Ok every time I turn around there seems to be yet another one of these types of stories out on the web. Is is because nobody can determine a winner any more, or is is because we have sore losers, or both? I think the real reason here is due to complexities with contracts today and you know this opens up some discussions for subsidiary talk. You would have to be living under a rock today and not ready news to miss the fact that big insurance conglomerates are buying up other companies. Is Aetna taking the same route United did with winning the Tri-Care contract? I don’t know if that was exactly the case but it is known they they hired the former HHS executive credited with writing the healthcare reform law as a VP and a few months before this recent event they hired the former US Assistant Attorney General from Minnesota as general counsel, so odd timing maybe or business models are changing or a bit of both.

Steve Larsen left HHS, who was the administrator directing the enactment of US insurance regulations is now Executive Vice President of Optum’s (United subsidiary) Health Unit.   One other interesting tidbit here he worked for Amerigroup, which is being purchased by WellPoint before taking his government role.  You can bet the lobbyists all had his number.  This first link is a post from a few weeks ago and has a ton of information on how this contract played out. 

Tri-West Won’t Challenge Tri-Care Military Contract Loss To United Health - Legal Decisions & Contract Awards Allow Machines To Move Money for Profit As Company Will Likely Close Down-Subsidiary Watch

Again with all the subsidiary action taking place do think some of this is happening in the day of selling mining data between divisions?

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

Not too long ago Aetna sent letters out in Texas to many MDs letting them know they are going to be dropped so I guess the contract over here in Florida looks better?  They also sent a bunch of letters out to doctors in California but those were a mistake Aetna stated..oh those rogue algorithms doing their work in the mail room again…

Aetna Notifies 130 Texas Doctors That It Will Terminate Their Contracts on July 1 – E & M Codes Primary Levels 4 and 5 Billing Analytics For Peer Comparison Used To Substantiate the Decision - Video

Here’s a couple more examples and there’s more of these including a battle in Kansas over insurance contracts too.  These are mostly government entity battles, cities, states, counties and so on.


Blue Cross Protesting Award of Texas Employee Retirement Health Plan to United Healthcare–Price Cut by $25 Million With Little or No Out of Network Coverage for Members

Blue Cross and United Healthcare Duking It Out In Nebraska Over State Health Insurance Contract–We Have More Subsidiaries My Cost Algorithms Are Better Than Yours?

State of Louisiana Rejects United Healthcare’s Protest Over Awarding Blue Cross/Blue Shield Contract To Manage State Employee Health Insurance–Battle of the Insurance Algorithms Continues..


Yes folks it’s all coming down to money and makes it hard to get care sometimes and how long do we have to wait on some of this, good question.  What ends up happening at the end of the food chain is this, doctors going broke and then insurers come back and try to figure out how to pay family practice doctors more, that is after they initially cut the compensation. 

Doctors Going Broke–You Can’t Even Give a Practice Away–Only Folks Buying Them Are Hospitals and Insurance Companies As It Relates to Reimbursement and/or Profits

Over at Wellpoint the battle has become so bad with shareholders wanting to know where the money is that the long time CEO said adios, let somebody else deal with those illiterate shareholders that invest and don’t understand how health insurance revolves around risk assessment algorithms…shareholders making it rough out there and of course few of them do any research to see where their money goes for the most part, they just want it.  This is the deal right off Twitter from someone a lot smarter than me but I agree with him 100% that all these algorithms out there are essentially becoming law or darn close to it.    I call it Algo Duping and you can search out that topic here at the Medical Quack as that’s deep subject of it’s own.    Here’s a link to a bunch of posts that talk about the Attacks of the Killer Algorithms too and I am surprised now that people are actually search this term but they are there for a reason, to help educate how algorithms affect you and I in real life, just show you how to look for them. 

In the meantime, aren’t these health insurance contracts a bitch?  BD

Aetna Life Insurance Co. is suing Jacksonville over the city’s decision to have Florida Blue provide its health insurance, a job Aetna had been doing since 1999. 

In its lawsuit, filed last week, Aetna says that meetings to pick an insurance firm were not noticed in accordance with state open-meeting laws, and that the city did not follow its own procurement procedures in making the selection. 

The company decries the selection process as “clearly erroneous, contrary to competition, and arbitrary and capricious.“

Aetna didn’t get points for providing a two-year rate guarantee to the city, for example, it says, while Florida Blue only guaranteed its rates for one year.

Florida Blue’s rates were $6 million lower than Aetna’s, the city said, although price is not the only reason the company was picked.

The formal choice of a company will take place during a Thursday meeting of the Professional Service Evaluation Committee, whose decision will be forwarded to Mayor Alvin Brown for the final call.

Aetna asked for a hearing before that meeting happens, but Fourth Circuit Court Judge W. Gregg McCaulie, who is hearing the case, was not available.



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