Blue Cross wants Doctors to violate patient confidentiality so their insurance can be cancelled

reply to post by junglejake

I agree its low down to commit fraud and hide a preexisting condition but the insurance company's should do their homework before they write a policy. Run them through all the test necessary to insure a healthy person.

Its a double edged sword though. Most of the time this affects the honest people also and causes them to be droped as well.

Ive paid blue cross for years with NO claims or illnesses. One day I need an MRI and what do you know they would not approve the MRI because they did not feel it was necessary despite my doctors recommendation.

I do not put it past them to use dirty tactics for their advantage. They do not want to pay out and when they must pay out they act like its their money when its not!

Originally posted by junglejake
If I'm going to cost my insurance company at least $3,000/year for insulin and doctors visits, they'd be idiots to charge me less than that per year unless they were a charitable organization.

If you can get the same health care for the same price without adding to the insurance company's bottom line, why would you contract for their services?

Isn't the entire purpose of having insurance to equitably spread the costs of service across all the policy holders?

Not just those who file claims.

Originally posted by Digital_Reality
I agree its low down to commit fraud and hide a preexisting condition but the insurance company's should do their homework before they write a policy. Run them through all the test necessary to insure a healthy person.

They should. This will soon amount to running DNA tests and genetic probability calculations for specific ailments.

Once we arrive there, perhaps goosdawg will post on ATS about how it is a conspiracy of population control, denial of benefits, high premiums - all around evil corporation greed and inhumanity.

Originally posted by Digital_Reality
Run them through all the test necessary to insure a healthy person.

But that's what they're doing by sending the applications to their primary care providers. What you suggest, having the patients take tests until they know of all preexisting conditions could have a very opposite effect, in that if cancer is detected before you or your doctor know about it, no insurance will pick you up. There's also the massive battery of tests that would have to take place. The costs would also be so prohibitive for insurance companies to sign up new members with that restriction that the entire industry would either stop insuring new people or collapse, which would not be good for anyone.

I'm not saying insurance companies are guiltless of some shady practices, but this really isn't one of them from what I can see. Even the article itself says,

The state's largest for-profit health insurer 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 Los Angeles Times reported on its Web site.

"Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," according to the letter obtained by the newspaper.

It is only applications that are being sent. This isn't a HIPPA issue, it's validating the potential customer's claims.

When I got my insurance I had to sign a waver for them to be able to access my health records from my doctor. I thought this was common practice. Is it not?

Originally posted by goosdawg

Isn't the entire purpose of having insurance to equitably spread the costs of service across all the policy holders?

I think you are confusing health insurance with socialism. I think I see why you think they are evil now.

editneliner

[edit on 13-2-2008 by benign.psychosis]

I still don't like the idea of the insurance company keeping tabs on me via my doctor on a regular basis. I can understand initially to make sure I have no preexisting conditions but having access to my personal information through my doctor at will is not ideal for a company that has a sole purpose of making money.

It leaves too much room for abuse and for them to misuse the information. We all know insurance company's are not the most trust worthy.

Yeah, the waiver is part of HIPPA compliance. Your doctor isn't allowed to share medical information without your permission, but your insurance needs your permission in order to be able to cover costs, so you need to sign the waiver in order for them to do their jobs.

There's no indication that this is a regular check-up, though. It's a one time thing on new applicants. Hence the term pre-existing. As in, something you were being treated for before you signed on with your new insurance carrier. It also is not saying that if you have a pre-existing condition you're going to be dropped -- only one you did not say you had.

reply to post by Digital_Reality


It's the definition of pre-existing condition that is causing some of the problem. Insurance companies now will define a minor infection ten years prior to a claim the pre-existing condition that was not disclosed on the application, which is their reason to disqualify the claim and/or the person from coverage.

Originally posted by junglejake
It's also not a patient/doctor confidentiality issue. Your insurance company is given more detailed information than you usually are on any procedures and tests run on you. All they're looking for is for your doctor to say if something is new or you've had it for a while.

So your saying its not a patient/doctor confidentiality issue? Then why did the media networks even run the story? This article's most important point is that patient/doctor condifentiality agreements are being violated.

What is a person to do when they can't even trust their doctor? The medical profession is highly based on a trustworthy relationship with your doctor. If your physician is not someone you can trust with your most private information then I would hope you would look for one that you can trust.

Think about When President Clinton was asked to release his medical records to the public during the 1996 re-election campaign, he invoked the privacy of the patient-doctor relationship and his lawyers refused to release his medical information.

Clinton obviously didn't take the subject litely as the Clinton administration issued the first set of federal privacy rules to protect medical informationin December 2000, requiring consumer consent before companies share medical data or detailed information about consumer spending habits. The rules also require companies to disclose their privacy policies prior to engaging in data transactions with users.

Should we as American's not have the same right as the former president to keep our medical history private?

People also need to think not only about physical health care, but also the mental health care system. Say you are a person who has overcome a pychological condition in the past and you are suddenly dropped from your insurance because your past mental health conditions "make" you a higher risk for injury or relapse.

Physicians' survival will depend on their ability to articulate eloquently to the public the fact that they have been and remain their patients' best advocates. If physicians are not successful in conveying this message, the medical profession will become an enslaved government trade union rather than remaining an independent and honorable profession. That is, in short,
what is at stake for the House of Medicine.

