Tuesday, July 27, 2010

NYT: Insurance Companies Duke it Out over 80 Cents On The Dollar To Be Used Towards 'Welfare of Patients':State Legislators at Risk 4 Secret Deals

whew: leave to a Rockefeller to speak the truth:.....

BCBSNC has a 'liason' committee which 'interfaces' with the NC State Legislature. NOTE: the suffixes of said committee all indicate alliance w/ BCBSNC (see: http://madamedefarge2scutinizingbcbsnc.blogspot.com/

July 23, 2010For Insurers, Fight Is Now Over


".....The legislative battle over the health care overhaul ended months ago, but it is hard to tell from the intense effort now under way by insurance companies to retool a critical provision.The law requires health insurers to spend at least 80 cents out of every dollar they collect in premiums on the welfare of patients, a critical issue for the companies’ bottom lines.....

But state regulators are only now deciding what precisely that means, as they draft the rules to enact the law. WellPoint, (gee, that's the company that just turned down some charges I sent in utilizing guidelines which Medicare adheres to but which they, as a 'pretend Medicare' company ----Medicare Advantage---dontyaknow----company---do not adhere to) which operates Blue Cross plans in more than a dozen states, wants to include the cost of verifying the credentials of doctors in its networks.

Insurance companies like Aetna argue that ferreting out fraud by identifying doctors performing unnecessary operations should count the same way as programs that keep people who have diabetes out of emergency rooms.Some insurers even insist that typical business expenses — like sales commissions for insurance agents and taxes paid on investments — should not be considered part of insurance premiums, which would make it easier for them to meet the 80-cent minimum.But consumer advocacy groups and others see the insurers’ proposals and their lobbying for a more expansive definition of what would be permitted as an effort to water down the law by including too many administrative costs under the umbrella of patient care. “A lot of what they are hoping to shift over there does not — and should not — qualify to improve an individual policyholder’s quality of care,” said Wendell Potter, a former insurance executive who now is critical of the industry and represents consumers in the discussions with state regulators.

On Tuesday, Senator John D. Rockefeller IV, Democrat of West Virginia, sent a letter to regulators expressing his concern that the insurers could have too much influence on how the regulations were being drafted. By his reckoning, insurers and their compatriots have submitted nearly 160 comment letters, totaling more than 600 pages, to the state regulators. Consumer advocates have submitted just 23, he wrote.“The health insurance lobbyists failed to beat the health care reform bill in Congress — but with billions of dollars at stake, we cannot and we should not expect them to throw up a white flag and start looking out for the livelihoods of American families,” Senator Rockefeller said in a statement. “They’re working every angle of the implementation process to shirk their obligations under the new law.”At stake, according to a report issued Thursday by Health Care for America Now, a coalition that supports the new law, is hundreds of millions of dollars when the law goes into effect next year. If the six largest for-profit insurers had had to meet the new standards last year, they would have been required to refund $1.9 billion, the coalition said.


Anonymous Anonymous said...


7:52 AM  
Blogger 家唐銘 said...

Actions speak louder than words.............................................................

5:29 PM  

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