Monday, November 26, 2007

Health Plans Programs Cancelled for Refusing to Reveal What They Pay Doctors

The Hartford Courant reported last week how the state of Connecticut has stopped four managed care organizations/ health care insurers from running its HUSKY state insurance program for poor children.

Escalating a long-running battle over the state's Freedom of Information law,the state is yanking the primary management of the HUSKY health insurance program for poor children out of the hands of four insurance companies.

The announcement Monday by Gov. M. Jodi Rell marked the latest stage in a battle that has lasted more than two years over whether the private companies could be forced to comply with public FOI disclosure laws.

The HMOs have refused to reveal the rates they pay to doctors for various services, saying the information is proprietary. Legislators have also complained that the insurance companies have refused to reveal how often they deny payments for prescription drugs and which drugs are rejected.

The two largest companies in the HUSKY program — Anthem Health Plans Inc. and Health Net — have repeatedly rejected Rell's demand that they comply with the disclosure law, and have said they are willing to drop their contracts if the FOI disclosure is required.

'These companies refuse to abide by our public disclosure law, despite being required to do so, and they were also willing to walk away from providing services to our children if they had to live up to this requirement,' Rell said Monday. 'They may have been willing to walk away, but I am not. We spend over $700 million a year in taxpayer money to provide these services under the HUSKY program to children and parents in Connecticut's working families. It is only right to fully disclose how this money is spent.'

Both the state's Freedom of Information Commission and Superior Court Judge George Levine have upheld the request for disclosure, ruling that the private companies are performing a public function by managing the state's Medicaid program for about 325,000 people. One of the four companies — WellCare Health Plans Inc. of Florida — did not join with the other three in appealing the Superior Court ruling to the state Appellate Court.

Low-income HUSKY patients were having difficulty getting appointments with specialists, and some believed that the appointments were blocked because reimbursement rates were so low, officials said.

This is a reminder that for many large health care corporations, transparency aren't us. So how are we supposed to let the "free market" improve health care, when no one knows what prices anyone pays for health services?

Note that we have also posted about how Health Net Inc is in trouble with California state health insurance regulators for concealing information from them and retroactively cancelling individual health policies after their holders got sick. We have also posted about how Blue Cross health insurance operated by WellPoint Inc is in trouble in California also for retroactively cancelling sick people's individual health policies. Anthem Health Plans are subsidiaries of WellPoint. Is there anyone left that believes US for-profit managed care organizations' warm and fuzzy statements (like Wellpoint's advertised commitments discussed in this post) about how they are out to improve health and help policy holders?

A little more truth and transparency would go a long way to improving the mess that is now US health care.

2 comments:

ConsumerAdvocate said...

Revealing what providers charge --exposing health care prices through consumer collaboration

Rather than wait for legislation to pass, complicated programs to be developed, or expensive applications to be implemented, I am heading up a grassroots initiative that enables consumers to promote transparency and reveal what providers charge. My project is called OutofPocket.com and is a tool to help consumers look-up true prices and find the best value for routine health care services in their neighborhood. The website relies on consumer collaboration and is a platform that enables consumers to share and collect true prices for routine health care services. OutofPocket.com is a public service of Flying Aces Technology, a health care consulting business. The project started out 12-months ago as an idea that turned into an experiment, and has taken on a life of its own. The directory collects true prices from three sources:

--User Generated Content: Consumers anonymously post prices they paid for routine health care services, along with their personal recommendations on the provider.

--Providers that Disclose Pricing: Health care providers and facilities are invited to submit electronic files of their true prices and services for inclusion in the directory.

--Government CMS: Medicare payment data for common medical procedures has been loaded in the directory.

I welcome any comments you would like to share about this project and please be sure to spread the word about www.outofpocket.com.

Mona Lori
Principal
OutofPocket.com

Working Girl said...

There should be no secrets in health care. The insurance companies should post their performance on things that impact consumers . . % claims denied, % policy cancellations, % claims requiring appeal, % appeals overturned, etc. etc. etc. Those performance statistics impact far more patients/consumers than those for providers/doctors/hospitals, etc.