RECISSIONS….Remember that scene in SiCKO where Michael Moore talks to a former healthcare insurance worker about the way insurance companies look for excuses to deny coverage after one of their customers gets sick and files a claim? It’s called “recission,” and apparently an arbitration judge in LA saw the movie too:
Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.
….Health Net had sought to keep the documents secret even after it was forced to produce them for the hearing, arguing that they contained proprietary information and could embarrass the company. But….at a hearing on the motion, the judge said, “This clearly involves very significant public interest, and my view is the arbitration proceedings should not be confidential.”
The documents show that in 2002, the company’s goal for Barbara Fowler, Health Net’s senior analyst in charge of rescission reviews, was 15 cancellations a month. She exceeded that, rescinding 275 policies that year — a monthly average of 22.9.
More recently, her goals were expressed in financial terms. Her supervisor described 2003 as a “banner year” for Fowler because the company avoided about “$6 million in unnecessary health care expenses” through her rescission of 301 policies — one more than her performance goal.
In 2005, her goal was to save Health Net at least $6.5 million. Through nearly 300 rescissions, Fowler ended up saving an estimated $7 million, prompting her supervisor to write: “Barbara’s successful execution of her job responsibilities have been vital to the profitability” of individual and family policies.
Italics mine. It’s worth pointing out that Health Net is neither unique nor evil. If healthcare is provided on an individual basis in a free market, this kind of behavior is inevitable. The only way to avoid it is to provide health insurance on a group basis regardless of past history, and the bigger the group the better since it spreads the risk more evenly. It’s one of many arguments in favor of national healthcare.
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