Blue Cross in CA

[Mr. Bill]

This is a very interesting article:

The state's largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients' medical coverage.

Blue Cross of California 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," including "pre-existing pregnancies."

Doctors balk at request for data - Los Angeles Times

 

[Guest]

This is the front-page, lead story in today's Sacramento Bee (circ. 250,000 give or take).

I sent the following letter to my Blue Cross rep:

To: Susan Reed, Blue Cross Rep

Susan:

Talk about a bad public relations job. You folks should have floated a "trail balloon" on this. The concept is not "totally" bad, but to spring it on doctors without any preparation makes no sense. It just makes Wellpoint look arrogant. It is only 7:30 am here and I had one of my Southern CA clients call me already on this! Maybe you could have told agents about this FIRST... maybe sent us a copy of the letter a few weeks before you sent it to doctors and went public? Does anyone with any public relations experience work at your company?

You've just created another reason for "everyone and their dog" to hate health carriers. You could have done this with a lot more finesse. I'm bracing for a firestorm of protest from my BC clients. We'll see how it shakes out. I don't see how this can be good for any of us in the long run.

Respectfully as always,

Al

This is NOT going to help us

Al

 

[Mr. Bill]

Interesting perspective. I guess when we get universal health care all our medical records will be available, so there won't be an issue.

 

[Soaringagent]

Wow, that's terrible...

 

[Dave020]

This is an interesting situation. Basically they got hammered for doing post-claims underwriting, now they are saying "ok, screw you, we'll do initial underwriting and concurrent underwriting. You happy now?"

And this coupled with a rather "relaxed" approach to underwriting currently going on at Blue Cross CA.

Another good reminder why the agent should never fill out the application. Imagine PMG comes back to carrier with discrepancy and patient says "well, my agent filled out that application".

 

[TXINSURANCE]

Isn't this a violation of HIPAA? What if they mail an application to doctor A that contains information between doctor B and doctor C? I would imagine privacy advocates are all over this.

Not to mention the disclosure of address, phone numbers, payment information (assuming they blocked this off the application).

This is really pushing the envelope, not good.

 

[Dave020]

I have not seen what they are sending to the doctors, however I would assume they have done enough "scrubbing" on these applications to assure HIPAA compliance.

Also not sure what they are allowed to share with PMGs versus Participating PPO providers, but likely there is a difference since PMG is capitated contract.

These are only HMO contracted provider groups, not PPO.

 

[Ahnuld]

I have not seen what they are sending to the doctors, however I would assume they have done enough "scrubbing" on these applications to assure HIPAA compliance.

Also not sure what they are allowed to share with PMGs versus Participating PPO providers, but likely there is a difference since PMG is capitated contract.

These are only HMO contracted provider groups, not PPO.

These are only HMO contracted provider groups, not PPO.

How does that makes difference?
I think I am suffering a temporary brain outage. So I will keep my, "Oh yeah, I knew that" to myself.

 

[Dave020]

How does that makes difference?
I think I am suffering a temporary brain outage. So I will keep my, "Oh yeah, I knew that" to myself.

Because PMG has a financial stake in costs of care. PPO providers receive a fee-for-service at NFR so they get paid by someone for each service they provide. HMO capitates contract and pays a monthly capitation fee to PMG. PMG has to decide how that money gets spent per patient.

 

[Ahnuld]

Dave020,

Thank you. I did not know that.