Hot Mess Managing Insurance
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Healthcare Administration Hot Mess
A recent news article in the Bloomberg News highlights a mess in the world of employer and union health insurance. Thanks to Barbara for pointing out this issue.
Remember that about 49% of us have health insurance through our work. And 65% of all those insurance plans are self funded. That means the employer or union has set up a trust fund to pay those claims. The employer or union generally hires a claims administrator to manage the claims payment for them.
According to Bloomberg, Kraft Heinz recently accused CVS Health’s Aetna of wasting its money by paying fraudulent medical claims. Two union health insurance plans in Connecticut alleged that insurer Elevance Health routinely overpaid medical bills. And the trustees of a bankrupt trucking company accused insurer UnitedHealth Group of mismanaging millions of dollars.
Recall that about $4 trillion is spent on healthcare yearly. Employers spend about 25% of that. Some of the employers who suspect mismanagement by their claims administrators are also frustrated that the administrators refuse to provide details. Big surprise. They are spending someone else’s money and are apparently may not be too careful and don’t want to share the details.
Here’s an example of administrator “alleged” shenanigans. The Connecticut union groups’ insurer, Elevance, was supposed to get the health plan a 50% discount from hospital charges, but instead they found some bills paid at double what the hospital charged, according to their joint lawsuit filed in December in federal court in Connecticut.
Here’s another. The International Union of Bricklayers and Allied Craftworkers Local 1 paid $43,490 for a procedure billed as a skin graft at Hartford HealthCare, more than twice Elevance’s negotiated rate, according to the complaint. The unions pressed Elevance, formerly called Anthem, for detailed claims data to figure out what was going on. But the insurer resisted handing it over, according to the Connecticut unions’ lawsuit. They claimed that the union’s contract with them said they don’t have to turn over data to the union, their customer, just trust me, ok?
Remember that the non partisan Congressional Budget Office report in 2020 on universal healthcare found that no matter the parameters of the single payer implementation, we save, as a country, $400 billion yearly on claims administration and unneeded overhead. I don’t know how these lawsuits will turn out but someone should tell these employers and unions that there is a better answer. Universal Healthcare - Single Payer - the Improved Medicare for All (HR 3421, S 1655). Remember that the US government administers Medicare successfully at a 2% overhead rate for tens of millions of us.
ACTION
Let’s make sure our Congressional Representative and Senators know that there seems to be claims cheating in employer and union funded plans and that Universal healthcare (HR 3421 or S 1655) will save a fortune for all of us while providing the care that all of us need. Here is a link to their contact information.
Or you can text SIGN PVFJVF to 50409 to send the message below.
I am your constituent. I just learned that employers and unions spend about $1 trillion yearly on health insurance and about 65% of that is for self funded plans. These self funded plans are administered by some of the biggest insurance companies. Some of these administrators are being sued by companies like Kraft Heinz and by several unions for mismanaging claims, overpaying, not providing promised discounts and then refusing to be transparent about their financial management. We all deserve a healthcare system that works for all of us, not one where rife with the opportunity to cheat others. HR 3421 or S 1655 will do that at lower cost according to the CBO report in August of 2020. Enact it now.
Well Done - You’re making it another good day for healthcare reform!!
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Claims Denials and Appeals & What to Do
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Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
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Alan, in addition to hiding paperwork and paying excessive amounts for some claims, the health administrators also have the incentive to “manage“ the care for patients. And this means, of course, that some treatments and tests recommended by physicians and other medical staff will be denied, reducing access to care and possibly having life changing or life ending impact.