There are days I'm embarrassed to live in this country. What kind of society lets this happen to its most vulnerable?

Of course I know that this can be overcome. Its just... sad really. When the almighty dollar is worth more than a human life, you know we are a society in need of help.

OT, but it looks like Bush is 0-2 on his WMD claims...

N. Korea's cooperation may undercut US intelligence: report

WASHINGTON (AFP) - The government of North Korea is providing information that could prove that, contrary to US claims, the communist country never intended to produce highly-enriched uranium for nuclear weapons.

... If North Korea successfully demonstrates that US accusations about the uranium-enrichment program are wrong, it will be a blow to US intelligence and the Bush administration's credibility, The Post said.

I would sue my insurer too with that wig.... Horrible choice of hair.

On a serious note, this is exact what Michael Moore was pointing out in his Sicko documentary. That's America in a nutshell...

Whitehouse @ 6:

I would sue my insurer too with that wig.... Horrible choice of hair.

On a serious note, this is exact what Michael Moore was pointing out in his Sicko documentary. That's America in a nutshell...

That's a nasty thing to say. Ever had chemo, Mr/Ms Sensitive? A lot of us who have had chemo do lose some, most or all of our hair. Along with all that nasty vomiting, diarrhea and general feeling of malaise. We can't all afford $1000+ hand tied, human hair wigs. Some of us can't afford wigs at all.

What would your comment be had she been a less concerned about her look and was all patchy, or bald?

Just askin.

Linda,

This reporter has been working on great stories like this for years; long before Sicko came out.

Also, kudos to the LA Times for putting up lawyers to help allow these otherwise private hearings known to the public.

The people who need to know about this will more likely listen to the Times than Michael Moore.

I hope this story keeps gaining legs for all our sakes.
:)

Guess who'll be first against the wall when the revolution comes?

I work at a large insurer, but we are not-for-profit which fits with my philosophy as a liberal. I am in charge of one of our product lines and this is definitely not the way we do business. California allows for-profit companies and it's a whole different game with those guys. My guidance to the staff is to find ways to pay claims as long as it's a service covered by the contract (e.g. we don't pay for woo-woo medical procedures). Don't paint all insurers with the same broad brush.

America, best health care any where as long as you can afford don't need it.

This is precisely why people all over the world think we're nuts. You can rattle on all you want about the 'wisdom of the marketplace' shaping a lean-and-mean, competive health care system, but it's obvious to anyone with two functioning brain cells that the 'product' in this case is not health care at all, but insurance-industry profits. In that sense, the 'invisible hand' works pretty good.

The sell this to the rubes the way cheapjack snakeoil hustlers always have; with flattery. They tell us we're not like those whiners in the rest of the world who get their health care handed to them on a platter by the nanny state. We're rugged, self-reliant Americans who make informed choices about our own health care in a free and open marketplace. Never mind that the 'choice' is between a work-sponsored plan with big deductables, co-pays and pre-existing condition restrictions, a private plan you can't afford, or nothing.

Should a procedure room for 15 minutes, some feel-good drugs, a biopsy and a few minutes of nursing care really cost $3,527?

Okay, this is seriously a non-scandal.

An employee who's job it is to cancel policies got a bonus IN PART based on the volume of policies cancelled? What other metric would you use to judge the departmental performance?

L.A. Confidential @ 20:

Should a procedure room for 15 minutes, some feel-good drugs, a biopsy and a few minutes of nursing care really cost $3,527?

Get this. I go see my doc, a well known cancer specialist, for a 10-15 minute exam every 6 months. I got billed $160 for her time and $165 for the room with an exam table, a sink and some latex gloves in it accidentally, one time. That's what they charge.

Also, when I had groinal blistering from radiation treatments, I was sent to the pharmacy for silver sulpha cream. My medicaid was screwed up, so I said I'll pay. What is it. She said $17. I wrote the check. She said "Sorry. I made a mistake. That's the Insurance cost. To individuals, it's $30."

Michael Moore is very credible.

Paulie @ 22:

Okay, this is seriously a non-scandal.

An employee who's job it is to cancel policies got a bonus IN PART based on the volume of policies cancelled? What other metric would you use to judge the departmental performance?

