the industry, so just as fast as they made it more profitable for the fortunate, they could make it as beneficial for the less fortunate. Also breaking them up is a good idea when their is a monopoly shared by 3 main companies, and yeah I am bitching about my cigarettes being more while at the same time pointing out the irony of it.

Got a source?
 

hazlnut

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More info on this issue:

Big health insurers to stop selling new child-only policies

Major health insurance companies in California and other states have decided to stop selling policies for children rather than comply with a new federal healthcare law that bars them from rejecting youngsters with preexisting medical conditions.

Anthem Blue Cross, Aetna Inc. and others will halt new child-only policies in California, Illinois, Florida, Connecticut and elsewhere as early as Thursday when provisions of the nation's new healthcare law take effect, including a requirement that insurers cover children under age 19 regardless of their health histories.

The action will apply only to new coverage sought for children and not to existing child-only plans, family policies or insurance provided to youngsters through their parents' employers. An estimated 80,000 California children currently without insurance — and as many as 500,000 nationwide — would be affected, according to experts.

I understand this issue a little better. What insurance companies are trying to do is incentivize parents to buy family plans, purchase full coverage for their families.

That I understand and agree with this.

On the surface it does look like a win-win. Health insurance companies are able to sell a more comprehensive value added product. Obviously, the rate for family coverage is higher than an individual child. Parents who budget for this will get their families covered and stop showing up at emergency room with a flu. This is also why the individual mandate (originally conceived by a conservative think tank) is so important, it gets people who are not covered by their employer and who don't qualify for Medicaid to budget accordingly and be responsible about buying health insurance.

Hear that, Teabrains, big Gov wants you to be responsible and not rely on emergency rooms to treat your type-2 diabetes.

I'm not clear on who the typical customer is for Child-Only plans. How many company plans cover the employee only? That would be the only instance where I could see a parent needing coverage for his child only. Foster children are covered by the state. If you become the legal guardian of a child that is not yours, then they should be covered under your plan.

While I understand the notion of wanting to save money, and younger parents only wanting to cover their infants/toddlers for now, the idea is to get as many people as insured as possible and not have the burden fall on the states when people show up at emergency rooms with things that could have been treated with regular visits to the doctor. And who pays if an invincible uninsured parent gets in a car accident?

I don't get why Teabaggers want to repeal the Health Care Bill (maybe because they have no clue how it's supposed to work)... It's government pushing people be more responsible for themselves through the individual mandate while incentivizing more competitive pricing and regulating ethical practices. These are attempts at pragmatic modifications to Free Market. I say we see how the bill works, then modify it as we go along. Eventually there's going to have to be a push towards more not-for-profit care, as that's the only way to really get pricing down.

The downside of not offering Child-Only plans:
*the new value-added family plan is unreasonably limited, and therefore not much of a value.
*parents don't budget accordingly and then wait until their children get sick.
*Children w/o coverage getting in accidents and having to be transported to public hospitals when they've been stabilized. Or parents demanding full coverage for their newly sick/injured child so they can stay and be treated at private hospitals.
*this becomes a major PR problem and damages the brand image for companies. Whenever companies put children at risk, even unintentionally, they open the door public outcry and possible unwanted attention to regulators they can't control.
*other unintended consequences.

In fairness to these bigger companies, it seems like they are saying, given our business model these are the only types of plans we can sell at present time. That's fine as it doesn't stop smaller companies from specializing in child-only coverage. Hopefully these will be reputable companies that don't take advantage of younger parents looking to cover their infants/toddlers.

The big consequence is that these companies who don't offer child-only coverage to healthy children may be hit with some big claims down the road when parents and state insurance regulators demand that they follow the law and cover a newly sick child.

One last question: While long-term growth is needed in most industries, what are the benefits of long-term growth in health insurance? These big companies have constantly shown a profit and paid their executives handsomely, but how has this benefited society? Set employing people at various pay-rates aside, every big company does this. How has private health insurance improved the quality of its product in a way that justifies these profits?

Compare 'advances' in private health insurance to that of say... cell phones. Or even pharmaceuticals, another health-related industry.
 

Harry Guerrilla

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More info on this issue:

Big health insurers to stop selling new child-only policies



I understand this issue a little better. What insurance companies are trying to do is incentivize parents to buy family plans, purchase full coverage for their families.

That I understand and agree with this.

