Letters: Anthem Employees Work to Ensure Access

Lastly—in the same Congressional testimony I referred to in my first letter, all 3 insurance officials (including Wellpoint’s) refused to rule out future recissions.

Regarding Anthem’s reply to my op-ed, I’d like to provide the following quote from the “Hearing Of The Oversight And Investigations Subcommittee Of The House Energy And Commerce Committee - Terminations Of Individual Health Policies By Insurance Companies”.  This is from Congressman Stupak’s opening statement:

“Over the past five years, almost 20,000 individuals, insurance policyholders have had their policies rescinded by three insurance companies who will testify today; Assurant, UnitedHealth Group, and WellPoint.

From a review of case files, the committee has identified a variety of abuses by insurance companies, including conducting investigation with an eye toward rescission in every case in which a policyholder submits a claim relating to leukemia, breast cancer, or any of a list of 1,400 serious or costly medical conditions. Rescinding policies based on alleged failure to disclose a health condition entirely unrelated to the policyholder’s current medical problem.

Rescinding policies based on policyholders’ failure to disclose a medical condition that their doctors never told them about. Rescinding policies based on innocent mistakes by policyholders in their applications. And rescinding coverage for all families for—excuse me, rescinding coverage for all members of a family based on a failure to disclose medical condition of one family member.

The investigation has also found that at least one insurance company, WellPoint, evaluated employee performance based in part on the amount of money its employees saved the company through retroactive rescissions of health insurance policies. According to documents obtained by the committee, one WellPoint official was awarded a perfect score of five for exceptional performance based on having saved the company nearly $10 million through rescissions.“

I’m very sorry that Anthem’s corporate spokesperson is upset about my comments, and I did not meant to offend individual employees—I merely would like to point out this corporate policy.

Regarding Anthem’s profits vs. revenues—that was an error for which I apologize.  If you look, the Times-Dispatch printed a correction the following day.

“unfounded accusations against Anthem and the hard-working individuals employed here warrant a strong defense”?…Too bad Virginia policy holders did not have a strong defense when picketing Anthem offices this summer over 14% premium increases.  Too bad they did not have the strong defense as does the American Medical Association vs. Wellpoint and the 2006 $448 million in settlements paid by Wellpoint re: physicians’ claim discrepancies. 

Too bad policy holders don’t have AMA’s clout to defend physicians that resulted in Blue Cross Blue Shield $131 million in settlement checks being distributed July 22, 2009 to physicians who submitted valid proof of claims.  Want to read more about insurer settlements to the AMA past several years for pirating physicians claims?  AMA web site has them listed and ALL major insurers have been caught cheating and settling for billions of $’s.  How much defense clout do you, as one customer, have against the insurers?

Oh, pity the insurers’ tiny net profit percentage.  Would the good Director of Corporate Communications like to review their medical cost ratio (% of premiums used to pay claims) and a breakdown of their gross profit?  What was Wellpoint’s medical cost ratio 15 years ago in Y1994 vs. 2008?  From a Jan 24, 2008 Wall St Journal report we read Wellpoint unexpected high medical costs relative to premium revenue.  High medical cost ratio?  WellPoint Chief Financial Officer Wayne DeVeydt said on a conference call
“The company continues to expect a medical cost ratio of 81.6% for 2008, and to anticipate medical-cost growth of less than 8%.”  Less than 8% medical-cost growth?  Why the 14% premium increase on Virginia customers?  Industry average medical cost ratio during early 1990’s was 95%.  Why is the ratio being driving lower and lower?

“We also oppose the “public option” in part because it, like Medicare and Medicaid, would underpay physicians and hospitals for the services they deliver?”  Is the Director saying physicians and hospitals will be legally forced to accept public insurance contracted pricing and proceed with treating patients with such insurance?  Providers are free to accept or deny any pricing before they obligate themselves to any insurer rates.  Insurers are then obligated to pay contracted rates.  I do wonder?  We find billions of $’s in settlements paid by Wellpoint and other insurers to physicians via the AMA.  Strange. We don’t find where AMA has had to fight Medicare for falsely denying physicians’ contracted pricing.  Do we feel an of our individual claims have been tampered in favor of our insurer?  How many over-payments in claims have you had?

The crew of insurers are tied to a central info tech machine, Ingenix (Health Intelligence), who recently bought AIM Health Care Services, a data mining entity whose sole function is to search past claims to find “irregularities” so clients can bill you for claims paid.  You feel good about an industry’s 20% denial rate for physician procedures?  Wait until you get a registered letter from your insurer telling you to repay thousands of $’s on a claim made years ago.