They broke the law. From the article linked above: "State law forbids insurance companies from tying any compensation for claims reviewers to their claims decisions."
They cannot base bonuses on policy cancellations. Obviously for a good reason.

You might try reading the article.
Oh and maybe think on how you'd feel if it were you or a loved one who was canceled by assholes like these.

Just a couple of suggestions.

I just watched SICKO the other night. I am NOT a big fan of Michael Moore, or of that type of exploitation...but I have to tell you, this movie opened my eyes to what the hell is going on in this country.

The insurance companies are RAPING America. Do yourself a BIG FAVOR, and watch this movie. I just learned today my daughter's insurance was cancelled because her son was born with PKU, and he requires a special formula for the rest of his life. WTF!!

Don't wait till it happens to you!! It's time to get the private industry OUT of the medical care system. Call is socialism...call it what the hell you want to...but we NEED universal health care in this country NOW!! It's ruining too many lives with "the private industry" screwing people over.

And the conservative douche-bags will tell that the free-market is the better alternative to health care in keeping costs down....yeah, when they don't have to offer or deny you services. Lets get real, insurance companies are in the business of making money. If that means dropping, the old lady whose is cutting into their bottom line, so be it.

The insurance industry is completely void of any moral integrity.

The 'senior analyst' 20K (spread over several years) seems a little light for saving $35M.

Sounds like they screw their employees as well as their (former) customers.

Ah yes. The free market at work.

Cancel your insurance, save that money, go to emergency room when you need care, don't pay the emergency room bill (since they can't turn you away if you go to the emergency room for care), the bill gets paid by the state - ie: the taxpayers meaning you and I.

OR you can....

Keep your insurance. go own paying those premiums AND pay your taxes so when the insurance company drops you after all you have paid in premiums so the CEOs and managers can get big fat bonuses. You have now paid insurance premiums AND taxes and are still left holding the bill.

The former option insures you get back from the system the tax dollars you pay into it. The later insures fat cat health insurance company managers get rich and you get left holding the bag. The Republicans want you to use your tax dollars to pay for their oil wars, not your own health care.

And where's George Bush? Shouldn't he be using the bully pulpit to highlight this latest slight against the average American by the corporatists?

Keep holding your breath. George Bush would sooner tell the truth than use the bully pulpit for something other than bullying.

Please continue to report stories such as this one.

Those of us in the United States who are not on the health insurers "preferred" lists are at their mercy, and as was demonstrated in Michael Moore's Sicko, we stand to lose everything we own.

I'm sounding like a broken record on this forum, but these companies do the things they do because of the workers who earn a living off them. The workers are just as guilty as the CEOs, when it comes to immorality, greed, selfishness, and total disregard for their fellow human beings.

The sad part, is that it takes a movie for some people to get the fact, that a corporation only purpose is to provide profits for its shareholders. Thus leaving your health in the hands of people who are looking for their profits first, and your health a distant second... it is to put it mildly fairly idiotic.

The sadder part was that as soon as Sicko came out, a few attack pieces and movies on Michale Moore came out. The MO always seems to be attack the messenger not the message. And to this day, months after the movie came out: Not a single damn thing has changed. And to this day there are plenty of apologists for the Healthcare corporations. Dumb doesn't even begin to describe the mental capacity of a big chunk of this population.

What drives me nuts, is that everyone ignores the big elephant in the room. The fact that this society is made up of a significant number of assholes. We can talk all we want, make them feel good movies, say a couple of mea culpas, and all that shit. But the fact remains, that us as a society let this HMO-based for-profit health care system happen. Nowhere else in the industrialized world such an aberration exists.

Hah. I had Health Net insurance through my employer for a while, and this SO doesn't surprise me. At one point it took them a full year to work out proper coverage on what was a simple, covered procedure.

I'd like to say that Blue Cross is better since they've paid a buttload over the past two years on some nasty medical problems and at least haven't come up with an excuse to drop me. Then again, but I spent half of the day Tuesday trying to get them to correct a mistake on their part on claims from LAST YEAR, that I've already called and had "fixed" four times so far. Oh, and they flat-out lost claims for upwards of $5K for no apparent reason.

It'd be funny if it wasn't so expensive.

