What follows will help you understand how and why your health insurance claims are routinely and regularly denied, and why they must be denied for our for-profit system to thrive.
I'm going to take you inside one company, TC3 Total Claims Capture and Control which functions solely to deny and underpay health insurance claims. Remember a denied claim goes right to the bottom line.
The insurance industry in the United States has a single purpose, to provide a stream of profits to shareholders who own the stock of healthcare companies. Guaranteeing the healthcare needs of the American people is not even an afterthought. Our private, for-profit insurance industry is a huge, sophisticated and dangerous denial machine.
The first concept you need to understand is the Medical loss ratio. You and I are losses in insurance industry lingo.
"I hope it is true that these companies intend to be a positive force in health reform efforts, but I tend to be cautious when the fox starts drawing up plans for a new henhouse"
Following along with the launch of "Health Care for America NOW! (HCAN)" initiative, AHIP (American Health Insurance Plans, a special interest group for the health insurance industry) has launched their own initiative for expanding health insurance coverage (and profits?) called "Campaign for an American Solution (CAS)". Their plan is a mixed bag that throws a few bones to progressives while trying to change the current (profitable) system as little as possible. HCAN has come out against the CAS plan:
"Americans understand that (the industry) puts profits before people and is not interested in the health of America. The last thing we can do is trust the health-care industry to fix the health-care mess," said Richard Kirsch, the national campaign manager of Health Care for America Now.
Things are not going well on the AHIP - America's Health Insurance Plans (we feel your pain) tour of our battered nation.
Karen Ignagni the CEO of the health insurance lobbyist AHIP was taped yesterday in Ohio.
Ms. Ignagni carefuly explained that profit is the guiding principle of AHIP, the for-profit insurance industry, and tragically, the entire U.S. healthcare system.
She says, "no margin, no mission".
This is a bad day for AHIP, because their leader/CEO, Karen Ignagni, told the truth, probably for the first time in her life.
Isn't the first rule of politics, don't tell the truth? Well, she fumbled, badly.
Take a listen. I've provided a decent transcript of some of the tape.
In a couple of hours, the insurance industry will roll out its shameless campaign of deceit in Columbus, Ohio.
And what exactly does bold faced deceit look like? Like this.
How do these liars sleep at night?
It is delivered to the American people courtesy of America's Health Insurance Plans (AHIP). I haven't a clue why they've selected Columbus, but this is the venue where the despicable conning of America circa 2008 will begin. Think of this as Harry and Louise 2.0
This is a very dangerous con job--Al Capone would blush. Even he couldn't cook up something this atrocious. We should gawk, hiss, scream and not allow a second of their deliberate deceit to go unchallenged. That said, we underestimate the survival instinct of the insurance industry at our own peril. The message for today though is AHIP is literally off and rolling. The battle has begun.
Last February, a poll by Lake Research Partners for HealthCare for America Now found 78% of voters believe that health insurance companies "put profits before people." It turns out that a few months later the CEO of WellPoint, the nation's biggest health insurance company, said yes, that's true! In April, WellPoint CEO Angela Braly told investors, "We will not sacrifice profitability for membership." In other words, we won't sell health coverage to more people if it means we will lose money.
We're hitting back against the insurance industry tomorrow. More below the fold...
America's Health Insurers to the Rescue . . . of themselves.
AHIP has a new website ahipbelieves.com that lets them jump on the "Health Care Reform" bandwagon. (Warning. You may want to shower after visiting this site.)
Their plan has 5 "key elements:"
Expanding the State Children's Health Insurance Program (SCHIP) to make eligible all uninsured children from families with incomes under 200 percent of the Federal Poverty Level (FPL).
Improving and expanding Medicaid to make eligible all uninsured adults, including single adults, with incomes under 100 percent of the Federal Poverty Line.
Establishing a Universal Health Account (UHA) to allow all individuals to purchase any type of health care coverage and pay for qualified medical expenses with pre-tax dollars, with federal matching grants for contributions made by working families to the UHA.
Establishing a health tax credit of up to $500 for low-income families who secure health insurance for their children.
Establishing a new $50-billion Federal Performance Grant to assist states in expanding access to coverage.
We who are advocates for the Single Payer (aka: expanded and improved Medicare for all) approach to acheving real universal health coverage in the United States are often accused of being zealots opposing the supposedly acheivable good (pre-compromising proposals like HCAN's) for the an idealistic unacheivable best. A more balanced then most version of this argument appears under the title Single Minded by Jon Cohn in the New Republic. PNHP has a response on their blog.
But as a one of those who has supported the obvious need for some sort of "universal health care" since I was first learned about the issue as a college and medical student in the 1980s, and only came to single payer per se recently, I have a few of my own points to make:
A few weeks ago, the California Nurses Association asked me if I'd be willing to attend the insurance industry's version of Netroots Nation (AHIP) and do what I do... capture bad guys being deceitful, bad and ugly.
I, of course, leaped at the chance. (Shout out to nyceve – without her, I wouldn't have gotten the gig).
To get to San Francisco, I had to fly from my home in Charlottesville, Virginia. The 7 hours spent in cramp-inducing airplane/airport seats surely contributed to a key issue that comes up later in this narrative.
So I arrived Wednesday afternoon and met up with nyceve, the activist crew of CNA, and all the nurses that flew in from hospitals around the country. We had a nice dinner buffet and heard from several people that have really been screwed by health bottom-line care corporations. Nataline Sarkisyan's mother and cousin spoke; the cousin left us all speechless and teary.
I woke up this morning thinking about a relative. A middle aged woman who fresh out of collage took a job in hospital administration and for years has been filling my ears with horror stories. Stories like steering near elderly and nearly bankrupt couples to a reverse mortgage so they can continue treatment.
