wellpoint

washingtonpost.com
Wellpoint Expands Primary Care Payments

The expansion includes raised payments and payments for currently unreimbursed services such as creating patient care plans.  They also unveiled a shared-savings program, up to 30% and plans to invest in staffing and data sharing in exchange for measures such as participating in monitoring programs and offering 24 hour access. Wellpoint plans to invest $1 billion.  They hope to achieve savings of up to 20% from improved health and reduced use of costlier services (ER visits).

Wellpoint companies include Anthem Blue Cross & Blue Shield in Virginia.  Wellpoint is taking a business risk by pursuing this investment.  Since providers tend to contract with several insurers competitors may take advantage of the program without making a similar investment or taking on similar risk of loss.  This free rider problem may have discouraged insurance companies from aggressively pursuing cost-savings–at least until now.

Health Insurers Value Profits Over People: Fresh Evidence

If Americans were to eavesdrop on behind the scenes talk of big health insurers, such as UnitedHealth, WellPoint, and Aetna, they would gain a better understanding of why premiums continue to rise, while the number of people with medical coverage continues to fall.   These three companies have announced their quarterly earnings in the past few days, and have earned a combined $2.51 billion from April through the end of June, much more than analysts expected.  On a per share basis, their earnings were up more than 17% on average compared with the second quarter of 2010.  These big for-profit health insurers have exceeded analyst’s expectations for several quarters in a row now.  So why do health insurer’s profits continue to grow, even as the country struggles to recover from the recession, and one out six Americans remains without coverage?  The answer is simple: health insurers value profits over people.

One of the secrets to maintaining these results is what insurers have defined “medical management”, which translates into the euphemism of denying claims and coverage.   The fewer claims they pay and the more procedures they refuse to pay for, the more money the investors have leftover to put in their pockets.

Another trick to sustaining this impressive rise in earnings is the greater responsibility and cost of sharing from policyholders. More and more companies’ policyholders are enrolled in plans that require greater cost sharing, thus policyholders pay more out of pocket than ever, while their insurers are paying much less.

These tactics, and many others, are used as excuses to evade what’s really going on here. We’re simply unable to get the care we need because of the outrageous deductibles of today’s health plans.   “WellPoint and Aetna and other insurers have demonstrated repeatedly that while they will do all they can to avoid sacrificing profitability for membership, they are quite willing to sacrifice their members—and the American public—for profits.”

Kantor & Kantor is an advocate for clients whose insurance companies have failed, or refused to pay claims, arising out of Disability, Health, Life, Long Term Care and other liability insurance claims.  We help people get medical care and treatment when it has been unfairly denied by their insurance company.  It’s unfortunate that health insurers are maximizing profit at our expense and sacrificing the health of its members.  If your health insurance claim has been denied, call us. WE CAN HELP.

http://www.huffingtonpost.com/wendell-potter/fresh-evidence-that-healt_b_914745.html