L.A. Confidential @ 20:

Should a procedure room for 15 minutes, some feel-good drugs, a biopsy and a few minutes of nursing care really cost $3,527?

miss_kitty @ 24:
Also, when I had groinal blistering from radiation treatments, I was sent to the pharmacy for silver sulpha cream. My medicaid was screwed up, so I said I'll pay. What is it. She said $17. I wrote the check. She said "Sorry. I made a mistake. That's the Insurance cost. To individuals, it's $30."

I don't know if this is because I live in California or if it's just as bad elsewhere, but this really does point to a good half of the problem. Whenever my insurance covers something, the bill shows what they were asked to pay and what they actually paid. Which is between 50% and 80% lower.

Now, it's pretty obvious that the medical establishments are able to stay in business getting paid the "insurance rate"--that is, after all, what the vast majority of people pay.

So why the HELL is it legal to charge 2-4 times what is obviously the going rate for medical care just because someone doesn't have an insurance company to insist on it? Explain to me on what planet it's legitimate to say "This procedure is necessary to keep you alive, and it costs us about $2000, but since you don't have insurance and can't go anywhere else to get it, we're going to charge you $8,000." I'm not making those numbers up, by the way. Oh, and in Japan (which does have nationalized health insurance, but you can still get care without it), the same procedure would cost $1000, BEFORE insurance pays their part.

The simple fact that that remains legal pretty much shows how corrupt the entire system is.

Do you think it might embarrass Health Net if the documents were made public?
This is how callous this system is. Stopping a person's benefits during a treatment of chemo.
She should be awarded more than 6 million.

I would not mind paying higher federal taxes, knowing that all the people in America are covered by some form of health care.
There is still room for those who would prefer private health care at their own cost. But the government needs to do something to this system. For one thing regulate the costs. Intervene with the drug companies on behalf of the citizens for lower costs of medicine.
Our system is one that is based on greed. When I see other countries offering quality health care to their citizens I wonder why can't our great nation do the same?
But, I guess it is all about the wallet.

The sell this to the rubes the way cheapjack snakeoil hustlers always have; with flattery. They tell us we’re not like those whiners in the rest of the world who get their health care handed to them on a platter by the nanny state. We’re rugged, self-reliant Americans who make informed choices about our own health care in a free and open marketplace. Never mind that the ‘choice’ is between a work-sponsored plan with big deductibles, co-pays and pre-existing condition restrictions, a private plan you can’t afford, or nothing.

So true! Nobody wants to be communisticalistical-like. And it's scary when people say SOcialism! I see coveralls on people . . .

Filthy Harry @ 19:

I would fix the insurance issue by simply making it illegal for insurance companies to question your doctor's decisions. Whatever the Dr. says you need, your insurance has to pay for. If the insurance companies don't like it, they can quit being in the insurance business. In this free market I'm sure someone willing to play will step in and fill the need.

There are already laws like this on the books. It doesn't help. The insurance companies work the laws and the loopholes such that they will find ways around accountability.

Why are insurance companies involved at all?

Corporations exist to make profits. The bottom line is that the few services a company covers, the more they maximize profits.

In order for the system to work the way we want it to, healthcare services need to be divorced from profit-driven corporations.

How do you like your blood money, Mr. Death?*

(* apologies to e.e. cummings)

we are serfs to the hmo's. Medicare for all

L.A. Confidential @ 17:

Insurance company generates a 40 percent profit while the hospital operates on 3 percent margin or so.

No insurance company generates 40%, but again, there are not-for-profit companies out there, like some BCBS plans, that are not-for-profit, whose goal is only a 1% profit annually. There are definitely bad companies out there, but it's not everybody!

Symes @ 57:

I've said it before and I will keep saying it until someone listens:

Look at Europe and Canada, take what they are doing (all of them) and combine them all into one broad strategy.
Go through it and find what does not work according to the countries that are using it and discard or fix.
Keep all the parts that work.
Implement it.

This is a far better strategy than ANYTHING that has been proposed here in the US, and we all know that reinventing what is already been used and tested is stupid.

That being the case, by extension our leaders are stupid.