Source: Miguel A. Faria, Jr., M.D.
Vandals at the Gates of Medicine, p. 206

Nowhere do I see the definition of socialism in the following:

insurance or assurance, device for indemnifying or guaranteeing an individual against loss. Reimbursement is made from a fund to which many individuals exposed to the same risk have contributed certain specified amounts, called premiums. Payment for an individual loss, divided among many, does not fall heavily upon the actual loser. The essence of the contract of insurance, called a policy, is mutuality. The major operations of an insurance company are underwriting, the determination of which risks the insurer can take on; and rate making, the decisions regarding necessary prices for such risks. The underwriter is responsible for guarding against adverse selection, wherein there is excessive coverage of high risk candidates in proportion to the coverage of low risk candidates. In preventing adverse selection, the underwriter must consider physical, psychological, and moral hazards in relation to applicants. Physical hazards include those dangers which surround the individual or property, jeopardizing the well-being of the insured. The amount of the premium is determined by the operation of the law of averages as calculated by actuaries. By investing premium payments in a wide range of revenue-producing projects, insurance companies have become major suppliers of capital, and they rank among the nation's largest institutional investors.
All emphasis mine

insurance - Information from Reference.com

The responsibility falls to the underwriter to guard against "adverse selection."

The underwriter's attempt to foist this responsibility onto the shoulders of the physicians of the perhaps fraudulently insured is disingenuous, at best.

The practice of allowing anyone to sign up without properly determining the status of their health, collecting premiums, and then only later dropping the insured at the first hint of a claim, is what, deservedly, brought these sanctions to bear on the companies involved.

Factoid: I heard on TV today that 1 out of 7 people, or 47 million people, in the US do not have medical incurance.

Anyway, I had a few comments on this thread:

Originally posted by Digital_Reality
Take the money you would normally pay to health insurance and put it into a high yield savings account.

I don't know of any savings mechanisms that would cover the cost of most average hospital stays. A pregnancy or a broken leg can easily cost you several thousand dollars. But some people swear by health savings accounts.

Originally posted by Digital_Reality
Another thing, I think if they cancel your coverage they should pay back every dime to date that you paid them that has not been used to pay your medical bills. That would make them think fast and reconsider canceling people's policy's. Why should they keep money you paid them that never got used if they are no longer going to cover you?? Do they think they deserve it just because?

I'd go along with that suggestion.

Originally posted by benign.psychosis
Originally posted by goosdawg

Let me give you another perspective, ye who doth portray victim.

First of all, the company issues insurance on a whim, without realizing what medical problems the customer has. This benefits the customer greatly in that they can get better coverage relative to their previous conditions.

What do you know, a corporation actually doing something nice? Giving people the benefit of the doubt - trust, in fact - that the customer is not hiding some type of severe ailment in an effort to exploit the insurance system and get their expensive medical treatment paid for, while contributing little to nothing in the process.

Now comes the part when the cheating, lying customer is revealed after incurring extremely high medical costs - after being with the company for merely one month - for the philanthropic, generous, caring insurance company. What wretchedness! What vile, evil ways. What right does the customer have to take advantage of an insurance company that altruistically waives the process of checking patients medical history?

As these evil villains are shown for what they really are, the company dumps their no good arses from the policy - never again to take care of those who would abuse, misuse, and play on the very lifeline that once stood tall to take such care of them.



[edit on 13-2-2008 by benign.psychosis]

I'm a bit unsure how to approach this post, since there seems to be a stray "Originally posted by goosdawg" jammed in there, and it's unclear whether this post is pure sarcasm or serious. Anyway...

No corporation is being "nice" or "altruistic" by waiving a pre-acceptance physical. They are merely trying to increase their subscriber rolls without due diligence, In other words, they are being negligent in their business practices.

Originally posted by junglejake

Originally posted by AWingAndASigh
In other words, the insurance companies only want to take your money and give you nothing in return. And they're willing to turn Doctors into corporate spies to make it happen.

Not really. This is more a fraud prevention system. When you switch insurance policies, often there is a period where pre-existing medical conditions are not covered, and you also, when you sign up, sign that the information you provided the insurance company is legitimate. The does effect the cost of your insurance.
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It's also not a patient/doctor confidentiality issue. Your insurance company is given more detailed information than you usually are on any procedures and tests run on you. All they're looking for is for your doctor to say if something is new or you've had it for a while.

Negative. They are sending subscriber's applications to doctors to review and, if applicable, to reveal. Not the same as normal patient-doctor-provider communications.

In the normal case, the doctor is bound by pre-existing agreement to co-operate. What Blue Cross wants is over and above that. The doctor's are under no obligation to co-operate.

reply to post by jsobecky


The root of the problem with insurance companies is that a health care system should not be a for profit business. IMHO. The very politicians in Washington screaming about "socialized medicine", are themselves reaping the benefits of the best "socialized" health care in the country, paid for by the taxpayers. How dare they? I grew up with "socialized medicine" as an Air Force brat and I was well taken care of, by the way. In fact, many aspects of life in the U.S. military system is "socialized". The military provides you with housing and even furniture for that home, in addition to so-called socialized medicine.

When a health care system is a for-profit business, profit will always come first at the expense of the insured.

I dont trust any of the insurance companies, Only a few people get into a business to truly help people, they are mainly in it for the money.

reply to post by kattraxx

Originally posted by kattraxx
reply to post by jsobecky

 

The root of the problem with insurance companies is that a health care system should not be a for profit business. IMHO.
:
When a health care system is a for-profit business, profit will always come first at the expense of the insured.

I agree with you. Good health is such a fundamental human necessity that the systems we use to achieve it in society should not be beholden to a profit line. The only exception I would make would be doctors and nurses salaries - they should be based on ability. The same goes for food and housing, imho.