California docs balk at BC Calif request for medical HX -see if they can drop members

pickledpepperRN · Feb 13, 2008

Good for those doctors!

lindarn · Feb 13, 2008

Found @HealthLeaders Media.com
California doctors balk at request for data
Los Angeles Times, February 12, 2008
Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history." The letter is not sitting well with physicians, who say Blue Cross is asking doctors to violate the sacred trust of patients by disclosing medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality

And we wonder why it is our best interests to have Universal Health care that does not include private insurance companies. We will all be alot better off when for profit insurers are no longer part of the health insurance equation.

Lindarn, RN, BSN, CCRN

Spokane, Washington

happydays352 · Feb 13, 2008

:barf02:Sick sick sick what is wrong with these people?

jeolsz · Feb 15, 2008

Once again a news article is painting the insurance company as the the big bad corporate bully. You guys really have to take a breath and not believe everything you read. This article is really slanted in one direction. Large national health insurance companies are usually not the companies that drop members, it is usually the smaller ones that do not have the money to survive catastrophic illnesses. Common sense would tell you that large companies would not offer their employees insurance that would potentially drop them for pre existing conditions. Usually insurance companies like to know as much as possible about their member's health history in order to head off avoidable hospitalizations by enrolling them in health programs specific to their conditions or even individual case management in a member with several co-morbidities.

I really take issue with newspaper articles that really lean on one side or the other especially with HMO's and health insurance. I have to site the example of the girl who died recently after " being denied" for a liver transplant. There was alot of hoopla and grandstanding during that episode, but what is happening 2 monthes later? What happened to all the lawsuits and such?

There are always 2 sides to every story, and I would like to hear Blue Cross's side as well.

HM2VikingRN, RN · Feb 15, 2008

I don't understand how you can seriously defend what appears to be "cherry picking" by BC-California. Adverse selection is adverse selection. The real concern is $$ NOT patient well-being.

jeolsz · Feb 15, 2008

You need to read what the article says:

"Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history."

They are not saying they are dropping members based on pre existing conditions.. The trend today is to prevent hospital admission by getting members educated on their illnesses and also working with MD's and other health care providers to prevent unneeded admissions. Many MD's are not as vigorous as they should be in current health care trends and continuing ed and in turn spend more health care dollars than actually have to be spent. Healthcare and managing cost can be complex and the more open communication there is between all involved, the better. As I said there are 2 sides to every issue..

Home Health Columnist / Guide · Feb 15, 2008

there are always 2 sides to every story, and i would like to hear blue cross's side as well.

blue cross of california halts letters amid furor

...in a statement issued about 6 p.m., the state's largest for-profit insurer said, "today we reached out to our provider partners and california regulators and determined this letter is no longer necessary and, in fact, was creating a misimpression and causing some members and providers undue concern....
...the letter had been sharply criticized monday by the california medical assn., and tuesday night its president, richard frankenstein, said: "this letter was part of blue cross' pattern of unfairly canceling policies when people need coverage most. we're relieved that blue cross is ending this particular tactic but continue to have serious concerns about this company's practices looking forward."...
blue cross sent physicians copies of insurance applications filled out by new patients, along with the letter advising them the company had a right to drop members who failed to disclose "material medical history." that could include "preexisting pregnancies."
the letter asked physicians to "immediately" report any discrepancies between their patients' medical condition and the information in the applications.
other major insurers in california said tuesday that they had not asked physicians to do anything like what blue cross was seeking.
schwarzenegger sharply criticized the practice, which he described as akin to telling physicians to "rat out the patients and to give the patients' medical history to the insurance company so they have a reason to cancel the policy."...
california insurers, including blue cross, are under fire for issuing individual policies without checking applications and then canceling them after patients get sick. the practice, known in the industry as rescission, is under scrutiny by state regulators, lawmakers and the courts

none of the bc plans in my area amerihealth, ibc, highmark, nj bc asking for this info.

