Why We Need Insurance Transparency — Daily Rise: Tuesday, July 19

Why We Need Insurance Transparency

We need greater transparency in the health insurance industry.

Case in point: A new class-action lawsuit in California that alleges Blue Shield skimmed tens of millions of dollars owed to patients.

The lawsuit claims that, since 2014, Blue Shield wrongly cashed $35 million in health rebates that should have gone to more than 446,000 patients. Under the Affordable Care Act’s medical-loss ratio rule, insurance companies that sell in the individual market are required spend at least 80% of collected premiums on medical care or “quality improvement activities.”

According to ModernHealthcare.com, Blue Shield appears to have incorrectly included “administrative mistakes as medical spending” — depriving patients of as much as $35 million in consumer rebates.

“It seems to me that what Blue Shield has done absolutely violates the letter and the intent of the MLR provision,” said Michael Johnson, Blue Shield’s former director of public policy.

Yes, that’s a former employee blowing the whistle on Blue Shield’s wrongdoing. He’s not alone. Jay Angoff, a former Missouri insurance commissioner and former director of the CMS’ Center for Consumer Information and Insurance Oversight, is serving as one of the plaintiffs attorneys in the case.

It shouldn’t take whistleblowers, watchdogs and class-action lawsuits to collect the money rightfully owed to patients. We won’t see true accountability until there’s transparency in government-mandated insurance markets.

11,000 Pages of Regulation

More than 11,000 pages of government health care regulations have been implemented since the Affordable Care Act. As one surgeon explains in a piece published at The Virginian-Pilot, government regulations are contributing to the rising cost of health care.

“Premiums, deductibles, co-pays — they’re rising faster than ever, forcing patients to make hard choices of where to cut back in order to afford their insurance,” explains Dr. Carrie Triepel, an orthopedic surgeon based in Virginia Beach. “It turns out that doctors and patients aren’t the only ones in the room anymore. We’ve been joined by an army of invisible, immensely powerful and incredibly expensive bureaucrats.”

Dr. Triepel says that the new regulations are contributing to insurance premium hikes. In Virginia, the wave of premium increases has been unrelenting.

  • 11 percent health insurance premium increase in Obamacare’s first year of implementation,
  • 8.4 percent health insurance premium increase in 2016
  • 9.4 to 37.1 percent projected health insurance premium increase in 2017

“They’re paying more for Obamacare’s army of bureaucrats, who should never be in the treatment room in the first place,” she concludes.

Better Patient Trials

As companies invest in new treatment innovations, they’re also finding new ways to improve patient trials.

The Wall Street Journal reports on the new effort to provide patients with additional services and incentives to join clinical patient trials. One company that’s developing a treatment for patients with dementia has teamed up with ride-sharing company Lyft — to provide patients with transportation to and from clinics helping to study a prospective Alzheimer’s drug.

“Regulators require the studies to determine if a compound works safely in subjects and should be approved,” the Journal reports. “Trial subjects are closely monitored at study research sites to see if the drug is proving more effective than a placebo or a medicine currently in use, without undue side effects.”

Patient trials are a critical component of the innovation process and development of new treatments. Every year, 1.8 million patients worldwide participate in 80,000 trials. It’s also “one of the biggest challenges in clinical research today.”

The obstacles are numerous: too much paperwork, additional medical testing, more patient monitoring, and the chance that you’ll receive the placebo. We’re pleased that companies are finding new ways to improve patient care.

Olympic-Sized Hospital Headache

Bloomberg is warning Olympic tourists to anticipate inadequate care in Rio de Janeiro.

All five hospitals recommended by Rio de Janeiro for Olympic tourists “don’t allow for accommodation of new patients,” a local medical panel has determined.

“There are a lot of patients admitted in improvised ways, in hallways, on gurneys and chairs, due to the lack of hospital beds and inadequate structure,” the state’s medical council warns.

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