Insurers' abuse of clients is sickening

By A TIMES EDITORIAL
Published October 16, 2007

As if Americans didn't have enough reasons to be outraged by the conduct of health insurance companies, federal auditors have come up with tens of thousands more. According to the New York Times, a series of federal Medicare audits have uncovered a raft of abuses by private insurers administering the Medicare prescription drug benefit.

Some of the nation's biggest health insurance companies have used deceptive marketing practices and denied valid claims, disadvantaging tens of thousands of victims. These companies have demonstrated a blatant disregard for the health and safety of their members.

The New York Times reviewed scores of federal audits documenting widespread violations of consumers' rights, including the following:

- WellPoint had a backlog of about 354,000 claims in certain Medicare plans, and it took on average 27 minutes for the company's call center to answer calls from its customers.

- Sierra Health Services claimed that 2,300 of its members who had HIV/AIDS had not paid their premiums and stopped their drug benefits. In many cases, the members had canceled checks to prove they had paid.

- Humana, a company that provides Medicare coverage to 4.5-million people, failed at times to tell its members that it had changed the list of drugs covered in its formulary. Also, it sometimes didn't offer explanations when it denied claims or inform patients of their right to appeal.

All told, the Department of Health and Human Services fined 11 companies more than $770,000 for deception and violating the rights of their members.

Some of the companies have responded to the audits by promising improvements, but these deficiencies are the kinds of problems that arise when a company's interests and those of its customers diverge. Health insurers make higher profits when they can entice customers to their plans and then not deliver on their promises. They make higher profits when they don't employ enough staff to handle all their customers' claims and grievances.

Denying medication to HIV/AIDS patients is not some small glitch that needs to be addressed. There are potentially life and death consequences to the decisions these companies are making.

No wonder the American public is disgusted with the health insurance industry.

[Last modified October 15, 2007, 21:33:50]