Its been quite a year for Blue Cross and the news with the 39% increase they had originally planned.  HHS called them back to Washington to look at their algorithms that justified the raise.  image

HHS to California Blue Cross – Bring Your Algorithms to Washington And Explain

They also had a security breach to deal with and if you have not read this one it is interesting to where the insured found her stuff floating around on the web and the first thing she did was get an attorney and then they notified Anthem.

Anthem Blue Cross Security Breach Occurred During System Upgrade – Information Accessed by Attorneys Looking for Information Relative to Lawsuits With Carrier

Also in the news was the “breast cancer” algorithm.  We all know by now if you have read this blog long enough that insurance carriers live and die by the algorithmic formulas where they score and do a risk management prediction on what you are going to cost them.  Last year there was the case of the breast cancer algorithm to where those patients were being dropped.  Sure a company can say they didn’t run a query to find those patients but when perhaps querying for other information and this appears in your face as well…you can perhaps think about what might have been a potential course of action here.  I have written a ton of queries and SQL statements and know exactly how that goes. 

My Algorithm Didn’t Do That, Did It? Is There a “Department of Algorithms” in Our Future?

At any rate October 1st is the rate increase and with economic times as they are with even more losing jobs I guess we will see how many can afford it until the assigned risk pools come into play.  Rate increases are tough and on one of my posts an anonymous commenter informed me too that one of the Medicare contractors is a subsidiary of WellPoint so perhaps that’s a big medial cost ratio ticket?  Just a question that popped into my head.  BD 

California insurance regulators cleared the way Wednesday for Anthem Blue Cross to implement scaled-back rate hikes after a previous rate increase was canceled amid an uproar over its size.

Anthem said it intends to put the new rates – averaging 14% and as high as 20% -- into effect Oct. 1 for nearly 800,000 individual California policyholders.

The Woodland Hills company backed off its initial plan to increase premiums in March as much as 39% after consumers, regulators, lawmakers and even President Obama criticized it. Insurance regulators say the six-month delay saved policyholders $180 million. Anthem is the state’s largest for-profit insurer.

Anthem Blue Cross allowed to move ahead with rate hikes | Money & Company | Los Angeles Times


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