i had a patient that enrolled in a medicare advantage plan called elderhealth last month. got is acceptance letter in the mail per the nurse who reported insurance change to me to correct our homecare biliing. when i checked medicare website, did not show advantage plan enrollment. called the insurance comany and rep verified on friday 2/8/08 effective date of plan was 2/1/08. i called the patient to confirm did they want this insurance as a lot of philadelphia resients approched by sales rep only to change mind and ccancel a week later. he confirmed desired plan as would cover drugs (plan selected had drug coverage option). i gave him his plan id number and he happily called it into his pharmacy which filled 3 rx to tune $900.00.

however, i had concern that under medicare regs he was not able to choose advantage plan with drug benifit after 1/1/08 as medicare only has open enrollment from 11/15 to 12/31 each year, and expressed that to the patient on friday.

i rechecked eligibility on 2/13/08 and was told not active. called patient and he stated was called by elderhealth rep that he really was not entittled to insurance drug coverage so was being droped----pharmacist called him to tell him drug payment taken back. his policy was recinded.

company never should have sent him a letter in the first place if enrollment depart set up properly to screen applicants.

i handle issues like this every day at work...was able to point him in the right direction that due to limited income and disability eligible for ssi and medicaid to cover cost of medicare, name of local state health center to get free meds untill can get medicaid approved then he will be eligible to enroll back in medicare advantage program. he states these problems caused him so much anguise definately won't choose them ever for his healthcare.

Home Health Columnist / Guide · Feb 15, 2008

march 22, 2007

dmhc fines blue cross of california for illegally rescinding health insurance policies. press release - survey report and plan response ...

the department of managed health care (dmhc) has fined blue cross of california $1 million for routinely rescinding health insurance policies in violation of state law. the fine is based on a non-routine survey report that used a random sample of individual health insurance policies that were rescinded by blue cross from january 1, 2004, to january 1, 2006. the survey was conducted after complaints from blue cross members that their policies were rescinded after they had submitted a health insurance claim or after they received medical treatment.

www.dmhc.ca.gov/aboutthedmhc/gen/ann/ann_prbcirhip.asp

jeolsz · Feb 15, 2008

Here is a link to the letter sent by Blue Cross:

http://www.calendarlive.com/media/acrobat/2008-02/35508226.pdf

also from medical news today:

"In a statement released on PRNewswire yesterday, 12th February, Blue Cross of California said that its action was nothing new. This "notification process" had been in place for years and they have never received calls or letters complaining about it. The company said it:

"Highly values the trust of its members and understands the personal relationship members have with their physicians and medical groups."

However, the insurer said it had responsibility to ensure members' records were up to date and one way it did this was to send a member's application form to his or her doctor to make sure it "mirrors what is reflected inthe physician's notes for that member".

Following the reaction by the California Medical Association, Blue Cross consulted with provider partners and state regulators, and determined the letter was no longer necessary and would be withdrawn because it was "creating a misimpression and causing some members and providers undue concern".

The company urged that the letter be seen in context, saying the action only pertained to a very small fraction (0.0015 per cent) of its 8 million plus members.

Insurance companies are allowed to cancel policies where they discover the applicant has failed to reveal a pre-existing medical condition, but there are limits to how far they can go. "

This is what I mean by other side of story.. not other opinions

Katie82, RN · Feb 23, 2008

blue cross of california halts letters amid furor
i handle issues like this every day at work...was able to point him in the right direction that due to limited income and disability eligible for ssi and medicaid to cover cost of medicare, name of local state health center to get free meds untill can get medicaid approved then he will be eligible to enroll back in medicare advantage program. he states these problems caused him so much anguise definately won't choose them ever for his healthcare.

i also see a lot of this, a lot of times these plan c policies are purchased by family members who fall for the promises of monetary savings. my state medicaid case management program is gearing up to begin case managing medicare patients, which means i have to learn a whole new set of dynamic regulations. but of the cases i have encountered so far, i was able to change them by calling the 800 #. it's very time-consuming, and the changes take a few days to be processed. every county government in the country should have a senior health insurance program (ship) that is federally funded - usually through the state office on aging, that helps seniors and disabled choose appropriate health insurance options. they are not income-eligible programs, so anyone can call. well worth the effort to any senior looking to change options.