This will shock only those who’ve never had to haggle with an insurance company, but a former employee of an insurance giant gave damning testimony yesterday against his former industry, telling lawmakers that companies like his go out of their way to avoid paying health claims even when they’re legitimate.
“I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry,” Wendell Potter, Cigna’s former vice president for corporate communications, told members of the Senate Commerce Committee. He continued:
Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand — or even to obtain — information we need.
The deception, of course, is by design. Publicly traded companies don’t exist simply to make profits, they exist to make more profits today than they did yesterday. Why else would anyone invest in them? And in the case of private insurers, what easier way to pad the bottom line than to deny expensive claims by stonewalling confused patients?
Potter expands, somewhat technically, in his written testimony:
The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies’ quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical “benefit” ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.Update: Here's some more shady insurance company goodness:
To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they’ve failed to trim medical costs.
Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.
The report was part of a multi-pronged assault on the credibility of private insurers by Commerce Committee Chairman John D. Rockefeller IV (D-W.Va.). It came at a time when Rockefeller, President Obama and others are seeking to offer a public alternative to private health plans as part of broad health-care reform legislation. Health insurers are doing everything they can to block the public option.
At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
