Now going back to the other part of your question, we do know some things about the extent of the problem. Even if we do not know the total dollar value of claims denied, for example, we do know the names of companies that have been taken to court and/or examined by regulating authorities, generally settling when they're caught.
A few of the significant examples:
- UnumProvident, the leading provider of group disability insurance in the U.S., and its subsidiaries Colonial Life, Provident Life, and Paul Revere allegedly systematically denied claims for which policyholders should have been covered. The company settled.
- The number of denied claims by Cigna, Guardian/Berkshire, MetLife, and NY Life, leading providers of group disability insurance, has risen in the last few years.
In Connecticut, regulators re-examined hundreds of insurance claims denied by Assurant Health. According to the Connecticut Insurance Department, over 800 claims were denied by Assurant companies from 2001 to 2007 by alleging that patients had health problems that pre-dated their policies.
The Los Angeles Times reported that the California Department of Managed Health Care concluded that Blue Cross of California improperly canceled individual health insurance policies after some members became pregnant or sought medical treatment for chronic conditions. Blue Cross in California settled.
California Insurance Commissioner Steve Poizner announced a settlement with United Healthcare over claims payment practices. The multi-state settlement, according to the statement for public release, "involved 37 states working together to protect consumers."
- Looking at figures from some state insurance commissioners, in New York there were 2,959 complaints against health insurers in 2006, 745 upheld on external review by the NY State Dept. of Insurance; also 11,280 internal appeals with 4,649 reversed (524 and 197, respectively, for WellPoint).
- From the Texas Dept of Insurance 2006 Accident and Health Complaint Index, a total 1,684 justified complaints. Companies against which numerous complaints were filed included Aetna, BCBS, Humana, UniCare, and United HealthCare.
Of thousands of complaints about health policies in the five largest insurance markets--California, New York, Texas, Florida and Illinois--the overwhelming majority involved bad or questionable claims handling. Common sense tells you that a few days' delay in every claim, multiplied by thousands of claims, adds up to billions for the companies. (Often, people do not know their state commissions or know how to file a complaint.)
By the way, critics of Medicare often omit to mention that one of Medicare's big problems is private insurers. On Oct. 7, 2007, the New York Times reported that 91 federal audits showed tens of thousands of Medicare recipients systematically had their claims improperly denied by private insurers. Audits revealed improper terminations of people with HIV/AIDS; huge backlogs of unprocessed claims and complaints; and failure to answer phone calls from consumers, physicians and pharmacists. Companies audited included UnitedHealth, which services six million Medicare recipients; Humana, with more than 4.5 million; and WellPoint, which owns Blue Cross of California. Problems included UnitedHealth's improperly denying claims without explanation to beneficiaries; Humana's not explaining claim denials or not informing beneficiaries that they could appeal; and a backlog of 354,000 claims in WellPoint subsidiary UniCare.
A report by the House Oversight and Government Reform Committee showed problems in Medicare drug coverage by private insurers.
The question to ask opponents of health care reform legislation should be simple and clear: Are you in favor of letting carriers get away with bad-faith practices such as denying claims fraudulently? Not answering their phones? Not explaining denials to policyholders? No? Then how do you propose to deal with the problem?
Wow. That's pretty comprehensive. So, Margie, as an investigative journalist who has looked deeply into health insurance excesses, you find the present legislation better than no legislation at all and a step in the right direction. What else would you like to tell our readers before we wrap up our interview?
The present legislation is more than just 'better than nothing.' More
than a step in the right direction, it opens the door on the
stranglehold over medical care.
I
would like you to tell readers,
1) let's not help Joe Lieberman, David Broder, the GOP in Congress, the
right wing media machine and the insurance industry shut the door. And
2) remember, much of the work still has to be done at the state level,
which starts locally.
You
did so much of the legwork over the past few years about health
insurance industry excesses, even though the corporate media chose to
ignore you and your findings. Thank you for sharing your take on
health care, Margie. I look forward to reading more of your work.
***
Margie Burns is a freelance journalist in metro D.C. with a blog on government, law and politics.
