Haunting Echoes of 'Health' Insurance

Way back in June of 2006, I had done a post ("Money or Medicine" - click the title link) on the shenanigans of health insurers and particularly a group called United Health (at that time hiding behind a quiet buyout of Oxford) who had earned a rather rich write-up in the NY Times. I was therefore less than surprised to see this heading at NPR today on my Google Homepage: "N.Y. Attorney General Accuses Insurers of Fraud".

Part of the answer must be that it's a bit like life insurance - you don't really know much about what you've actually got for your investment till it is (far) too late to make any changes. Folks that get really sick and then get shafted are already in such bad shape both financially and personally that their feeble voices are well below our threshold.

We will insist on believing the slick sales talk, and continue to be awed by the shiny brochures and the oh-so-well-designed websites that we forget that all that cosmetic costs real money and its coming out of the premium that so quietly gets deducted from your paycheck every month. Effective cosmetic cover is only really needed when there is no intrinsic beauty to reveal. Individual horror stories are a dime a dozen, but few seem to be aware that their fates are a result of careful planning and cleverly hidden execution. The return on investment for the shareholders is the permanent goal. Shafting and systematically cheating a few thousand here or there is the acceptable collateral damage along the path to that ROI.

Granted that the present U.S. government is more concerned about protecting the turf of such big businesses than overly worried about the healthcare that the general populace does or does not get. Still, I wonder how such corporations can continue to convince people to pay the dues that keep them raking in the money even when their primary aim is to take folks for a cheap but royal sounding ride?

We are so proud to be among 'the protected' and we will continue to be proud until it's too late and we are too far gone to be able to do anything about it but cry.

Thanks to Peter Kuper for the wonderfully apt illustration.

MONEY or MEDICINE

Oxford Health Plans told hundreds of doctors and thousands of its subscribers that it would no longer pay for medical care at Jamaica Hospital Medical Center, and gave them a month to make new arrangements.

© Peter Kuper

In 2004 Oxford agreed to a new contract that increased the rates it paid the hospital, then continued to pay the old rates for more than a year after MediSys and Oxford negotiated new contracts to set the rates the insurer would pay to two MediSys hospitals, Flushing Hospital Medical Center and Jamaica.
Oxford drafted the contracts, and MediSys signed them and returned them to Oxford. But after a few months, MediSys realized that Oxford was still paying the old, lower rates, and it complained to the insurer.
At that point, Oxford raised a new and unexpected subject: the anesthesiologists at Flushing Hospital. The anesthesiology group does not have an agreement with Oxford to be part of its network of doctors. When Oxford members have surgery at Flushing, the anesthesiologists bill the insurance company for their full fees, not the lower rates Oxford would negotiate with in-network doctorsOxford responded by asking the hospitals to pressure the Flushing anesthesiologists to join Oxford's network. MediSys rebuffed that request, saying it was up to the anesthesia group to make its own insurance arrangements.
When repeated protests produced nothing, Jamaica officials raised the possibility this year of canceling the contract, but Oxford talked them out of it.
Then, doctors and patients received letters from Oxford informing them that as of May 2, Jamaica would no longer be an Oxford provider. Doctors who had admitting privileges at other hospitals were told that they would have to take their patients elsewhere. Doctors who had privileges only at Jamaica were told that they would no longer be paid to treat Oxford members, and their patients were told to find new doctors.
“These are mostly elderly people who have heart disease and diabetes and arthritis, people who see a lot of different specialists, and they were panicked," "And all of a sudden, they're told they can't go to all those docs at Jamaica”. They scrambled to make arrangements at other hospitals. Doctors said they were inundated by calls from patients requesting their medical records so they could change doctors.
Many were like the woman in her 60's with chronic hepatitis C, "She came in one day hysterically crying, completely distraught, saying she got this letter from Oxford that I could no longer be her doctor," Dr. Basello said. "Later, she missed appointments because she didn't think she could keep coming to me”.
Jamaica and the state say, Oxford has not made any retroactive payments and because of the lag in billing, they do not know yet whether Oxford is paying the new rates.
Calls to Oxford were referred to its parent company, UnitedHealth Group, which bought Oxford in 2004. Jamaica officials noted that the Oxford moves they object to happened after the July 2004 takeover by UnitedHealth, one of the nation's largest and most profitable health insurers.
Excerpts; read the whole artcle at : http://www.nytimes.com/2006/05/30/nyregion/30jamaica.html and special thanks to Peter Kuper for the artwork