Posted on 09/07/2010 10:36:43 PM PDT by Cardhu
California regulators are seeking fines of up to $9.9 billion from health insurer PacifiCare over allegations that it repeatedly mismanaged medical claims, lost thousands of patient documents, failed to pay doctors what they were owed and ignored calls to fix the problems.
In court filings and other documents, the California Department of Insurance says PacifiCare violated state law nearly 1 million times from 2006 to 2008 after it was purchased by UnitedHealth Group Inc., the nation's largest health insurance company by revenue.
Regulators said the companies broke promises to maintain smooth operations for 130,000 of PacifiCare's customers, resulting in what insurance officials nationwide believe is the largest fine ever sought against a U.S. health insurer.
"This is about intentional disregard for the interests of doctors, hospitals and patients in California, and the pursuit of cutting costs at any means possible," said Adam Cole, the insurance department's general counsel. "It's a story of intense corporate greed."
PacifiCare and UnitedHealth Group have rejected the state's assertions, and they are fighting the proposed fines in a lengthy legal hearing that began 10 months ago in Oakland and could conclude as early as next month.
The insurers maintain that the state's case largely involves administrative errors that did little harm to anyone. They point out that three-quarters of the allegations relate to PacifiCare's alleged failure during a short period in 2007 to inform doctors and patients in correspondence of their right to appeal coverage decisions.
(Excerpt) Read more at latimes.com ...
That's what I read.
So which big GOP donor runs this outfit?
“[Pacificare] repeatedly mismanaged medical claims, lost thousands of patient documents, failed to pay doctors what they were owed and ignored calls to fix the problems. ..... This is about intentional disregard for the interests of doctors, hospitals and patients”
Well, I had PacifCare for a few years, and this was indeed par for the course. Now I have Cigna and basically the same thing. As for as I can tell, they all operate like this. It’s all deliberately hardcopy based, resulting in the maximum number of errors, lost documents, etc. The really curious thing, though, is that the errors are ALWAYS in the insurance company’s favor.
In “The Rainmaker” based on John Grisham’s book, the crooked insurance company “Great Benefit” was shown to have automatically denied ALL claims the first time by policy. Well, let me tell you something, they ALL do this, particularly if you self-file as a consequence of going out of network. They’re simply counting on you being too sick and/or too ignorant to put up a fight, and unfortunately it works.
Quite frankly, I’m glad to see someone address this issue. Maybe if Pacificare is taken to task, the rest of them will have the fear of god put in them!
From the article:
...the California Department of Insurance says PacifiCare violated state law nearly 1 million times...That comes to about $9,900 per violation.
Or maybe United Health Group can just file C-7 and put everyone on Obamacare!
What you said.
Is PacifiCare the non-profit insurance out there?
Re: “Is PacifiCare the non-profit insurance out there?”
*****************
Not positive, but I’m pretty sure PacifiCare is FOR profit — Blue Shield of CA is still not for profit........ and I think they are the best of the bunch, if there is a ‘best.’
Yes long ago :
PacifiCare was founded as a nonprofit corporation by Samuel J. Tibbitts of the Lutheran Hospital Society of Southern California in 1975 and became a federally qualified health maintenance organization (HMO) three years later.
In 2009 Claims denial rates by leading California insurers, first six months of 2009:
· PacifiCare -- 39.6 percent
· Cigna -- 32.7 percent
· HealthNet -- 30 percent
· Kaiser Permanente -- 28.3 percent
· Blue Cross -- 27.9 percent
· Aetna -- 6.4 percen
"Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences," said Burger.
PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick's family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. "This was his last effort and the procedure had worked before with people in Nick's situation," said his older brother Ricky.
Cigna gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life.
In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as "investigational" even though the lumbar artificial disc she was to receive had FDA approval. At the time of denial, which she calls "insurance hell," Kutcher had "already gone through pre-op testing, donated a unit of blood, had appointments with four physicians." Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.
Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.
"The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about," Burger said. "Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice."
“The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation," she said.
"At the heart of this case is the $9.2-billion deal that put PacifiCare under the wing of UnitedHealth Group, an insurance behemoth based near Minneapolis that now has 25 million policyholders in 50 states and had $81 billion in revenue last year."
so PacifiCare denies 40% of claims and Aetna less than 7% and we’re supposed to feel bad for Pacifiripoff?
Maybe CA shouldn’t get the money, but Pacifiripoff definitely needs to be taken to task.
What California will do when all the private companies have left the state due to the oppressive policies of the state?
“That comes to about $9,900 per violation. “
Is that in line with fines for other violations by other insurance companies?
Does CA usually fine per violation or group them and reduce the fine under normal circumstances?
Regardless, it looks like it was a crummy company.
That's a good question. I don't know the answer to that. However, I threw that number out there to try to put it in some perspective. It may still be outrageous--I don't know.
“That’s a good question. I don’t know the answer to that. However, I threw that number out there to try to put it in some perspective. It may still be outrageous—I don’t know. “
Ah well, we’ll probably find out more as the situation progresses.
Regardless, one has to wonder why in the hell it took CA so long to act. The fact that it is 9.9 billion dollar fine means they took way too long to act.
It would be interesting to see where the political contributions of these insurance companies went.
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