California's Real Death Panels: Insurers Deny 21% of Claims

tewdles, RN · Sep 3, 2009

and people are worried about the government rationing care?

HM2VikingRN, RN · Sep 3, 2009

IOW not only is 25% of our health care dollars being spent on "administration" another 25% is NOT being spent on care. 50% is not being spent on patients by this reckoning....

elkpark · Sep 3, 2009

and people are worried about the government rationing care?

Yeah, go figure ... :rolleyes:

GCTMT · Sep 3, 2009

Thanks for the article. But at this point, is anyone actually surprised anymore to read these sorts of activities by the health insurance companies? It's almost like something we have come to accept in our society (those of us not active in health care reform) like car accidents and murder.

tewdles, RN · Sep 3, 2009

Also, as an aside to this topic...I read in the Detroit newspaper the other day that theDetroit public school system (which is in serious financial trouble) reviewed their health care contract with BCBS and GUESS WHAT??? They discovered that BCBS had been over paid by over 2 MILLION DOLLARS! Of course, the insurance company didn't "discover" this...they pocketed the money(they quickly reimbursed it when caught)...nor did they consult with the school system and advise them that there were changes that could be made to the management of their insurance program that would save them more than $150k/year!!! Makes one wonder how many executive bonuses were based upon this situation dominated by dishonesty and greed. And yet, we TRUST these companies to make decisions about the health and care of OUR LOVED ONES when it is proved TIME AND TIME AGAIN that their overriding interest is in profit, not in what is RIGHT!

Katie82, RN · Sep 5, 2009

Thanks for the article. But at this point, is anyone actually surprised anymore to read these sorts of activities by the health insurance companies? It's almost like something we have come to accept in our society (those of us not active in health care reform) like car accidents and murder.

I would hope healthcare reform will help people unhappy with their coverage. A "government option" would allow dissatisfied folks to "speak with their feet" as they leave that company. I am with Tricare, which provides good coverage at a reasonable price, but it is subsidized by at least twenty years of service in which your entire life belongs to the DOD. I do not want to leave Tricare, but they are not perfect, I have had items denied. I should have the option to stay where I am. I have also, on many occasions, used employer-subsidized private insurance and have not had any major issues with any of them. A growing trend that is causing dissatisfaction is coverage provided by employers who are "self-insured" - they hire an insurance carrier to administer the policy, but pay the claims themselves. This coverage tends to be expensive and restrictive. My current employer is self-insured, the deductables are outrageous and they only pay for a portion of the claim - most of my co-workers use the $4 plans at WalMart and Target because the copays are out of sight. I don't blame BC/BS for this, they are simply doing the paperwork, I choose to use Tricare. Some opponents to the public option think the private insurance carriers will be forced out of business. I'm not sure, in a private enterprise system, it may force lowered premiums because of competition. This still does not address the major issue, however. The system itself is too expensive. Something is going to have to be done to decrease costs within the system. I recently had a MRI of my knee in preparation for surgery. The cost of the actual MRI was $330 - which I can rationalize as overhead - expensive machine, expensive housing for the machine, etc. And I required an hour of their time. However, the Radiologist who read sat in front of the computer screen and required 5 minutes to tell me I had a torn meniscus was also paid $330. I can't rationalize that one, especially in a system that is only paying my PCP $56. for a 15 min office visit. This stuff needs fixing.

ozoneranger · Sep 12, 2009

and people are worried about the government rationing care?

we are, and for good reason

the oregon health plan was conceived and realized by emergency room doctor john kitzhaber, then a state senator,[1] and dr. ralph crawshaw, a portland activist.[2]

it was intended to make health care more available to the working poor, while rationing benefits.[1] at the time, oregon was considered a national leader in health care reform.[3] the law passed in oregon was not initially compatible with federal law, so a waiver was needed. president bill clinton approved the plan on march 20, 1993, though he required a revision to the plan due to a concern about whether disabled people would have equal access.[4] at the time, medicaid covered 240,000 oregonians.[4]

in 1994, the plan's first year of operation, nearly 120,000 new members signed up, and bad debts at portland hospitals dropped 16%.[1]

the plan's costs increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001.[1] significant cuts were made to the oregon health plan's budget in 2003.[5]

new enrollment in the program were closed from mid-2004[6] until early 2008, when a lottery-based system was introduced. tens of thousands of oregonians signed up, competing for 3,000 new spots in the plan.[7][8]

the legal foundation for the ohp is generally spelled out in chapter 414 of the oregon revised statutes.[9]

the oregon health plan became the focus of national scrutiny in 2003, after deep budget cuts led to 100,000 people in mental health and/or substance abuse treatment losing prescription coverage under the program.[12]

this year and last, the oregon health plan stirred up controversy when enforcing 1994 guidelines[13] to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years.[14]

springfield resident barbara wagner said her oncologist prescribed the chemotherapy drug tarceva for her lung cancer, but that oregon health plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. she appealed the denial twice, but lost both times.[15] tarceva drugmaker genentech agreed to supply her the $4000-a-month[16] drug for free.[17] wagner's plight garnered a flurry of attention from the media,[18] the blogosphere,[19][20][21][22] and triggered protest from religious groups.[23][24][25] wagner died in october 2008.[26]

http://en.wikipedia.org/wiki/oregon_health_plan