Thursday, September 21, 2006


Ezra Klein yesterday on retroactive cancellations of policies by health insurers:

In practice, the scam works like this: Selah Shaeffer, age four, was diagnosed with an aggressive, cancerous tumor in her jaw. The family had been with Blue Cross for about a year, and the bump was ex[a]mined and biopsied after they'd begun insurance. But because it was growing before, Blue Cross cut off reimbursement for surgeries it had already authorized, and is now trying to recover $20,000 from the Shaeffers. Or take the Nazertyans, who had premature twins. They were covered by Blue Shield all throughout, and disclosed all facets of the birth and operations. Blue Shield not only dropped, them, but was trying to get back $98,000 they'd already paid under the rationale that the Nazertyans hadn't disclosed an early miscarriage. After the LA Times reported the st[or]y, Blue Shield called off the debt collectors.

What's so remarkable about all this is what it exposes about how health insurance in this country works: We rely almost exclusively on private insurers whose primary business imperative is not to pay when we get sick. They do that by seeking to deny coverage before the fact, or reject claims afterwards. They pay for platoons of employees who have no job other than scrutiniz[ing] thousands of policies a week to find sufficient cause for cancellation. Say what you will about the inefficiencies of the public sector, but can it really match the ruthlessness and absurdity of insurers spending large amounts of money so they don't have to insure? Is that sort of profit motive really what you want underlying your health care coverage?

Nothing to add here. Seems pretty messed up to me.

1 comment:

Karla said...

It doesn't work from the provider side either. I was solicited to join the Intermountain Health Care panel because they didn't have enough therapists from my geographic area. However, they have many different plans, and although I'm on their web site as a provider, only a very small percentage of people actually insured by IHC can actually see me and be covered. The insurance company gets the benefit of claiming a huge provider list with many options without ever actually paying for any services.