November 29, 2023


I really enjoyed reading this message from Wendell Potter’s Health Care Un-covered where he says:
Our reporting and advocacy is having an impact, in Washington and across the country. Members of Congress on both sides of the aisle and the Biden Administration are beginning to scrutinize and crack down on the business practices of Medicare Advantage insurers. And there is growing evidence that employers, including county and municipal governments that planned to force their retirees into Medicare Advantage plans . . . are having second thoughts. Those employers are learning that they may have been sold a bill of goods – and misled and outright lied to – by insurers that make huge profits from their Medicare Advantage business.

Potter draws heavily on a recent ProPublica report pointing out that patients are being “cheated” by Advantage plans ignoring state laws regarding life-threatening conditions.

Across the country, health insurers are flouting state laws like the one in Michigan, created to guarantee access to critical medical care, ProPublica found. Fed up with insurers saying no too often, state legislators thought they’d solved the problem by passing hundreds of laws spelling out exactly what had to be covered. But companies have continued to dodge bills for pricey treatments, even as industry profits have risen. ProPublica identified dozens of cases in which plans refused to pay for high-stakes treatments or procedures — from emergency surgeries to mammograms — even though laws require insurers to cover them.
Apparently, “thinly staffed state agencies” don’t bother investigating a denial unless a patient files a complaint. State agencies are in a position to investigate patterns of improper denials, but generally do not, at least in Michigan. Only when someone complains, I’m assuming in the form of an appeal. 

And this from a ProPublica article this past month, “Health insurers have been breaking state laws for years”:
Over the last four decades, states have enacted hundreds of laws dictating precisely what insurers must cover so that consumers aren’t driven into debt or forced to go without medicines or procedures. But health plans have violated these mandates at least dozens of times in the last five years.
Companies find ways to “weasel out” of paying for benefits that cost big bucks. If the law requires them to cover “cancer drugs,” for example, they’ll just call it something else — like, I don’t know, “gene therapy.” Poof. No need to pay.

Thirty years ago a Michigan doctor and state senator named Joe Schwarz helped write a law requiring companies to pay for cancer drugs that would make chemotherapy more effective. He thinks “You shouldn’t split hairs between the term gene therapy and the term chemotherapy or the term radiation therapy or the term surgical therapy. They’re all cancer therapies and they should all be covered.”

Most salient is the point made by one patient’s widow:  “Insurance is meant to protect people ... not to make them fight through the last day to get what they should.”

I’m with her. 

So every time groups like the one Potter runs, or ProPublica, or PNHP, or Public Citizen, or the Center for Medicare Advocacy report on the scandalous ways Advantage plans bump up their profits at our expense, I can’t help but salivate. 

I truly despise these sociopathic business models, and I hope our municipal unions stop going down such antisocial, nefarious paths.

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