As part of the Affordable Care Act, health insurers must spend at least 80% of the money they earn from premiums on actually providing health care, with the remaining cash used to cover all administrative, advertising and payroll costs. Those insurers with plans that don’t follow this ratio are soon supposed to start giving the extra money back in refunds and discounts. But new legislation introduced in the Senate this week could jeopardize this, while giving insurance companies even more money to stick in their dog pillows.
The health insurance industry is generally known for its efficiency, generosity and — of course — for its customer-first attitude. That’s why it comes as such a shock that several of the more beloved insurance institutions like Wellpoint, Aetna, Cigna and United Healthcare have decided to stop selling you insurance policies for your sick children.
The showdown over skyrocketing insurance rates in California got even nastier yesterday. The state’s Attorney General’s office announced that it has subpoenaed financial documents and launched an investigation into allegations of illegal premium hikes and wrongfully denied claims by seven separate health insurance providers.
CNN reports on insurance industry whistle-blower Wendall Potter who, after working in the machine for 20 years, quit in order to right a few wrongs. Last week, Potter testified before the Senate about former employer Cigna’s policy of “purging.” In other words, Cigna would drive small businesses with expensive insurance claims to dump their Cigna policies.
Remember last December when Cigna delayed approval of a liver transplant for a leukemia patient and she died? The girl’s family has filed a lawsuit against the insurance giant.
The lawyer for the family whose daughter died after CIGNA declined to pay for her liver transplant said that he will urge the DA’s office to press manslaughter charges against CIGNA for having “maliciously killed her.” [AP]
CIGNA denied a girl’s liver transplant, saying it was “experimental,” then changed it’s mind after 150 family, friends, and nurses association members protested outside CIGNA headquarters. But the reversal was too late, Natalee Sarkisian, 17, died last night at UCLA medical center. The insurance company had initially agreed to pay for the liver transplant, but then after Natalee developed a lung infection, then got a bone marrow transplant from her brother, delayed, and then denied coverage, the family says. She was in a vegetative state, battling leukemia. In an email sent out shortly before Natalee died, the insurance company wrote, ” … CIGNA HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant.” Score another one for the bean counters.
Ahhh, the second of the insurance stories has trickled in and it’s a rip-roaring doozy.