Our system in Canada is not perfect......but you won't go broke. You can go to the doctor as many times a year as you want without a co-pay(I guess thats a user fee every time you go?) You can even go to the doctor, or the emergency room in another city or town if you have to, there is no problem because of a hospital or a doctor belonging to a different healthcare group.

Doug @ 14:

I work at a large insurer, but we are not-for-profit which fits with my philosophy as a liberal. I am in charge of one of our product lines and this is definitely not the way we do business. California allows for-profit companies and it's a whole different game with those guys. My guidance to the staff is to find ways to pay claims as long as it's a service covered by the contract (e.g. we don't pay for woo-woo medical procedures). Don't paint all insurers with the same broad brush.

Due Diligence, Doug, you're a liar until proven otherwise, just like insurance companies treat all their clients.

miss_kitty @ 8:

Whitehouse @ 6:

I would sue my insurer too with that wig.... Horrible choice of hair.

On a serious note, this is exact what Michael Moore was pointing out in his Sicko documentary. That's America in a nutshell...

That's a nasty thing to say. Ever had chemo, Mr/Ms Sensitive? A lot of us who have had chemo do lose some, most or all of our hair. Along with all that nasty vomiting, diarrhea and general feeling of malaise. We can't all afford $1000+ hand tied, human hair wigs. Some of us can't afford wigs at all.

What would your comment be had she been a less concerned about her look and was all patchy, or bald?

Just askin.

On face value it would be a cruel thing to say. But she owns a hair saloon. I would expect there would be better choices than pretending to be a blonde like Lindsay Logan. I truly hope she has a good recovery from this desease but that blonde wig is horendous.

Vanna @ 48:

The sell this to the rubes the way cheapjack snakeoil hustlers always have; with flattery. They tell us we’re not like those whiners in the rest of the world who get their health care handed to them on a platter by the nanny state. We’re rugged, self-reliant Americans who make informed choices about our own health care in a free and open marketplace. Never mind that the ‘choice’ is between a work-sponsored plan with big deductibles, co-pays and pre-existing condition restrictions, a private plan you can’t afford, or nothing.

So true! Nobody wants to be communisticalistical-like. And it's scary when people say SOcialism! I see coveralls on people . . .

And the sickest part of all this, is that Bush and his billionaire corporate-cronies are the biggest tax-payer, teat-sucking socialists on the face of the earth.

Incidentally, the true center is the set of principles, foundations and protections as put forth or codified in the Declaration of Independence and the Constitution.

