Health Insurer's Letter Seeks to Get Coverage Canceled:
California Doctors' Group 'Outraged' at Information Request
Feb. 12, 2008—
LOS ANGELES (AP) - 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.
Blue Cross is one of several California insurers that have been criticized for issuing policies without checking applications and then canceling coverage after individuals incur major medical costs. The practice of canceling coverage is under scrutiny by state regulators, lawmakers and the courts.
Troughton said the request of doctors has been in place for several years and Blue Cross has not received any complaints about it. The health insurance company doesn't always cancel the policies of patients with discrepancies in their applications and occasionally offers them another plan, she said.
Lynne Randolph, a spokeswoman for the state Department of Managed Health Care, said the agency would review the letter. Blue Cross is fighting a $1 million fine the department imposed in March over alleged systemic problems the agency identified in the way the company rescinds coverage.
"They are playing a game of 'gotcha' where they are trying to use their doctors against their patients' health interests," said Anthony Wright, executive director of HealthAccess California, a healthcare advocacy organization. "That's about as ugly as it gets."
(Copyright 2008 by The Associated Press. All Rights Reserved.)
Outrage Prompts Blue Cross to Halt Info Requests:
Doctors Said Insurer's Request to Report Pre-Existing Conditions Could Hurt Doctor-Patient Trust
By DAN CHILDS
ABC News Medical Unit
Feb. 13, 2008 —
After a barrage of criticism from doctors, privacy groups and government officials, insurance giant Blue Cross announced Tuesday evening that it would halt letters it had sent to California physicians that urged them to report patients' pre-existing health conditions, possibly causing them to lose insurance coverage, according to The Los Angeles Times.
Doctors across the country seethed with indignation at the requests, which they felt placed business interests over the needs of patients.
"This is outrageous," says Dr. Arthur Feldman, chairman of medicine at Jefferson Medical School in Philadelphia. "The 'Blues' are sitting on billions of dollars while most cannot afford health insurance and 46 million have no insurance. This will require congressional action."
"This so simply and succinctly exposes what health care 'insurance' in the United States is: a business," says Dr. Joanna Cain, director of the Center for Women's Health at Oregon Health and Science University in Portland.
"For a business, this makes sense," she says. "For a basic service that more Americans every day are losing access to, that will impact the financial future of the nation with a less healthy population, and that makes us the laughing stock of the developed world for not covering basic medical care for our citizens, it makes no more sense than any of our health care financing schemes."
The doctors' reactions to the proposal by the state's largest for-profit health insurer echoes that of the California Medical Association, which blasted the idea Tuesday morning. Dr. Richard Frankenstein, president of the Association, told The Associated Press that the letter sent by the insurer asks 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."
Cost-Cutting Effort, Company Says
Telephone messages left with the press office of WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, were not immediately returned. A spokesperson for the company told the Times, who broke the story Tuesday morning, that the request was made in an effort to cut costs for members.
The letter that the company sent out to doctors clearly implies that these cuts would come from revoked medical coverage for members who did not report certain pre-existing conditions.
"We ask for your assistance to help identify medical omissions because you, being the primary care provider, will have firsthand knowledge of services provided or requested," the letter reads. "Within the first two years of membership, Blue Cross has the right to cancel the member's policy back to its effective date for failure to disclose medical history."
Doctors say the approach is flawed -- and could ultimately damage the trust between doctors and their patients.
"Personally, I believe it is another corrupted concept by insurers," says Dr. Joel Saper, director of the Michigan Head Pain and Neurological Institute in Ann Arbor.
"While I understand the importance of that info to them, physicians cannot be asked to compromise the special trust and relationship we develop with our patients. We cannot be cast into a policing role to enhance insurers' profitability."
Dr. Walter Peterson, professor emeritus of medicine at the UTSW Medical Center in Dallas, agrees. "I applaud any effort to save money, but it should not be a doctor's responsibility to blow the whistle on his patient," he says. "If a patient has lied on his or her application [about] pre-existing conditions, it is up to the carrier to find out, not a physician."
And Saper says patient health could be the main casualty if the doctor-patient relationship is strained. He notes that if patients fear their doctors will report discrepancies in their medical records, "it will induce patients to be inaccurate in the timeline of their illness patterns, which must be accurate in order to establish the correct diagnosis and clinical perspective, and so much more."
