Blue Cross To Docs: Help Cancel Coverage

Calif. Health Insurer Sends Letters Asking Physicians To Report Pre-Existing Conditions

(CBS/AP)  Citing an effort to hold down costs, health insurance giant Blue Cross wants doctors in California to report conditions it could use to cancel new patients' medical coverage, it was reported Tuesday.

The state's largest for-profit health insurer is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," the Los Angeles Times reported on its Web site.

"Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," according to the letter obtained by the newspaper.

One of the conditions noted in the letter that could force a new patient to be dropped by Blue Cross - pre-existing pregnancies.

WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said it was sending out the letters in an effort to keep costs at a minimum.

"Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members," WellPoint spokeswoman Shannon Troughton said in an e-mail to the newspaper.

"Blue Cross feels it is our responsibility to assure all records are accurate and up to date for HMO providers," she said. "We send these letters to identify members early on in the process who may not have been honest in their application."

Troughton added doctors are not required, but rather can volunteer, patients' information to Blue Cross.

Doctors were unhappy about the letter, warning that some patients might hide any medical history that could affect their prospects of receiving health insurance.

"We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Association.

Blue Cross is one of several California insurers that have been criticized for issuing policies without checking applications and then canceling coverage after individuals incur major medical costs. The practice of canceling coverage is under scrutiny by state regulators, lawmakers and the courts.

Patients in a raft of lawsuits accuse the insurers of canceling coverage over honest mistakes and minor inconsistencies on applications that they contend are purposely confusing. Victims of cancer and other serious medical problems often are unable to get new coverage once their insurance has been rescinded, reports the Los Angeles Times.

Troughton said the request of doctors has been in place for several years and Blue Cross has not received any complaints about it. The health insurance company doesn't always cancel the policies of patients with discrepancies in their applications and occasionally offers them another plan, she said.

Lynne Randolph, a spokeswoman for the state Department of Managed Health Care, said the agency would review the letter. Blue Cross is fighting a $1 million fine the department imposed in March over alleged systemic problems the agency identified in the way the company rescinds coverage.

"They are playing a game of 'gotcha' where they are trying to use their doctors against their patients' health interests," said Anthony Wright, executive director of HealthAccess California, a healthcare advocacy organization. "That's about as ugly as it gets."

[magtaz-2009]

I believe these letters are becoming a growing problem across the U.S. I live in Missouri and have seen copies of these type of letters. This has caused me much concern. If you or anyone knows of someone or anyone I could or should contact please let me know. at [e-mail] I have Aetna/Blue Cross/Blue Shield

[lizardbate]

With the money insurance companies pay to our fine elected officials don''t expect much to be done!!!! Insurance companies are glad to take your hard earned money, then use it to try figure out how to keep from paying for the services you need.

[frankbowers]

As an insurance agent in Texas (since 1961 and am 70) we are told the insurance companies can not reproduce the apps. so how can they do it leglly in Ca. This is a disgrace. Blue Cross is int an insurance company they are a holding company only and sell the policies here in Tx I guess they do the same in CA. The best of good byes Frank Bowers in Austin, TX

[davek455]

insurance companies and their reps are greedy scum

[rf35]

I wonder where Blue Cross employees get their health insurance from? Surely not Blue Cross...the employees would know better!

[cantshutup]

What can I do to help stop this?

[tommancuso]

Must See:

Sicko
by Michael Moore

Why do we accept being 37th in the world in Health Care? Because the Insurance and Drug companies want it that way. And the GOP is protecting their interests.

[deemsnyd]

Posted by BarbJC1 at 12:28 PM : Feb 13, 2008


Agreed.

[barbjc1]

One way of keeping down cost is this. I request a copy of the hospital bill. I thoroughly examine it and in the past I had found charges for services and medications I did not have.
Insurance companies are not the only crooks here.
I have a daughter that had surgery last June, her bill was $19,000 for a 36 hour stay in the hospital. That included the surgeon''s fee but that is ridiculous.

[deemsnyd]

Posted by oldpilot954 at 11:16 AM : Feb 13, 2008


I agree, something has to be done to take the power away from the insurance companies, but people also need to realize that a very real problem that goes unmentioned here is that your local hospital and mine is willing to work with the un-insured. I work at our hospital and we offer people huge discounts if they don''t have insurance. We bill the insurance companies large amounts because they pay so little, that''s the only way to get about what the test cost. The way we see it, it isn''t fair to charge people with no insurance or high deductibles what we wouldn''t get from the insurance companies anyway. This works well in our community and has had a positive response. However, we also have a large portion of people who just refuse to pay anything. Even when you are willing to work with them and fit some kind of monthly payment into their budget. We also have a social worker on site that helps them fill out applications for assistance. Often times they qualify for the hospital charity fund. How much more would you like for my hospital to do for you? And still, there are people out there who just want to beat the system, not pay a cent, and expect to have the red carpet rolled out for them while the rest of us pay for their lack of integrity.