On the surface it does look like a win-win. Health insurance companies are able to sell a more comprehensive value added product. Obviously, the rate for family coverage is higher than an individual child. Parents who budget for this will get their families covered and stop showing up at emergency room with a flu. This is also why the individual mandate (originally conceived by a conservative think tank) is so important, it gets people who are not covered by their employer and who don't qualify for Medicaid to budget accordingly and be responsible about buying health insurance.

Hear that, Teabrains, big Gov wants you to be responsible and not rely on emergency rooms to treat your type-2 diabetes.

I'm not clear on who the typical customer is for Child-Only plans. How many company plans cover the employee only? That would be the only instance where I could see a parent needing coverage for his child only. Foster children are covered by the state. If you become the legal guardian of a child that is not yours, then they should be covered under your plan.

While I understand the notion of wanting to save money, and younger parents only wanting to cover their infants/toddlers for now, the idea is to get as many people as insured as possible and not have the burden fall on the states when people show up at emergency rooms with things that could have been treated with regular visits to the doctor. And who pays if an invincible uninsured parent gets in a car accident?

I don't get why Teabaggers want to repeal the Health Care Bill (maybe because they have no clue how it's supposed to work)... It's government pushing people be more responsible for themselves through the individual mandate while incentivizing more competitive pricing and regulating ethical practices. These are attempts at pragmatic modifications to Free Market. I say we see how the bill works, then modify it as we go along. Eventually there's going to have to be a push towards more not-for-profit care, as that's the only way to really get pricing down.

The downside of not offering Child-Only plans:
*the new value-added family plan is unreasonably limited, and therefore not much of a value.
*parents don't budget accordingly and then wait until their children get sick.
*Children w/o coverage getting in accidents and having to be transported to public hospitals when they've been stabilized. Or parents demanding full coverage for their newly sick/injured child so they can stay and be treated at private hospitals.
*this becomes a major PR problem and damages the brand image for companies. Whenever companies put children at risk, even unintentionally, they open the door public outcry and possible unwanted attention to regulators they can't control.
*other unintended consequences.

In fairness to these bigger companies, it seems like they are saying, given our business model these are the only types of plans we can sell at present time. That's fine as it doesn't stop smaller companies from specializing in child-only coverage. Hopefully these will be reputable companies that don't take advantage of younger parents looking to cover their infants/toddlers.

The big consequence is that these companies who don't offer child-only coverage to healthy children may be hit with some big claims down the road when parents and state insurance regulators demand that they follow the law and cover a newly sick child.

One last question: While long-term growth is needed in most industries, what are the benefits of long-term growth in health insurance? These big companies have constantly shown a profit and paid their executives handsomely, but how has this benefited society? Set employing people at various pay-rates aside, every big company does this. How has private health insurance improved the quality of its product in a way that justifies these profits?

Compare 'advances' in private health insurance to that of say... cell phones. Or even pharmaceuticals, another health-related industry.

Insurers used to offer cheaper, more affordable plans, for a lot of different situations not that long ago.
With more regulation and insurance mandates, those plans have been legislated out of existence.

Wanting more and expecting to pay less, it doesn't work like that.

Most people can get their kids covered under the heavily subsidized SCHIP plans.
There should be very little whining.
 
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hazlnut

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Insurers used to offer cheaper, more affordable plans, for a lot of different situations not that long ago.
With more regulation and insurance mandates, those plans have been legislated out of existence.

Be more specific. You seem to be talking about consequences that happened over time 1990-2000, 2001-2009? Give examples of older mandates and regs that have directly caused the elimination of a specific type of plan.

*Where these plans all they were cracked up to be?

*How did a mandate cause the elimination of a good plan?


Wanting more and expecting to pay less, it doesn't work like that.

The free market works like his -- people shopping for better service/product at a competitive price. Choice. Yes, that's how it works. When you limit choices, there is no free market.

For a long time, the Health Insurgence Industry relied on what is called Information Asymmetry and consumers had relatively little influence on their own health service choices.

Health insurance is the moral hazard model of Information Asymmetry, the consumer lacks lacks information about performance of the agreed-upon transaction or lacks the ability to retaliate for a breach of the agreement. Many cases you can't even argue that the consumer didn't read the 'fine print' because the ultimate decision about specific coverage came from a claims rep. In a for-profit model Claims departments were incentivized to cover as few claims as possible, while sales department were selling group policies to company reps. The buyer relies on the seller’s expert opinion to a much greater degree than he would in any other market.

Most people can get their kids covered under the heavily subsidized SCHIP plans.
There should be very little whining.

Wouldn't it be better if middle-income families w/o work insurance purchased their own comprehensive and ethical plans?
 