And who's allowing HealthNet to DUMP beneficiaries ?
.
1998 -- DHHS OIG & U.S. Attorney General -- PUBLIC FRAUD - Intent to Harm http://www.usdoj.gov/usao/eousa/foia_reading_room/usam/title9/crm00983.htm
983 Guidelines for Implementation of the Health Care Fraud and Abuse Control T42CFR417 Program
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1998 -- National HEALTH CARE FRAUD AND ABUSE CONTROL PROGRAM [ subject to prosecution ], under the Joint Direction [ T18CFR371-illegal agreement to induce forfiture of existing federal Hospital Insurance Benefits DHHS T42CFR417 Anti-dumping violation ] of the ATTORNEY GENERAL and the Secretary of [ DHHS ] the Department of Health and Human Services (HHS)(1), acting through the Department's [ OIG ] Inspector General (HHS/OIG), Designed [ HMO Grievance Procedure T42CFR417 criminal denial of covered Hospital Insurance claims to force illegal HCFA Medicaid kickback conversions/Volentary Disclousure/SELF-Audit Program T18CFR4Crime ] to coordinate Federal, State and Local Law Enforcement activities [ misprison of a felony / defrauding federal health insurance programs OPM FEHBP CITE: 5CFR890.105 ] With Respect to ( Claims ) Health Care Fraud and Abuse.
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Illegal Denial T42CFR417 = Adverse Determination: of Federal Hospital Insurance Services T42CFR409.33 Against the Elderly results in DEATH. The 1998 'National Health Care Fraud and Abuse Control T42CFR417 Program' is genocide in USA - with love, the CLINTONS.
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CITE- 18 USC Sec. 1518 01/02/01-EXPCITE- TITLE 18 - CRIMES AND CRIMINAL PROCEDURE PART I - CRIMES CHAPTER 73 - OBSTRUCTION OF JUSTICE-HEAD- Sec. 1518. Obstruction of criminal investigations of health care offenses -STATUTE
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Violation of Crime Victims Rights - Under federal law [42 U.S.C.10606(b)] and also 42 USC 1983. Civil action for deprivation of rights and The U.S. Constitution: Fourteenth Amendment.
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DHHS OIG News Release 21 October 1998 - Public Fraud T42CFR417 Anti-dumping Violation: misprison of a felony
VOLENTARY DISCLOUSURE of Health Care Fraud <~ T18CFR371 illegal aggreement ( SELF-Audit )
For Immediate Release Contact: ……………Judy Holtz (202) 619-0893
Wednesday, October 21,1998 ……………….Ben St.John (202) 619-1028
The ( DHHS OIG ) Department of Health and Human Services’s Office of Inspector General ( OIG ) today unveiled an expanded and simplified Program For [ Federal HMO Hospital Insurance Contract ] Health Care Providers to 'volentarily report' [ misprison of a felony T42CFR417 ] Fraudulent Conduct [ Hospital Insurance Fraud DHHS T42sec417 anti-dumping violation: felony ] Affecting Medicare, Medicaid and other [ OPM FEHBP, TRICARE, CHAMPVA et al ] Federal health care programs.
Unlike the pilot program,which was only available to ‘certain’ ( Federal ) health care providers in a few STATES and had strict eligibility requirements, the New Program is OPEN TO ALL ( Federal ) providers NATIONWIDE under signaficantly Relaxed Requirements ( misprison of felony DHHS T42CFR417 anti-dumping violation ) for ( Health Care fraud ) participation.
NOW ALL ( Federal ) health care Providers Doing Business with Medicare, Medicaid,or Other Federal health care programs [ OPM FEHBP / TRICARE / CHAMPVA / etal ] that ” Want to ” disclose Violations of Law [ Title18CFR24Crime ] are eligible for acceptance into The [ National - Health Care Fraud & Abuse -illegal agreement to induce forfiture T42CFR417 Control ] Program. The [ Federal HMO Hospital Insurance Service Contract ] Provider will have the option of doing 'SELF-audit' [ DHHS T42CFR417 Anti-dumping violation ] in conformance [ illegal agreement ] 'with OIG' [ defrauding federal health insurance programs with respect to claims: T18CFR286Crime: OPM FEHBP 5CFR890.105 criminal denial of COVERED Claims T18CFR371 to FORCE illegal HCFA State Medicaid kickback conversions ]
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Patron: RE: H.R. 3199 - USA PATRIOT Conference Report (Sensenbrenner - Judiciary) (Subject to a Rule) (Sec. 4) Requires the Attorney General, on an annual basis, to submit to the House and Senate Judiciary Committees a report containing: (1) the number of ACCOUNTS from which the Department of Justice (DOJ) has received VOLENTARY DISCLOUSURES of customer communications ( T42CFR417 adverse determination:Federal Contractor grievance service - illegal agreement - Anti-dumping Violaion - misprison of a felony ) or records under provisions authorizing disclosure of the contents of electronic communications in emergencies [ Federal Hospital Insurance ] involving immediate danger of death or serious physical injury [ DHHS T42CFR417 Anti-dumping Violation ]; and (2) a summary of the basis for voluntary disclosures to DOJ where the pertinent investigation was closed without the filing of criminal charges. [ Region V CMS/HCFA illegal agreement with Michigan & Ohio to Dump Federal Beneficiaries into HCFA State OFIS Medicaid Program for the POOR - felony federal health care offence T18CFR371Crime ALLOWED & Concealed ] Contact - THOMAS (Library of Congress)
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1998 -----U.S. Attorney General and Office of Inspector General - Health Care Fraud and Abuse Control [ T42CFR417 ] Account would be established as an expenditure [ HCFA State OFIS Medicaid kickback ] account within the Federal Hospital Insurance (HI) Trust Fund.
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Sincerely,
All ENTITLED Federal Employee Health Beneficiaries & the General Public who are being criminally denied DHHS T42CFR417 Existing Federal HMO Health Insurance Coverage, illegally billed for HMO denied covered claims and forced into HCFA State HMO Mediciaid Programs for the POOR. Title18CFR1001Crime.