[oldpilot954]

One of the reasons that health care is so high is that insured people have to pay for those that do not have it. My local hospital says that %60 of the people that enter without insurance never pay their bills. Therefore, they pass those costs on to the people that do pay or have insurance. I am against national health care after talking to some of my Canadian friends but a government regulated insurance program is a necessary. BlueCross seems to be the worst company but every company I deal with refuses to pay until you submit multiple times. I generally support free enterprise but I think health insurance companies need gutted.

[ianlou]

In America, it is illegal to privately own a community%u2019s sole source of drinking water because Lawmakers determined that access to drinking water is a matter of life and death.

How have we allowed the healthcare insurance industry to become rich by extorting American citizens for services that are often a matter of life or death?

The American Health care system is a national embarrassment!

As for the "We have the best doctors in the world" argument, who cares if you are one of the millions ofs Americans who can''t afford to see one?

[lochlan-2009]

What a shocker, and they''re doing it just before we are going to go to mandatory insurance accross the country.

[trillion1]

We''ve had Blue Cross for years and they are just plain crooks now. We''re paying the highest preimiums we ever have and the coverage is laughable.

[slim1h2o]

The government does not pay the hospital the difference between the $2200.00 and $450.00. If it did, hospitals wouldn''''t be going out of business everyday.

Posted by deemsnyd at 09:52 AM : Feb 13, 2008

That''s true, and too,, if the hospitals did their job, and not brushing people off,, they wouldn''t need assistance. Or over charging Insurance Co.s''

[deemsnyd]

The government does not pay the hospital the difference between the $2200.00 and $450.00. If it did, hospitals wouldn''t be going out of business everyday.

[deemsnyd]

AND which of you idiots doesn''''t understand that when these rejected people file for bankruptcy and the doctors claim the losses on their taxes - THE TAXPAYER GETS THE BILL ??? The hospital will get paid by the government and the inflated bill, not what the INS co. would have paid. EXample : my daughter had pneumonia, Total bill? $2200.00 What did everyone accept from Ins ? $450. The taxpayer will suck up the $2200 when these people can''''t pay. Insurance companies and Republicans, like the police, ARE NOT YOUR FRIENDS.
Posted by magoo2u1 at 03:33 PM : Feb 12, 2008


How do you figure the hospital gets paid by the government? The hospital gets the 450.00 from the insurance company. If they had a contract to accept what that company pays, then they don''t bill the patient for the remainder. They may bill the patient for a 20% coinsurance or a deductible depending on how the individual policy, but why do you say that "the government will pay the hospital."???

[thoughtful5]

Oh now I get it. They disable your button for a few minutes after each post. How confusing.

[thoughtful5]

I apologize for all the repeated posts of my letter. Whenever I clicked "publish" I kept getting a message that the button was temporarily disabled so "others could post their messages, too". So I would let some time go by and try to post again.

Webmaster, I hope you are reading this!

[thoughtful5]

I live in Indiana and Anthem Blue Cross/Blue Shield already contacts my doctors asking for medical records before they will process a claim. This is their leverage; you have to give them access to your records or they won''t pay on your claims. The letters to doctors in CA are probably to people who have older policies and don''t have this clause written in.

The news article is right, I am already withholding information from my doctor because I am afraid they will get the medical records. Even if he does not write down a diagnosis, if my symptoms go on the chart they could still say he should have made the diagnosis and call it a pre-existing condition. This nightmare starts over for us every 6 months because we cannot afford long-term insurance since my husband cannot get it at work anymore. I am trying all kinds of alternative medicines and am basically doctoring myself.

It used to be that everyone paid into insurance and the sick people got taken care of. Nobody minded because we all knew we could be next.

It was very telling when Bill Clinton was being impeached and his supporters kept defending him with the phrase "Character doesn''t count." Well character does count, and not just in politics. Sure people are in business to make money, but you can make money without abusing people. You just can''t make as MUCH money. If there is a need for government intervention, I don''t think it is to take health care over. It would be to regulate abuse.