Harry Guerrilla

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Be more specific. You seem to be talking about consequences that happened over time 1990-2000, 2001-2009? Give examples of older mandates and regs that have directly caused the elimination of a specific type of plan.

*Where these plans all they were cracked up to be?

*How did a mandate cause the elimination of a good plan?

Preventative mandates largely killed the emergency/surgical only plans.
Where before you paid out of pocket for visits and insurance covered emergency/surgical care.

From what I remember, the plans cost around $100 a month for the average person.

Wellchild care mandates, preventative screening mandates, all those things are not included with a surgical/emergency insurance plan.
They are affordable out of pocket.

The free market works like his -- people shopping for better service/product at a competitive price. Choice. Yes, that's how it works. When you limit choices, there is no free market.

For a long time, the Health Insurgence Industry relied on what is called Information Asymmetry and consumers had relatively little influence on their own health service choices.

There is no such thing a perfectly symmetrical information, not even with the government.
With government, they make aggregated choices.
Choices on the average, as we know there are always exceptions and such many people get left out in the cold.

Private insurance offered more choice and flexibility.

Health insurance is the moral hazard model of Information Asymmetry, the consumer lacks lacks information about performance of the agreed-upon transaction or lacks the ability to retaliate for a breach of the agreement. Many cases you can't even argue that the consumer didn't read the 'fine print' because the ultimate decision about specific coverage came from a claims rep. In a for-profit model Claims departments were incentivized to cover as few claims as possible, while sales department were selling group policies to company reps. The buyer relies on the seller’s expert opinion to a much greater degree than he would in any other market.

Courts exist for any breach of contract.
Fine print is a bogus argument, you can read the document before you sign it and if you're really worried it would cost you little to have it reviewed by a lawyer.

Few claims as possible means that they deny invalid claims and not claims covered by the agreed upon contract.
If you didn't read what was covered, it's your fault, not the insurer.

Wouldn't it be better if middle-income families w/o work insurance purchased their own comprehensive and ethical plans?

People should be buying plans outside of their employer.
Government shouldn't be creating incentives for employer plans but they have been for quite some time.
 

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super popular medicare advantage zeroed out: CBO Testimony Echoes Insurers

bottom line, you can't expand m&m by some TWELVE MILLION while simultaneously reducing their already severely overstrained and direly relied-upon funding by HALF A TRIL

as obama said at the georgetown townhall day before yesterday (which the nyt described as a "therapy session for disillusioned obama supporters,") the math just isn't there

Governors balk over what healthcare bill will cost states - The Boston Globe

live it, libs, love it

it's YOURS!
 
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emergency room visits actually INCREASE, despite what the solons suggest

Emergency room visits grow in Mass. - The Boston Globe

it's cuz there aren't enough doctors to treat the millions of newly insured, leading to "primary care access problems"

none of this is news

which is why you need to read more and talk less
 

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hazlnut

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Preventative mandates largely killed the emergency/surgical only plans.
Where before you paid out of pocket for visits and insurance covered emergency/surgical care.

From what I remember, the plans cost around $100 a month for the average person.

1)Those plans were sold to low income households. The companies aggressively denied claims, knowing the low percentage of low income people that would seek legal representation. Or could afford it.

2)State mandates? If you want to go state by state, mandate by mandate... or just give some specific examples of how a state mandate 'eliminated' something that was a valuable insurance product.


Wellchild care mandates, preventative screening mandates, all those things are not included with a surgical/emergency insurance plan.
They are affordable out of pocket.

The regs vary state by state. Certain types of insurance like supplemental health insurance, short term coverage or international travel coverage - are exempt from those requirements.

Regs are there to insure quality service and coverage.

There is no such thing a perfectly symmetrical information, not even with the government.
With government, they make aggregated choices.
Choices on the average, as we know there are always exceptions and such many people get left out in the cold.

Fair enough.

But minimizing those left out is the point.

Private insurance offered more choice and flexibility.

They have moved toward offering a limited number of choices once you're in the plan. Competitive pricing is still not there.

Courts exist for any breach of contract.
Fine print is a bogus argument, you can read the document before you sign it and if you're really worried it would cost you little to have it reviewed by a lawyer.

Insurance company bean counters have this down to a science -- they budget for a certain number of legal claims. And they can figure out which type of claims are easiest to deny, which type of client is least likely to hire an attorney, and which type of legal action is least likely to be successful.

And you missed my point about 'fine print' -- when a claims rep in some other state is making a final decision on treatment, there is no fine print. And to the extent those decisions are based on profit and not reasonable, ethical honoring of the contract, government must regulate that.

