Medicare benefits for those permanently disabled don’t kick in until 29 days after a cancer diagnosis.  This article talks about those with insurance so I’ll move the focus over there.  We have seen the stories about those having cancer denied treatments, or some treatment, even those with insurance, so is health insurance, really health insurance?

Just my own personal thought on the “rainy day” reserve funds they all keep, why do patients need to struggle and get knocked out over a very complicated algorithm.  Risk management continues to rule rather than better healthcare, as the insurance industry has made extensive use of technology to create complicated algorithms and business intelligence software.

One thing I do like is the Attorney General of New York bringing carriers to task and making the fact “known” that business intelligence is being used against policy holders and potential clients, with the dissolving of Ingenix, a business intelligence software company that made over 1 billion last year scrutinizing claims to find loopholes to deny.   Many of the other big carriers also used this service as well, so once again it comes down to creating and running algorithms to deny or allow claims.  Ingenix was not under any privacy rules such as HIPAA, so guess what happened? 

It’s a shame the healthcare world in the US has to function this way and those needing care have to battle the complicated world of health insurance formulas and algorithms and pray that claims are covered.  BD

Milliman Intelliscript, part of the Milliman Company, collects data from Pharmacy Benefit Managers (PBMs) that are not covered by the Health Insurance Portability and Accountability Act of 1996. Then insurance companies pay a small fee to obtain the data, which they use to deny or approve claim requests.”

Ingenix, a Minnesota-based health information services company that had $1.3 billion in sales last year -- and Wisconsin-based rival Milliman -- say the drug profiles are an accurate, less expensive alternative to seeking physician records, which can take months and hundreds of dollars to obtain.

"Two million cancer survivors today are forgoing care they need simply because that care is unavailable because they cannot afford it," Seffrin said, adding that lack of access to quality care is now a major case of cancer death in the United States.

"This issue is not only a serious public health issue; it is a moral imperative for change."

Christy Schmidt, one of the report's authors and a cancer survivor, told that the report is even more frightening considering that all of those profiled had health insurance.

ABC News: Cancer Care Costs Squeeze Millions of Americans

Related Reading:

Prescriptions risk score used to deny health insurance
Health insurer accused of overcharging millions – United Health Care/Oxford Insurance 50 Million Fine
UnitedHealth settles misstating executive compensation allegation with the SEC – Use their PHR?
Health Insurance Reserves – How much is in the till, could it be 1 or 2 trillion nationwide?

Insurer's Reserves Criticized


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