Hey HealthNet, if you're doing something that would cause your company embarrassment if it got out, perhaps you shouldn't be doing it. Just a thought.

Isn't it time now to set up a new website where the names, home addresses and telephone numbers of these so-called "senior analysts in charge of cancellations" along with the same personal information about the officers and directors of these parasite corporatioins, are listed to enable American citizens to directly express their anger?

I am surprised that no one has added the other half of our idiotic healthcare system, and that is that it often dictates our choice of employment. If we had single-payer, employees would have more freedom to change jobs if they wished, and those approaching retirement age would not be trapped as they wait to take advantage of their retiree healthcare benefit (assuming it's not yanked out from under them at the last second).

I'd also like to know why it is even legal for self-paid patients to be billed 2x and more what the insurance companies pay, effectively SUBSIDIZING the care of the insured.

The only reason the insurance companies get away with their shennanigans is that many of those among us who are healthy believe in their soul of souls that their own good health is due to their moral or behavioral superiority, so why should they have to pay for the care of their inferiors? Once they get sick, suddenly it's a new tune.

I can only agree with others who've asked how employees of the insurers can sleep at night after days spent denying healthcare to the sick. People are morally obligated to examine how they spend their working lives, because if they are complicit in such practices, they are as guilty as the company they work for; each of us remains responsible for our acts, and we need to remember that.

Marc @ 44:

Hah. I had Health Net insurance through my employer for a while, and this SO doesn't surprise me. At one point it took them a full year to work out proper coverage on what was a simple, covered procedure.

I'd like to say that Blue Cross is better since they've paid a buttload over the past two years on some nasty medical problems and at least haven't come up with an excuse to drop me.

While I'm hardly surprised, given that they're for-profit, I actually found HealthNet to be the best insurer I've dealt with. Blue Cross/Blue Shield is confusing because it's now different companies in each state, but the one in California came across as straight-up evil. On the other hand, BC/BS Hawaii, which was non-profit and a little less harsh in coverage, was also staffed by utter morons who would not lift a finger to help you sort out an incorrect claim.

miss_kitty @ 24:

Also, when I had groinal blistering from radiation treatments, I was sent to the pharmacy for silver sulpha cream. My medicaid was screwed up, so I said I'll pay. What is it. She said $17. I wrote the check. She said "Sorry. I made a mistake. That's the Insurance cost. To individuals, it's $30."

Are you sure they didn't mean the cost after the insurance coverage (i.e., the copayment is $17)? I've usually come across this in the opposite direction: the doctor's office charged $120 to the insurer, but if you paid in cash it was only $60. Of course, the reason for that goes back to what Marc mentioned about insurers only paying half of what they're billed, and most places will charge individuals the $120.

As for the utopia of European systems: I don't have much experience, but I can tell you they're certainly not all good. I just moved to Ireland from the US and the health care system here is a mess. Hospital care in public hospitals is covered; if you're poor or elderly you can get a card that covers everything; prescriptions are somewhat subsidized (I haven't been able to figure out to what extent because information is impossible to find); and for a few chronic conditions your treatment for those is covered, but other than that you're pretty much on your own.

On top of that, there is no private insurance equivalent to what's in the US, even if you had the money. The private plan that my employer offers costs a lot, covers very little (prescriptions: total of EUR30/year), will not pay any claim until you've been paying in for 6 months, and won't pay anything for a pre-existing condition until you've been paying in for 5 years. Fortunately my pre-existing condition (epilepsy, with EUR180/month in medication costs alone) is one of those covered, but if it wasn't, I'd be screwed.

As if to add insult to injury, medical costs can be counted as a tax deduction - but all dental and optical treatment is specifically excluded. Of course, those are the things that I'm likely to spend the most on out-of-pocket, since things associated with major injuries or my epilepsy are covered.

So the end result is that while the bar for coverage here is higher than for Medicaid, if you're middle class and working at a job that would have health coverage in the US then you're worse off here. I'm all for single-payer universal coverage, and willing to pay the equivalent of insurance premiums in taxes for it, but don't believe it when they say that every industrialized country besides the US has universal health care.