Sunday, October 07, 2007

How Many Reasons Do We Need For Single Payer Health Care

From the New York Times comes this about the wonders of privatizing 'supplemental insurance' and the new drug benefit program. I found this particulalrly telling

Medicare officials have required insurance companies of all sizes to fix the violations by adopting “corrective action plans.” Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits.

The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint.

A mere $770,000 ? Humana has over 4.5 million Medicare people signed up. If Humana paid the whole fine it would come to less than 18 cents per customer. I find that outrageous.

Some of the findings. Were these not the most egregious ?
These findings were typical of the deficiencies described in Medicare audit reports:

¶UnitedHealth, which serves more than six million Medicare beneficiaries, did not have an “effective program” to supervise its marketing representatives, agents and brokers. In some cases, United improperly denied claims without giving any explanation to beneficiaries. Peter L. Ashkenaz, a company spokesman, said, “We terminated a few agents and brokers for misrepresenting our products.”

¶WellPoint, one of the nation’s largest insurers, had “a backlog of approximately 354,000 claims” at certain Medicare plans offered through its UniCare subsidiary. The company’s call center took an average of 27 minutes to answer phone calls from its members and 16 minutes to answer calls from health care providers. More than half the callers hung up before speaking to a company representative. Karen Brown, a spokeswoman for WellPoint, had no immediate comment.

¶Humana did not always tell beneficiaries about changes in its list of covered drugs. In some cases, Humana did not explain its reasons for denying claims and did not inform beneficiaries of their appeal rights.

¶The Sterling Life Insurance Company, a subsidiary of the Aon Corporation, did not pay claims correctly or handle appeals in a timely way. The company has “a demonstrated pattern of failure” to meet Medicare performance standards. Problems were compounded by a rapid growth in enrollment. Sterling said it had taken steps to improve compliance.

¶Two sponsors of popular Medicare drug plans, MemberHealth and Bravo Health, did not act on requests for coverage of specific drugs within 72 hours, as required by the government. Bravo did not comply with federal rules requiring doctors to review all claims denied for a “lack of medical necessity.”

I wonder how much this lackey got being paid (and you know it is a hell of a lot more than the ol' Chief ever got paid).
D. Alan Scantland, senior vice president of MemberHealth, a subsidiary of the Universal American Financial Corporation, said, “We don’t believe that we were compromising any beneficiaries’ health because of what we were doing or not doing.”

And under the Yeah, right heading
Medicare has taken “vigorous action” to halt marketing violations, said Abby L. Block, a Medicare official.

Michael O. Leavitt, the secretary of health and human services, says the Medicare drug benefit is saving people money.

And twenty years ago you couldn't have sold this story to the movie/TV industry, 'cuz it was just too unbelieveable.


unkawill said...

Why do you block comments?
What are you afraid of?

Kathy said...


I'm not sure what you're talking about, unkawill. This is the first comment you've posted to Liberty Street.