Others worry that such a system could prevent patients from getting needed care simply because it would become unaffordable without insurance.
A Sign of Things to Come?
But along with their indignation at the Blue Cross letter, some doctors say they fear that this cost-cutting tactic could become a trend -- especially as new diagnostic tests for disease or disease risk enter the medical realm.
"I do believe this is the wave of the future, and it will become more prevalent as we move into the genomics and specifically gene screening for disease risk and, in particular risk for diseases for which there is no treatment," says Dr. Mike Hogan, assistant professor of medicine at the Mayo Clinic in Rochester, Minn.
Others, like Dr. Sanjeev Saksena, say that the development should be regarded as a call for universal health care.
"This is already being done in other surreptitious ways by all insurers," says Saksena, professor of medicine at the Robert Wood Johnson Medical School.
"One of these days our public will realize that not-for-profit payers are needed for health care and finally appreciate what all other Western nations know -- universal health care is needed and cannot be provided by the for-profit sector."
So sad that insurance costs an arm and a leg, the companies make huge profits and they stoop to such tactics.
I had a blood clot form BCP pills when I was younger and I could not get health insurance for many years because of that being on my history, it really sucked.
Now I am covered under my husband's work policy, we pay so very much for coverage, yet we are afraid to seek medical help because we hope that he will be getting a new office in another state this year and that will mean we will need a new insurance plan.
I have a fear of doctors and a fear of health insurance.
I know from personal recent experience that Blue Crap/Blue Sh!t will do anything to protect their profit, even if it's detrimental to your health. I had to fight them tooth and nail to approve a necessary operation.
When my doctor sent detailed information and pictures to them, they rubberstamped it because it's their policy to rubberstamp. They're hoping that customers will be too lazy or meek or dumb to ask for an appeal and fight it.
Personally, I think these pre-existing condition clauses should be done away with. If this is the way citizens are being insured in America, then this has got to go. How wrong does it seem to dole out health coverage from a company whose bottom line is its profit?
I know twenty years ago insurance companies made a profit but they didn't expect their customers to die for it. What happened here to make it get this bad?
__________________ If mama ain't happy, ain't nobody happy.
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Luke's in kindergarten!
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Blue Cross would not cover 100% of my daughter's bili-blanket she NEEDED after she was born. What the heck are we paying for with our $135 per WEEK premiums?!
I saw an article recently that said it was cheaper for insurance companies to treat the complications from obesity than to prevent it. They just don't care about anything other than money.
This is definitely one of my biggest "pet peeves." Gets me going every time!
__________________
Proud to be a Stay at Home Mom Me 31 ~ DH 29 2 Little Girls
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Im lucky I guess I have only had good luck with our bc/bs ppo insurance. We dont pay alot in (good contract through our work) and our surgeries and treatments are fully covered. The only time there was a question was my perinatalogist assisting in my csection but all I had to do was call the specialist for more paperwork sent in. When my husband had hmo we had huge issues with our insurance and meds and with our other provider.
If I understand it correctly (didnt read everything, to long sorry lol) as long as preexisting conditions are being told upfront there wouldnt be a problem. My insurance in Michigan is the same way and always has been.
Since its through my husbands work they cant deny me. Life insurance is the same way for us, they have to allow us $10,000 at least and I can raise that $10,000 each year after. They said I was denied but I called around and found they were required to give me that much regardless.
So many people want universal health care and this is the only beginning of the mess if it goes through. You wont be able to get anything done and you will die waiting for it.
__________________ Pcos controlled with diet and glucophage
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I'm not for socialized healthcare; I think that would be a disaster over here. Hopefully someone will come up with a solution in my lifetime.
But does anyone remember back in the '70s/'80s when BCBS was the premiere health insurance and they made sure their customers were covered? Now it's the total opposite with them and most all of these insurance companies.
I know the cost of healthcare has gone up--people are living longer and there's an influx of illegal immigrants making our hospitals burst at the seams. When patients don't have to pay one red cent, of course hospitals have to jack up the prices somewhere else.