Today she is celebrating a demotion. Less pay and more work but from now on she will only have to deal with foreigners who come here for elective surgery. Through applying for and receiving this demotion a huge weight has been lifted from her shoulders and the atrocious acts that were making her miserable will no longer effect her lifestyle.
There is a way too courteous war being fought in this nation. The war wages on between a large group of advocates that want to insure sanity in the way Americans receive healthcare and a much smaller gang of thugs that are looking to continue collecting corporate campaign donations from the medical industry.
Often times the many companies and people who actually perform these many despicable acts against middle class Americans take the brunt for performing their stated missions. Why is that?
Some of you know that last Thursday, June 19th was a nationwide day of action against the for-profit health insurance industry.
I was in San Francisco where AHIP was holding its annual convention.
I marched with the heroes from the California Nurses Association. CNA took the lead in organizing the protests nationwide.
The protests began on Wednesday, June 18th outside the Moscone center. We had a press conference with Los Angeles City Attorney Rocky Delgadillo, Hilda Sarkisyan (who, I'm thrilled to let you know will be at Netroots Nation as a panelist on the health policy panel--I'll tell you more about that in another diary), Rick Colombo, the father of Nick Colombo and many others.
As promised, here's my diary about the June 19th rally against AHIP, the people supposedly "insuring people's health" but in reality they are parasites sucking the lifeblood out of our economy and our people.
I have a lot to talk about here so I think I'll put it behind the flip.
Americans across the nation demonstrated in favor of guaranteed healthcare and in protest of AHIP — America’s Health Insurance Plans — the insurance industry lobbyists who profit from our pain and folks in Louisville joined in the protest. I put together the video below to give you a flavor of the protest.
It's sad that John McCain and Senator Mitch McConnell are so out of touch with the needs of the people they are supposed to be representing. It seems that John McCain and Senator Mitch McConnell find it easer to represent the over paid healthcare CEO's than the folks who were out on the streets protesting today.
Click here to view photos of the event
Important note for Kossacks in San Francisco: If you're attending the demonstration, please look for us at 12 noon at 4th and Howard Street - Moscone West. We'll be carrying a large orange banner which will say, (of course), DAILY KOS.
Thousands of Americans are assembling today at 12 noon today outside the Moscone West Convention Center in San Francisco. We're here to demonstrate against AHIP and for single-payer healthcare in the United States--what the rest of the civilized world accepts as normal.
AHIP is the chief lobbyist of the for profit Murder By Spreadsheet insurance industry.
It's the first time AHIP has held its annual convention and been greeted with thousands of outraged Americans. We're going to give them a hearty welcome to the City by the Bay.
We're here because AHIP is a parasitic organization whose only purpose is to take money and destroy lives. Before the day ends, AHIP will know it can no longer waltz into a great American city unchallenged. We will fight AHIP wherever it goes. And ultimately the American people will get guaranteed and affordable single-payer healthcare.
UPDATE: I was just advised that the The Courage Campaign has a petition asking McAuliffe not to appear at the AHIP gathering. Please take one minute to sign it.
Yes, that Terry McAuliffe, the former chairman of the Democratic National Committee.
But before I tell you what Terry's up to, you might be amused to know that I applied for press credentials to cover the health insurance industry depravity which will unfold next week in San Francisco. All I wanted to do was write about Terry's speech and to let you know what AHIP is planning in the year ahead. The bastards turned me down, with a curt one sentence email from Robert Zirkelbach, one of the press flacks from AHIP.
Subject: RE: Press credential request for Institute 2008
Date: 6/12/2008 4:31:32 P.M. Pacific Standard Time
From: rzirkelbach@ahip.org
Reply To:
To: nyceve@xxx.com
Unfortunately, I am unable to provide you with a press pass for the Institute.
Scared that nyceve might tell the truth to some bloggers? Holy Patootie, they ain't seen nothin yet.
38,000 insurance industry executives will be in attendance, and they will know we mean business. I'll be there and I hope as many Bay area people as possible can get away for an hour or so to join in this important day of protest.
Additional details will follow.
Remember a week or so ago, I suggested you pay attention to the New York Times list of the top emailed stories. I think of the Times email list as a barometer into the psyche of a certain swath of the population.
DarkSyde has come up with a new name for America's largest health insurer, UnitedDeath. And nyceve just throught of a better title for the diary.
This is how the the chief lobbyist for AHIP, Karen Ignagni belittles the investigation into UnitedHealth and others by Andrew Cuomo the New York State Attorney General.
Let's do two things at this interesting juncture. Step back for a moment and understand the flagrant distortion contained in the statement. Then recognize that these are the unscrupulous people healthcare Swiftboaters we will be battling come January, 2009.
The WSJ has a story today about the Nataline Sarkisyan case, with reference to John Edwards. It's a story well covered here at Daily Kos. The comments from specialists not associated with the case are interesting. What's especially interesting (beyond the story), buried in the article, is this:
Karen Ignani, president of America's Health Insurance Plans, the main industry lobby group, said it's addressing the desire for health-care change by making its own proposals for universal coverage. Last month, it offered a proposal for guaranteeing access to individual health insurance to anyone who applies. The industry has long opposed that idea in practice.
The group also plans to work with medical societies on how to finance or cover experimental treatments. "We're not taking a P.R. approach to this but a policy approach," she said. "People want us to solve the problem, not just discuss it." [my bold].
Still, Robert Laszewski, a health-care consultant in Washington, said the industry often muffs its public-relations strategy. Cigna's delay in reversing its decision on Nataline's transplant "shows just how tone-deaf" the industry is, he said.
While they may be tone-deaf, they're not stupid. Does anyone think that guaranteed individual health insurance, even an industry-driven version, would even be on the table unless the industry smelled the possibility of a Democrat in the WH?
