Thursday, June 18, 2009

Recission aka if You Need Insurance, You Can't Have It

health care, public, private, bayh, recission,
Steve Benen at Political Animal did an excellent post on the health insurance industry and recission.

Recission is the practice of dropping people from coverage once they sick, even though they were paying their premiums and obeying all the rules. Oddly, that's quite legal. Oh, health insurance companies will occasionally give some justification for recission in an especially egregious case, but it's always ludicrous.

One executive said rescission is about "stopping fraud and material misrepresentations that contribute to spiraling healthcare costs." So, for example, when a woman in Texas was diagnosed with aggressive breast cancer, her insurer dropped her coverage because the company found an instance in which she visited a dermatologist for acne, and didn't tell the insurance company about it. This, the insurer said, was an example of "fraud and material misrepresentation."

Wtf does acne have to do with breast cancer? Nothing. It was just an excuse, and a bad one at that. In fact, it's the sort of excuse that makes one suspect that insurance companies aren't particularly concerned with being called on their behavior. Why should they be?

From the desk of Evan Bayh:

That my wife Susan is being paid $337,000 a year to be on the board of directors of Wellpoint is not a factor when I insist that there be no 'public option' for health care reform.
It is a matter of deep personnal conviction that I believe that if people are going to get sick and require health care, the investor class of our country should be making a profit from it. True reform will be requiring every American to purchase medical insurance thru a for-profit corporation, preferably Anthem or Blue Cross or Blue Shield which are owned by Wellpoint.

Yeah, no conflict of interest there.

Let's not forget what health insurance executives get paid for condemning sick people to suffering and death (unless you think the health care fairy stopped by and cured that woman from Texas?).

*United Health Group
CEO: William W McGuire
2005: 124.8 mil
5-year: 342 mil*

CEO: John Rowe
2005: 22.1 mil
5-year:57.8 mil*

Cardinal Health
CEO: James Tobin
2005:1.1 mil
5-year:33.5 mil*

CEO: H. Edward Hanway
2005:13.3 mil
5-year:62.8 mil*

CEO: Michael McAllister
2005:2.3 mil
5-year:12.9 mil*

CEO: John Hammergen
2005: 13.4 mil
5-year:31.2 mil*

PacifiCare Health
CEO: Howard Phanstiel
2005: 3.4 mil
5-year: 8.5 mil*

Well Choice
CEO: Michael Stocker
2005: 3.2 mil
5-year: 10.7 mil*

CEO: Larry Glasscock
2005: 23 mil
5-year: 46.8 mil*

Oh, yeah. We don't need a public option. We need to keep paying William W. McGuire $124,800,000 a year to kill people. I honestly feel like grabbing some recissionees and congregating outside his office, chanting "Hey, hey, WWM, how many cancer patients did you kill today?"


  1. Any excuse will due, so long as dig and scrape enough.

    Even here in Canada they do not cover everything. The public system does not cover (most?) corrective lenses or most dental work. You have to get that from other insurance eg Blue Cross. That's why me and my parents are being set back about $2000 (which we don't have available right now) so I can have an impacted wisdom tooth extracted.

    Am I correct in assuming that you not having insurance that covers glasses is why you're holding a fundraising drive for glasses funds?

  2. True, insurance companies exist to make money. They have it all calculated down to the dime. When I had stomach surgery, my doctor wanted me in the hospital a day early to start IV antibiotics. My insurance company said I could just take pills. They know that if I or someone like me died from a major infection, the lawsuit payouts would still leave them with more money than if they had to cover an extra pre-surgery day in the hospital for everyone. Fortunately my surgeon insisted, argued with the insurance company, and said I was going in a day early whether they paid or not.

    But it isn't going to be any better with a public option -- just slightly different. When my wife lost her job after her stroke, we had to go on state insurance because I'm self-employed, she's uninsurable, and our cobra ran out (after draining our savings). One of the first things they did was decide that she didn't need some of the medicines she was on, and that they could use substitutes. Why? The stuff she was on was too expensive. So she got things that worked far less effectively. The same type of people who work for private insurance work for government insurance. Cost savings are still a major factor even though they don't exist for profit.

    Oh yeah, and the government will give someone full disability, but makes them wait two years before they are eligible for Medicare. That makes a whole lot of sense. Generally people who are disabled have major health problems and can't wait two years for coverage. But that's the government.

  3. re: glasses drive. my vision insurance covers one vision visit every two years, and $80 towards either glasses or contacts every two years.

    last year, i got contacts, because you can get a lot of contacts for $80, but that won't cover the frames, let alone the lenses for glasses.

    skip forward a little over a year, and i can't wear contacts anymore because my eyes are no longer making enough tears, and my 2-prescriptions-ago glasses are broken beyond repair. and i can't see 6" in front of my face.

    my dental is even less functional. they only cover white fillings for the first four teeth on the top, otherwise amalgam. well, i don't know how big some people smile, but you can see about 8 teeth on top when i smile, and i get all my cavities on the gum line (very visible), so i ended up paying $240 for 3 fillings.

    currently, i'm waiting for this one tooth to start hurting, and then i'll just get it removed entirely (it's the last tooth in the back) which my insurance will cover in the entirety, rather than getting a small filling 4 months ago.

  4. and don't get me started on disability. we just now, after a year of waiting, applied for disability for the hubby. he has MS. they denied him straight off the bat, which the lawyer says they always do, no matter what's wrong with you. it'll be at least another 6 months, at the earliest, before approval, and the last thing a person with MS can afford is a year and a half with no income and no medical insurance.


  5. I've heard first time rejection is typical, although my wife actually got approved. But she had a whole battery of specialists backing up her claim. Your husband having MS should get approved eventually -- hopefully the second time. It's ridiculous that they are turning someone down with a major debilitating illness.

    My dental plan is not having one at the moment :). If anything goes seriously wrong it is just getting pulled.

    Your vision is once ever two years? That's pretty lousy. Ours covers frames, but only for a restricted selection. I get pretty much the same thing every time though.

  6. My step-father was also refused the first time he applied for disabaility, that's standard. However, he now makes just enough on disability that he can't get medicare, so you need to watch that they don't screw you out of that. He has to go to a local free clinic.
    Don't feel bad, my vision is also every 2 years. They pay for part of the lenses, but not the frames. Cost me an arm and a leg to get my bi-focals this year. Grr!!

  7. my insurance is through Ohio State, so it's pretty damned smart in some spots, dumb in others.

    first off, everything done w/in OSU anything gets a 40% discount. then i have either a $10 or a 10% copay. for a while.
    but meds... i get a total of $1750 a year (Sept-Sept) on meds. and my meds? costs $350/month (not counting those i get for free for being freaking poor) so the last of my Rx was used up in January.
    i only get $500/year for a dentist, and they only pay 50%.
    i get a free eye exam. period.

    and that is my insurance, in a nutshell. and i have to have at least one more surgery, when they are still fighting over the LAST surgery, which should have been all on the hospital since they managed to give me MRSA and all...


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