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HEALTH PLANS: Wellpoint can’t leave bad enough alone

You’d think the folks at Blue Cross of California or in their parent corporation in Indianapolis would have heard of Lisa Girion of the LA Times by now. Do they really think that by compounding the PR disaster they had with the recission stories of last year their public image is going to be helped by sending their prospective members’ applications to doctors and asking them to check them?

Health plans already ask doctors for medical records of their patients. And that’s a big enough pain as it is. Now it’s apparent that they’re asking them to check the forms of new enrollees. Their explanation that it’s for the good of the medical groups taking capitation probably doesn’t wash, as it’s probably the patient’s previous medical group which has the relevant information. Here’s the through the looking glass story from Lisa Girion at the LA Times.

My only assumption is that Wellpoint has decided that it can get away with basically anything and is desperate to make hay while the sun shines. After all no corporation can get away which such silly behavior for ever.

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  1. California’s regulators have prevented Wellpoint and other health plans from doing what the law allows: risk-rating. By recently interpreting law on rescission to require plans to prove that a beneficiary “willfully misrepresented” his health history or status, DMHC and CDI have made it impossible for health plans to underwrite. Asking the doctors to do the job for them is yet another example of negative, unintended consequence of government interference.
    As for the doctors complaining about insurers telling them how to “practice medicine”, there is an easy answer: Quit! In the U.S., there is no law preventing a doctor from running an entirely cash-based practice.

  2. The “wealthy” argument is a little overdone. I am not familiar with Wellpoint’s 2007 data but I did review UHC’s. UHC paid out in claims about 83 cents for every $1.00 in premiums that they collected in 2007 for their insured business. That means the other 17 cents had to pay for all the salaries of their employees, pay for technology, plant and equipment and have something left over for profit. I dare say that most charitable organizations in this country do not spend that high a percentage on their charitable activities as a percent of what they collect in contributions. In other words, the overhead of most charitable organizations in this country is much higher than the health insurance companies.
    Even if you wiped out all the profits of the health insurance companies you would not reduce health care costs by more than 8-10%. The real problem is the costs embedded in the health care system.
    One example…in my community we have a hospital with 475 beds and it has 7,700 FTE’s on its payroll. That is about 17 employees to support every bed in the hospital. If each of those workers makes $75,000 in pay and benefits that is almost $1.3 million in revenue that must be collected each year to support that one bed with just the labor costs. We are not even talking about the technology, plant and equipment costs. To pay the $1.3 million in wages and benefits for nurses, techs and others you need about $3,500 in revenues per day per bed just to meet that payroll.
    I think we need to be focused on the bigger picture in health care. This is complex and difficult to do, I know. It is much easier to look for scapegoats like Wellpoint and UHC. However, I would like to see someone try to.
    I know there are many that think that a single pay government program is the answer. I don’t doubt that it would reduce costs… but at what price? For the most part Medicare and Medicaid do not reimburse at anything close to private rates. If all rates went to Medicare rates where is the money to pay those 17 employees per bed at my local hospital?

  3. Those “shots” come a lot easier when there are individuals getting wealthy off of what amounts to other’s misfortune. Just a thought!

  4. I am not denying that this is a bad PR move but I suggest that there are very practical reasons why Wellpoint would do this.
    For example, consider the ill will they already get when they refuse to pay a claim when it turns out that it relates to a pre-existing condition that was not disclosed on the application for insurance. It is no fun taking PR hits on those and both the patient and the providers end up taking real financial hits they were not expecting. This clearly was some of the thinking behind this move. They were trying to keep their providers and their applicants from being blind sided later.
    Let’s face it, everybody hates the insurance companies. They are always going to be the bad guys. I am just glad I don’t have to sit in their chairs. It is a lot easier taking shots at them.

  5. Seems that WLP is almost as Greedy as Exxon…
    Wellpoint Inc’s quarterly profit rose 7 percent, but an unexpected rise in its benefit expense ratio, or the percent of revenue it uses to cover medical costs, helped push down shares of the largest U.S. health insurer.
    Company shares fell nearly 5 percent to $74.95 during Wednesday afternoon trading.
    WellPoint, which operates Blue Cross and Blue Shield plans in several states, posted net income of $859.1 million, or $1.51 per share, up from $801.1 million, or $1.28 per share, in the 2006 quarter. The earnings matched analyst expectations.
    Analysts surveyed by Thomson Financial expected a profit of $1.51 per share on revenue of $15.26 billion.
    WellPoint reported $15.56 billion in revenue, helped by a 7 percent rise in premiums.
    http://www.forbes.com/feeds/ap/2008/01/23/ap4565371.html

  6. I can’t wait to see this fiasco unfold. I do think they’ll get hurt on this.
    There’s two things that really tick me off:
    1. Asking primary care physicians to serve as pre-existing condition police agents is ridiculous, and has questionable ethics. Would I want to be fully open with my physician if I knew there was a chance that I could be “reported” (and potentially dropped by my health plan)?
    2. The other thing is that this is one of a list of things that get pushed to primary care physicians to do without reimbursement. Whether it’s auditing charts to complete forms for HEDIS requirements, or whether it’s spending hours on the phone to explain why a non-formulary medication is required, or now, whether it’s to report pre-existing conditions, it’s expected that the PCP will do all of this without reimbursement.
    Contrast this with the gastroenterologist that scopes all day, starts the patient on a PPI, and has the primary care physician do the grunt work to get his/her PPI authorized.

  7. When California Blue Cross (formally a non-profit) was taken over by Wellpoint (turned into a for-profit), it seems like showing some kind of profit for their corporate executives and shareholders by denying some coverages wasn’t enough. They need to go further! I would agree that Wellpoint is trying to get away with it.
    Insurance companies have become more and more involved in the practice of medicine by trying to dictate to doctors the procedures they should give to their sick patients and the fees for those services. Doctors complain that they cannot practice medicine independently and are hampered by insurance companies who look over their shoulders and dictate how they should practice medicine. Can you blame doctors for not rushing to respond???

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