We don't have to look far to see examples of the health insurance oligopoly taking unfair advantage of the public. Apart from the premium increases in the headlines, there is the more insidious increase in hidden costs.
United Health, a company that paid its CEO $1.2 billion a few years ago, is in a legal dispute with several New York hospital groups because United is insisting that it be notified with 24 hours of when someone is admitted to a health care facility. If hospital personnel miss the deadline by even a few hours, the patient is only partially covered by the terms of the contract.
The insurance company people adjudicating these claims are not doctors. They are just people sitting in cubicles playing God.
Creating these noncontractual arbitrary deadlines is becoming an expensive epidemic. Here in California, Blue Cross is insisting that businesses notify them within seven days if a terminated employee has not paid for their COBRA coverage after a 30-day grace period.
Avoiding this trap involves carefully reading postmarked envelope dates and understanding the deadlines and authorization requirements. The notification periods and grace periods are byzantine enough, but the consequences of being wrong or late can cost businesses a bundle while creating an unearned windfall for Blue Cross.
COBRA coverage is the option that allows a former employee to continue being covered under a former employer's policy as long as the former employee pays the bill. Normally, the cost to maintain coverage by paying the entire monthly cost would be prohibitive for most out-of-work employees, but the government has temporarily reduced the cost to 35 percent of the billed amount.
Effectively, the government is paying 65 percent of the monthly bill and this will continue until March 15. Then what? Nobody knows, but the revolving door of temporarily out-of work citizens probably includes a combined total of 100 million of us over the next several years.
Meanwhile, today's terminated employees paying for coverage are given up to 30 days to pay each month's bill. Their payment to their former employer must be post-marked within that 30-day period, and then Blue Cross allows seven days to receive the information that they have NOT paid.
Missing the seven-day deadline triggers another month of premium payments that the employer has to absorb in total (no government subsidy) - and for which Blue Cross has no practical obligation to pay claims.
Other insurance carriers have been operating on a 60-day period for notification purposes and have offered to back off the premium charges retroactively if notified within this reasonable period.
What's the rush at Blue Cross? Simple. Human error, time constraints, holiday mails and a number of other factors can get in the way of a seven-day window for reporting a nonpayment. Someone in Blue Cross senior management must have introduced this great way to increase profits without raising premiums or cutting expenses. Of the carriers operating in California, Blue Cross is alone with this practice.
It's time for a health insurance equivalent of the Public Utilities Commission - an organization that would have the power to force these companies to operate in a nonprofit status. That status works well for, say, Blue Shield and prevents a senior executive from walking away with a $250 million annual bonus - an event that California allowed to happen at Blue Cross when the latter became a public company not so long ago.