Here we go again, and if you have not caught wind of this yet, “it’s a business decision” based on extreme math modeling and profits.  Aetna not too long ago also pulled out of California on both the exchanges and is no longer selling individual policies, they all want the business accounts via employers.  This is a big issue today as all the insurers are competing in this area quite aggressively.  Government contracts are also heavily coveted by insurers and those too have been very aggressively pursued.  In California some policy holders got an extra bonus of a 19% increase for their last 3 months of coverage, so was this a move to say “hurry up and switch”?

Aetna Who Is Leaving the California Individual Health Insurance Market at the End of the Year Jacks Up Policies 19% for the Remaining 3 Months And Withdraws From Participation in the Connecticut, Maryland and Georgia Exchanges

I have said it before and it’s worth repeating that our government doesn’t model very well and end up behind the 8 ball and this is everywhere from Congress and of late even the White House is failing here.  White House used to do a lot better but of late, not so good with putting more lawyers in places to where a technologist backed up with a team of lawyers would be much better as they are just totally out done.  I read every day and when I see stuff like “hurry up Health IT and having Facebook contests”, I just have just shook my head in disbelief on some of it and where some feel the perception of reality lies.  The reality is math models that manipulate risk for profit, either up or down.  Insurers are experts at this for sure.

Lack of Modeling and Algorithm Sleuths and Stalkers In Government, Part of Why We See Such “Silly” HHS and Congressional News About Financial Donations And/Or Solicitations…

I just wrote yesterday about the “app contest” now for behavioral health, again where’s the perception here?  We have some lost folks out there I swear.  Is this the Miley Cirus bunch calling some of these shots?  I’m beginning to wonder. Also cluttered news about Steve Ballmer, hey maybe he’s tired and wants to retire, but I full understand that a ton of news articles needs to be generated to allow those investors using software that reads the news to have something to base their sells and buys upon in the markets.  If you have not watched the documentary, Quants, the Alchemists of Wall Street, roll on down to the footer here and watch it as it will explain how this works, so again maybe Mr. Ballmer is just tired and want to have some family fun.

Back on target here, will United pull out too, probably not as they have a pretty high stake in New York already with their Oxford insurance subsidiary but who knows.  Recently Oxford was in the news regarding a US Supreme Court decision that over turned the rules from insurers that doctors could not collaborate and group together with insurers with litigation issues.  This was a long time coming and goes back quite a while. 

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

Also there’s been a very confusing doctor-insurer matter that has hit and I don’t know if others outside of United have been hit but contracts with their reimbursement and pay for performance provisions are actually paying doctors less than Medicare.  When you have business intelligence math models and algorithms it gets to be quite complex.  This was first noticed a few years back with the calculations for out of network pay to where most of the major insurers licensed and used formulas created by a United subsidiary.  BD

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job

(Reuters) - Aetna Inc, the No. 3 U.S. health insurer, said on Thursday it has decided not to sell insurance on New York's individual health insurance exchange, part of the country's healthcare reform.

New York is the fifth state where Aetna has pulled its application to sell the plans that go on sale on October 1 and into effect on January 1, 2014. It has also reversed course in Maryland, Ohio, Georgia, and Connecticut, where it is based.

Aetna spokesman Cynthia Michener said it made the move after assessing its business strategy, following the acquisition of smaller insurer Coventry Healthcare in May. Coventry also filed applications to sell plans in more than 10 states.


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