Back in June, we were treated to an insightful two part series on Florida's new Health Care initiative (Part is is here, Part 2 is here), written by an anonymous guest blogger. Recently, I received a tip from another reader, and asked our Anonymous Blogger to once again lend us his expertise.
Recently, Business Week offered its take on the problem of the uninsured, and blogger Pam weighed in with her review of the BW piece. Our Anonymous friend offers his perspective:
Some interesting points in the original piece and some inside information of which many industry people are not aware is brought to light. For some that have been on the underwriting side, this is old news, a way to more accurately assess risk. It also catches a lot of medical conditions that someone may have “forgotten,” like the guy who forgot to disclose that he was diabetic until the system showed he had been on Glyburide for the last 5 years. It also allows some companies to apply with a “gatekeeper” application, rather than having their employees fill out lengthy and sometimes confusing forms.
Now, I ask myself: is there a potential for abuse and is it possible that carriers are using this tool too aggressively? Absolutely. In the land of HIPAA will we ever know what happened with the Sheltons? No, but I would bet there was more to the underwriting call than we see in the story, possibly supporting either side of the event.
When an individual signs an application, they are asked to disclose certain medical information, and authorize the insurance company to verify this information. This database is a tool for verification. When an application comes in, they should see the same meds on the app as are on the report, correct? I would think catching the missing info up front and taking action would be much better that going in after the fact and denying all claims retroactively due to material misrepresentation.
Actuaries (you know, glasses and pointy heads,) tend to have projections regarding their membership outlined ahead of time, so I would doubt this information is adjusting the membership. Plus, different companies have different thresholds for acceptable risk. I can not confirm or deny the 30% as put forth by the crack think tank of “industry veterans.”
Now to the next piece:
We see a concern over the potential misuse of information regarding a person’s prescription records. This is a fear we all have, having an unauthorized individual or group obtaining sensitive personal data. But it tends to play in to all the points made above.
“Certain medicines, if you know what to look for, are a clear sign that someone is undergoing treatment for cancer or HIV.”
Exactly.
“And John McCain's health plan would make sure a good many of us get even less -- something he probably knows right down to his $520 Ferragamo loafers, given that his own cancer history (with its attendant prescription history) would probably result a denial of coverage if he were almost anyone else besides Sen. John McCain.”
Now we see the real point of this piece, slam McCain. Nice jab at class warfare there, plus I think if I were in those $520 shoes, I’d be on Medicare, our own wonderful single payer system. Actually, by the time I get there, it will be long gone into insolvency.
"But John McCain would never have to live with the realities of his own radical health plan, which would raise costs by dismantling the employer-based coverage system that insures 60 percent of us, putting us in the same position as the Shelton's; with a medicine cabinet full of prescriptions we need to keep us healthy, that could also get us denied health care coverage because they're instrumental in helping the insurance health industry "identify high-risk, reduce costs, lower loss ratios, and increase revenue."”
Here I kind of agree with our commentator. I don’t think either candidate has an acceptable platform on this issue.
Thanks, Anon, for a well-thought-out and well-written review.
Now, I ask myself: is there a potential for abuse and is it possible that carriers are using this tool too aggressively? Absolutely. In the land of HIPAA will we ever know what happened with the Sheltons? No, but I would bet there was more to the underwriting call than we see in the story, possibly supporting either side of the event.
When an individual signs an application, they are asked to disclose certain medical information, and authorize the insurance company to verify this information. This database is a tool for verification. When an application comes in, they should see the same meds on the app as are on the report, correct? I would think catching the missing info up front and taking action would be much better that going in after the fact and denying all claims retroactively due to material misrepresentation.
Actuaries (you know, glasses and pointy heads,) tend to have projections regarding their membership outlined ahead of time, so I would doubt this information is adjusting the membership. Plus, different companies have different thresholds for acceptable risk. I can not confirm or deny the 30% as put forth by the crack think tank of “industry veterans.”
Now to the next piece:
We see a concern over the potential misuse of information regarding a person’s prescription records. This is a fear we all have, having an unauthorized individual or group obtaining sensitive personal data. But it tends to play in to all the points made above.
“Certain medicines, if you know what to look for, are a clear sign that someone is undergoing treatment for cancer or HIV.”
Exactly.
“And John McCain's health plan would make sure a good many of us get even less -- something he probably knows right down to his $520 Ferragamo loafers, given that his own cancer history (with its attendant prescription history) would probably result a denial of coverage if he were almost anyone else besides Sen. John McCain.”
Now we see the real point of this piece, slam McCain. Nice jab at class warfare there, plus I think if I were in those $520 shoes, I’d be on Medicare, our own wonderful single payer system. Actually, by the time I get there, it will be long gone into insolvency.
"But John McCain would never have to live with the realities of his own radical health plan, which would raise costs by dismantling the employer-based coverage system that insures 60 percent of us, putting us in the same position as the Shelton's; with a medicine cabinet full of prescriptions we need to keep us healthy, that could also get us denied health care coverage because they're instrumental in helping the insurance health industry "identify high-risk, reduce costs, lower loss ratios, and increase revenue."”
Here I kind of agree with our commentator. I don’t think either candidate has an acceptable platform on this issue.
Thanks, Anon, for a well-thought-out and well-written review.
Posts
