Health Insurance Companies Already Gaming the New System...
 

Health insurance companies are gonna be a thing of the past. Until then, they are gonna steal as much as possible on their way out leaving 1000s to die a quiet death. Single payer/Medicare for all is gonna be here sooner than you think.


source: http://www.huffingtonpost.com/2010/0..._n_519503.html
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Insurance Industry Already Finding Ways To Game New System

The insurance industry's attempt to weasel out of one of the few provisions of the new health care reform law that took effect immediately is a harbinger of what's to come.

In this case, the companies that were balking at covering sick children quickly relented under media, congressional and White House pressure.

But far from being satisfied with a windfall of new customers and massive government subsidies, the nation's insurance companies appear to already be busy devising ways to game the new system. Their goal, as ever: Maximizing profits by paying out as little on actual health care as possible.

And next time they start to weasel, Congress and the White House -- and the media -- may not be paying attention anymore.

"This is what you're going to see as each element in this plan comes up for implementation," said Marcia Angell, a former editor of The New England Journal of Medicine who now teaches at Harvard Medical School. "This insurance industry is going to give up nothing."

In the short run, companies are expected to keep doing what they've been doing, which means, among other things, jacking up their rates. "There's nothing to stop them from raising their premiums, and that's what they're going to do," said Angell, a supporter of "single-payer" health insurance.

The new law's ban on discriminating against adults with preexisting conditions doesn't kick in until 2014.
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"In the meantime, they can continue to cherry pick the healthiest customers, while foisting the sick into the new high-risk pool," said Wendell Potter, a former senior health insurance executive at CIGNA who went rogue and became a consumer advocate.

That's only the beginning, though.

"They also will continue to try to shift more and more of the cost of health care from them to the people that are enrolled in their plans," Potter said. That involves moving people currently in managed care, with its relatively modest co-pays, "out of those plans and into high-deductible plans that make people pay thousands of dollars before the company will pay a dime," Potter said.

"Managed care was last decade's silver bullet," he told HuffPost. "The new silver bullet for the insurance industry is the high-deductible plan. More and more people will not get a dime from their insurance companies."

And for people who can't afford to pay the full deductible, that's a lot like not having insurance at all.

What else will the industry do? "The companies will certainly be tightening up internal practices to avoid paying claims," Potter said. "One way to do that is to make it more burdensome on providers and make it more difficult for providers to get the reimbursements that they're due. They already are difficult to work with for a lot of providers."

The more burdensome the paperwork, the more likely a provider is to make a mistake. "And if they make a mistake, the claim is kicked out," Potter said.

In the longer run, companies will still be in a race for more profits. The trick will be coming up with ingenious new ways to avoid covering the sick.

One particularly ripe area of speculation concerns how aggressively and imaginatively the insurance companies will market themselves to attract profitable healthy clients and avoid the sick and the old.

"You can do little things with marketing materials," said John Gorman, chief executive officer of Gorman Health Group, a Washington, D.C.-based managed care consulting firm. "How you set up your Web site" could make a difference, he said; so could "where you put certain drugs on your formulary" -- i.e. which drugs cost how much.

"And the plans will play those games," Gorman said. "You're going to see a lot of marketing materials with rocket bodies on the cover."

Potter agrees: "They'll certainly be offering programs that will appeal to people that are younger and more likely or able to exercise and otherwise lead healthier lifestyles."

Henry Aaron, a senior fellow at the Brookings Institution think tank, told HuffPost he recently overheard a major insurance company executive joking about the prospect of being forced to sell plans to the elderly. "We'll sponsor dances and make our pitch at 11 p.m.," Aaron recalled the executive saying. Another possibility Aaron mentioned, only half joking: putting the company's offices on the second floor -- with no elevator.

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theyve been denying children care for years that is what has sparked this whole thing. Children born with something they call it "pre-existing" like it pre-existed in the womb LOL

If we dont have healthy kids, we will never have healthy adults.

Health insurance companies bottom line is profit.

When will some of you understand that concept?

no kidding, shocking that they would try to maximize profits...


In other news.... it has been rumored that adult paysite owners added crossales on their join pages...

:1orglaugh

:1orglaugh:1orglaugh:1orglaugh

Hopefully if you breed your child wont be born with a "preexisting" condition and we will see you change your tune when you try to get your child health insurance and are denied becuase your kid was born with a problem.

Thats what is happening now and anyone who supports profit over helping children has some mixed up priorities.

As a father now, these things concern me.

It is pretty easy for them to game the system since they helped write the bill behind closed doors and the politians that got the most money from insurance and big pharm lobbies were Obama, Pelosi, Reid ect.

Big pharm spent more money lobbying (mostly democrats) last year than any other lobby in history. You really thought this bill did not help them?

yes it is profit...

Really? Who told you that?

Really? Who told you that?

Well, I feel it's ok, Harry Reid and Pelosi are going to need a new job in november and Im sure they have made deals with the health care insurance companies

TheSenator, What type of profit margins do health insurance plan providers run at?

Um ... are people over there stupid? I thought Americans were fairly smart .. but honestly what did you think that bill was going to do?

My health, pharma and insurance stocks are doing nicely over there, and while I reside in a country with real healthcare, i am happy that the idiots who pushed that bill have made me money :) Anyone with 2 braincells knew it was good for the industry, not so good for the people. Mandating the buying of health insurance just for being alive ... man that is fucking sensational! You think you got back at the rich? No way .. they are laughing all the way to the bank on the back of this one :)

And yet in four short years we'll all be obliged, by law, to purchase this virtually worthless insurance :disgust

But but but everyone will have insurance! :1orglaugh


Making insurance illegal is looking better everyday.

Some of the best/worst(depends on how you look at it) health insurance companies run at 25% profit margin. Meaning that for every dollar a customer pays 75% go towards medical care.

The new law requires that they use between 80 to 85% of every dollar towards medical care.

So, what this will create is more bloat in the system requiring health care providers to run more test before actually giving care. The more bloat the bigger the profit.

You're answering a different question.

Your thread was about profit margins. I asked what their profit margins are.

Yes, they have salaries to pay, office space to pay for and maintain, benefits for their employees outside of healthcare, legal expenses, marketing costs, and on and on. Therefore, yes, a % of their revenue does not go "directly to medical care". You may think its too high, and you have every right to, however that wasn't the question that was asked.

So again, what profit margin do they operate at?

Single payer is the civilized way to go.

Failing that, leaving insurance optional (like it was) is the next best choice.

What we have now is the worst of both worlds.

Then again, most of us knew that right from the get go :disgust

+100000000000000 for single-payer

:1orglaugh :)

Those figures are not profit margins. Those figures are what they must keep in a "lock box" for payouts on medical care.