Few claims as possible means that they deny invalid claims and not claims covered by the agreed upon contract.

That's a very ignorant statement not backed up at all by practices over the last 3 decades.

If you didn't read what was covered, it's your fault, not the insurer.

Again, extremely naive.

Companies sell insurers computer programs and claims management protocols designed to reject as many legitimate claims as possible. Also keep in mind, that for many, once a claim is rejected, the process of an appeal is so daunting and overwhelming, that many of these claims go unpaid. This is part of the business model of the insurance industry.

A significant number of claims denials are related to medical necessity, or the lack thereof. The health plan is essentially saying that the physician or medical provider that treated you did so without a justifiable medical reason, or that it was cosmetic, experimental, or investigational. Or when a patient goes to a hospital which is contracted with their health plan and feel everything was taken care of, but then they receive out of network bills from the anesthesiologist, pathologist, radiologist, assistant surgeon and so on, which are reduced in payment due to "Usual and Customary".



People should be buying plans outside of their employer.
Government shouldn't be creating incentives for employer plans but they have been for quite some time.

Employers can get better group rates.

But if a coal mining company is buying into an insurance plan that doesn't cover lung disease... That's were gov comes in.
 

The Prof

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that's nice, but here in reality under the reform that has exhausted for lifetimes any futher efforts of reform, ER visits steeply INCREASE, med advantage is GONE, the m&m's are simultaneoulsy EXPANDED massively and DEFUNDED drastically, and all 50 states are facing what dem gov of tennessee phil bredesen (speaking for bill richardson of new mexico, christine gregoire of washington, bill ritter of colorado and brian schweitzer of montana, once progressive superstars all) called THE MOTHER OF UNFUNDED MANDATES

read

it's YOURS!
 

apdst

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Health Care and the Tragedy of the Commons - Adam Wernick - Open Salon
~snip


We need to embrace preventative medicine, nutritional counseling, local free gyms. we need to think out of the box and change how we think of healthcare. Everything we do should not be seen as a means to make a fekin' buck. :2no4:

Where the hell's the fun in that?!? I can't buy a new boat, unless I spend a majority of my time making a friggin' buck.

It's called, "making a living", and if more people engaged in it, the economy would be better off. Or, let me say, if the government would get out of the way, then more people could engage in it and the economy would be better off.

One way of, "getting out of the way", would be to throw this piece-a-**** healthcare bill in the toilet and start over with a plan that makes actual sense.
 

apdst

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1)Those plans were sold to low income households. The companies aggressively denied claims, knowing the low percentage of low income people that would seek legal representation. Or could afford it.

2)State mandates? If you want to go state by state, mandate by mandate... or just give some specific examples of how a state mandate 'eliminated' something that was a valuable insurance product.




The regs vary state by state. Certain types of insurance like supplemental health insurance, short term coverage or international travel coverage - are exempt from those requirements.

Regs are there to insure quality service and coverage.



Fair enough.

But minimizing those left out is the point.



They have moved toward offering a limited number of choices once you're in the plan. Competitive pricing is still not there.



Insurance company bean counters have this down to a science -- they budget for a certain number of legal claims. And they can figure out which type of claims are easiest to deny, which type of client is least likely to hire an attorney, and which type of legal action is least likely to be successful.

And you missed my point about 'fine print' -- when a claims rep in some other state is making a final decision on treatment, there is no fine print. And to the extent those decisions are based on profit and not reasonable, ethical honoring of the contract, government must regulate that.



That's a very ignorant statement not backed up at all by practices over the last 3 decades.



Again, extremely naive.

Companies sell insurers computer programs and claims management protocols designed to reject as many legitimate claims as possible. Also keep in mind, that for many, once a claim is rejected, the process of an appeal is so daunting and overwhelming, that many of these claims go unpaid. This is part of the business model of the insurance industry.

A significant number of claims denials are related to medical necessity, or the lack thereof. The health plan is essentially saying that the physician or medical provider that treated you did so without a justifiable medical reason, or that it was cosmetic, experimental, or investigational. Or when a patient goes to a hospital which is contracted with their health plan and feel everything was taken care of, but then they receive out of network bills from the anesthesiologist, pathologist, radiologist, assistant surgeon and so on, which are reduced in payment due to "Usual and Customary".





Employers can get better group rates.

But if a coal mining company is buying into an insurance plan that doesn't cover lung disease... That's were gov comes in.

Why didn't those low income households seek help from government funded healthcare that already exists?
 
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