__________________ If mama ain't happy, ain't nobody happy.
To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts. Married since 1999
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Luke's in kindergarten!
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But does anyone remember back in the '70s/'80s when BCBS was the premiere health insurance and they made sure their customers were covered? Now it's the total opposite with them and most all of these insurance companies.
I remember being on my mom's blue cross plan, it also covered dental and eye care, it was affordable even though we were pretty poor back then.
The insurance I had before I got married refused (at first) to pay anything to have a metal splinter removed from my eye, they said they would only pay a certain amount if it became infected and was likely to lead to me losing my eye! I had it removed anyway since I couldn't blink because the damn thing hurt so bad, eventually they paid for some of it, but not much. If it didn't cause such severe pain I would have kept it in there, it was actually quite pretty and sparkled.
I'm not for socialized healthcare; I think that would be a disaster over here. Hopefully someone will come up with a solution in my lifetime.
But does anyone remember back in the '70s/'80s when BCBS was the premiere health insurance and they made sure their customers were covered? Now it's the total opposite with them and most all of these insurance companies.
I know the cost of healthcare has gone up--people are living longer and there's an influx of illegal immigrants making our hospitals burst at the seams. When patients don't have to pay one red cent, of course hospitals have to jack up the prices somewhere else.
I wonder if its due more to personal contracts instead of the entire insurance company or some states? My dad has to jump through hoops more with his and so do a few others I have talked to. I do know local hospitals are more particular around here.
We have a copay on hospital fees as of last year of $50 on a nonemergency visit and you pay it before you go home now as before you would pay it when they sent you a bill. My dad's was the same way as he had a deductible on his insurance for his surgery and it had to be paid in full two weeks before. We do not have many illegal immigrants in this area from what I have been told just many people who dont pay their hospital visits at all and dont try to set up a payment plan. It just screws everybody in that situation as our bills go higher, our insurance gets pickier, and it ruins the other person's credit.
__________________ Pcos controlled with diet and glucophage
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My brother has Downs Syndrome and my parents health insurance will not cover his speech therapy as it is a pre-existing condition. Luckily after waiting 8 years for a Medicaid waiver, it is finally covered.
__________________ Me-30 DH-32
2 furbabies-Heff & Nash the best dogs in the world.
1 angel baby-Morgan lost 9/10/2005 at 7 weeks
Mommy to 1 precious miracle born on 3/28/08-Gracie-5lbs 11oz 19.25 inches long. Overcame PCOS and MTHFR/Factor VIII clotting disorders.
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Ireland, that is pathetic on the part of the insurance company. We were born with the genes that might cause health problems early or later in life, so isn't all this "pre-existing" conditions!
These days people switch insurance companies so often, it's going to get to the point where these companies won't have to cover anything because it's all pre-existing conditions before they sign up with the next company.
__________________ If mama ain't happy, ain't nobody happy.
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Luke's in kindergarten!
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We've been through every insurance plan and it's crazy. Finally DH landed a good job with fantastic benefits and we have the best insurance we've ever had and it's BC/BS. Our health booklet like 80 pages of riders that are added on to the basic coverage. It covers infertility treatments, obesity treatments, vision care, neuro care like autism treatments, etc. It is the most comprehensive plan I have ever seen in my life and we don't pay an arm and a leg for it, either.
I am sick that the only way we got this great plan is because my husband found "the" job... plans like this should exist for individuals and not just groups who negotiate with the "in" crowd of the insurance co.
__________________
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PCOS+IR, Hypothyroidism
Sleep Apnea (cured by tonsillectomy)
30-Something Mommy of 2
Logan Scott born April 9, 2004!
Conor James born Nov 1, 2006.
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The healthcare industry and Capitalistic Insurance BUSINESS make my brain want to self implode. But, then again if such a medical malady were to occur, I couldn't get medical coverage for that because my attitude is a pre-existing condition which propegates the common response of beligerant anger eposides causing temporary acute aphasia, thus resulting in refusal to pay such high premiums and deductibles which support the industry's financial successes.
__________________ Me 30, DH 29, married since 2003.
Langerhans Cell Histiocytosis Survivor
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Forever converted menstrul cup user!
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Evil Health Insurance Companies... 
News from the next day... 
