I read somewhere in the news today that the President’s plan contains IT, well I certainly hope so and speaking of such let’s get some IT to run some audit tables based on what I am reading here.  Algorithms can manipulate and change numbers to get desired results.  You can’t get around this, it’s how they do business based on business intelligence software.  This is also interesting to see that they have such a big stock pile of reserves when it was just last week another office of Blue imageCross was saying they only have enough reserve funds for 2 months worth of claims.  

Also in the news today was a story about a man who was denied a liver transplant.  His doctor at UCLA said he would die waiting to get one and advised him to travel to another state where he might have a little better luck, as in 2006 Blue Cross had approved it.  He had the surgery in Indiana and then they refused to cover, so it was ok here in California but not for the same surgery in Indiana?  Here’s one more lawsuit in the courts. 

Blue Cross Cuts for Physical Therapy – Payment Algorithms Changing to Flat Fee of $75 No Matter What the Level or Duration of Care Provided

Class Action Lawsuit Filed Against Blue Cross Blue Shield in Florida – Out of Network Ingenix Algorithms

In one more story here in Orange County a man tried to get covered under his “pet” insurance or at least he asked.  He was fed up as he could not get through to customer service to find out what was going on and then Blue Cross denied his application for a cheaper higher deductible plan because he had seen a podiatrist within in 6 months for ankle surgery.  I went through that once with Blue Cross too, it’s the truth as I could not do the same thing as I had seen a doctor within 6 months so in order to get a lower cost, higher co-pay policy, I had show that I had not seen a doctor in 6 months. 

Administration Not Satisfied with Blue Cross Explanation of Recent Rate Increase – Did They Bring the Algorithms?

What’s this about preventive healthcare with algorithms like that!  The truth is this had nothing to do with preventive healthcare and is all about scoring and projecting cost.  I was honest but what if I had lied as I went to the doctor with an ear ache. Gee and they wonder why we don’t trust health insurance companies.  I about fell off my chair when I heard that one.  So what’s the answer, liar’s poker here?  I feel that a company that puts a stipulation like that out there is plain out telling you it’s not about preventive and better care, but rather it’s about your risk assessment, so I don’t understand completely this concept, was I supposed to go somewhere else or kick over in 6 months? 

As I have already said, these folks need to be non-profit for any healthcare reform to work, because as long as they operate in this fashion with stock holder liability first, we will never get anywhere, so non profit, government take over, what’s it going to take to work.  Being traded on Wall Street won’t cut it and reform will be a huge disappointment to all, especially if a private option is not given and done correctly.  It sounds to me like they really need that increase to help finance all the court cases they have going on, due to the way they have conducted business over the last few years.  BD 

Health insurance giant Anthem Blue Cross said it was raising rates on thousands of individual policyholders in California because the cost of their medical care exceeded the premiums they paid last year.
At the same time, other parts of Anthem reaped a profit. A Times analysis of the company's regulatory filings shows that $525 million in Anthem's earnings in 2009 was shipped to its corporate parent WellPoint Inc. The analysis' findings were not disputed by Anthem.

The extraordinary greed of Anthem/WellPoint Blue Cross is a clear indication that this company has put profit before people," said Garamendi, who as California insurance commissioner presided over the companies' merger. "People need to be able to get out of the shark pool with a public-option lifeboat."

They are moving all the profits to the holding company," she said. "And then they cry, 'Woe is me. We're not making enough money.' They are just moving the money to hide the jackpot."

But not all the profit has gone to the corporate parent. Anthem has accumulated more than $1 billion in cash -- exceeding what regulators require the company to reserve to cover outstanding claims, The Times found.

And from 2005 to 2007, Anthem made annual payments of more than $2 billion to affiliated companies for unspecified services, according to an analysis of regulatory filings by Consumer Watchdog.

As Anthem Blue Cross sends profit to WellPoint, it plans hefty rate hikes for Californians - latimes.com


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