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ObamaCare Clusterfuck: How the insurance companies will bend the cost curve

The same way they're doing now: By denying care. See this fascinating case in the LA Times:

In a rare case, a Los Angeles jury awarded $3.8 million in compensatory damages to a Porter Ranch doctor who contended insurance giant Anthem Blue Cross retaliated against him for being a strong patient advocate.

See, there's your problem. Jury trials.

The jury found that Anthem, the state's largest for-profit health insurer, violated Nordella's right to "fair procedure," and the company did so with "malice, oppression or fraud." That latter finding prompted the hearing Friday in Los Angeles County Superior Court to determine punitive damages.

Nordella said he was turned away because he had challenged the denial of hundreds of patient claims over the years when he was previously included in Anthem's network. He said he often protested Anthem's conclusion that care wasn't medically necessary and would not be covered. Nordella went so far as to meet with top Anthem officials in 2001.

Anthem "held this grudge and continued to lie and deceive," Nordella said in an interview.

Shocker, I know.

Doctors and health insurers have battled over reimbursements and the denial of claims in court for years. But legal experts said cases like Nordella's usually never reach trial or result in multimillion-dollar verdicts.

"I was surprised by the size of the verdict, and it's really the first case I'm aware of in years," said Carol Lucas, a healthcare lawyer in Los Angeles who represents doctors and medical groups. "Insurance companies will likely look at what happened here to Anthem, and they will make sure they can justify any exclusions from their networks."

No, they won't. They'll double down. They'll think the only problem with Nardella is that they didn't throw him out soon enough.

This case comes as health insurers, in a bid to hold down costs, are increasingly dropping doctors and hospitals and promoting smaller networks. Insurers typically try to negotiate lower rates with the fewer providers left in the network, who get higher patient volume in return.

Nordella said many doctors are unwilling to challenge powerful insurance companies because their incomes are so dependent on being in these provider networks. "Physicians are so afraid to come forward," he said, "and I hope this changes that."

I hope so too, and I'm sure some will. But I would bet ObamaCare triggers a great consolidation and rationalization of the networks. If the cost curve is going to be bent, yet health insurance companies are to maintain the same level of profits, then something's got to give, and it's going to be patient care. Sure, we could wait around for electronic medical records or those guys at Dartmouth to come up with something. Or, we could throw the doctors who want to give care out of the network. Which do you think is going to happen?

No votes yet


Submitted by jawbone on

will propose some kind way to disallow doctors from advocating for patients as a way to cut costs, insurance companies certainly will double down as you predict -- and win far more cases than they lose, especially on appeal...uh, running out of predictions right now, but it will crappy coverage from crappy insurance.

And the for-profit private insurance companies will still reap high levels of profit.

Medicare will continue to be attacked by Neolib Corporatists Dems and Obama as long as he's in office. Repubs will also attack Medicare, but after they remind the voters incessantly that Obama and Dems are responsible for their higher out of pocket costs for Medicare and their lower checks from SocSec. If they gain majorities, they will further privatize and cut Medicare and undermine and try to privatize SocSec. They will try to limit jury trials for such situations as malpractice and what this doctor encountered with ConservaDems and Corporatists joining them.

I'm sure there are worse things coming as well....

albrt's picture
Submitted by albrt on

You guys are making Obamacare more complicated than it really is.

Why bother bending the cost curve? The insurance companies can simply keep raising rates now that they have an IRS-enforced captive market.

I'm pretty sure they will also count executive bonuses as medical losses for the medical loss ratio. Eric Holder and his successors will demand a 5% cut of the proceeds and allow them to keep doing it without admitting wrongdoing.


katiebird's picture
Submitted by katiebird on

This comment really belongs on your "Navigator" post from a few days ago.

Following a link at Ezra Klein's Page of Disgusting Shame, I found this call for ACA Navigation grant applications

Scroll all the way to the bottom of the page for a link to the PDF of the requirements. It's written in gibberish but did include a notice of information conference calls:

Conference Calls regarding the ACA Navigator Grant Applications:

HHS will hold two pre-application conference calls for potential applicants. The conference calls will provide an overview of this project, budget guidance, review the instructions provided by this FOA and other available materials, and will include an opportunity for potential applicants to ask questions.

First call: Thursday, April 11, 2013 from 3:30 to 5:00 p.m. Eastern Daylight Time :: Toll-free teleconference phone number: 877-267-1577; ID: 5119

Second call: Friday, April 19, 2013 from 3:30 to 5:00 p.m. Eastern Daylight Time :: Toll-free teleconference phone number: 877-267-1577; ID: 2917

I don't know if my attention span is long enough to sit in on the whole thing, but I think it could be an interesting session.

Submitted by lambert on

... will you return and comment, and maybe I can for the next one?

* * *

In a way, the whole requirement for Navigators is a backdoor admission that the health insurance companies are lying weasels.

It really is a Rube Goldberg device; they screwed a "Lying Weasel Lie Undo-er" right onto the tailpipe of the "Lying Weasel Emission Device" that powers all the other gears and bells and whistles on the thing.

For those who came in late, this is a Rube Goldberg device:

katiebird's picture
Submitted by katiebird on

(grrr.... lost comment)

Was running late today and all the lines were full by the time I could make the call. I WILL manage better next Friday. It's on my calendar and I won't let anything collide with it.

I figure this could be a chance to know what is actually going on and I don't want to miss it. If I could/can, I would sign up to BE a Navigator. Or even for a grant. I read the documents though, and it doesn't sound like they want regular people managing these things.

Well, who could blame them?