Blue Cross of California

WellPoint's finance chief has been pushed out of the company, accused of unspecified financial improprieties. Effective immediately, WellPoint senior vice president and chief accounting officer Wayne DeVeydt will take over as executive vice president and CFO. The company demanded that CFO David Colby resign after it concluded that Colby had violated the company's code of conduct. This came despite Colby's having been promoted only two months ago to vice chairman.

The company …

> Doctors are doing well in Hawaii. New research by the federal government has found that doctors there make more, on average, than workers in any other job category. Article

> Blue Cross of California has launched a media campaign critical of proposed state healthcare reforms, which would require insurers to sell policies to all comers regardless of their medical condition. …

Blue Cross of California has settled a lawsuit challenging its policy-cancellation practices, agreeing to stop rescinding individual policies unless it can prove that a beneficiary intentionally lied on their application. The agreement brings the curtain down on a class-action lawsuit involving 6,000 policyholders, who argued that the health plan had improperly canceled their coverage in a manner violating state law. The managed care company had contended that they have the right to …

Two of California's largest provider associations have joined a suit against Blue Cross of California, arguing that the health plan wrongly denied them payments for patients whose policies were later canceled. The California Medical Association and the California Hospital Association are jumping into a suit originally filed by Coast Plaza Doctors Hospital and Methodist Hospital of Southern California. Consumer organizations have blasted Blue Cross, which is accused of canceling individual policies after beneficiaries need expensive treatments. Blue Cross has argued that once policies are canceled due to incomplete or inaccurate applications, the patient must pay all bills. The hospital and physician associations say that this has left them with staggering bills. (California hospitals claimed $7.7 billion in bad debt last year, though the association can't say how much was due to Blue Cross retroactive policy rescissions.) The providers contend that Blue Cross must pay for any treatment it has authorized, even if the patient's insurance is later removed or the plan decides that the patient should not have been covered. They also argue that the cancellations were themselves improper.

WellPoint, by some measures the nation's largest health plan, has decided to take some aggressive steps to promote its new member health index (MHI). WellPoint has begun tying the index, a comprehensive measure of health improvement in its 34 million enrollees, directly to the compensation of every WellPoint employee. While it's increasingly common to compensate physicians for member health improvements, tying all employee bonuses to such a measure may be a first. The MHI includes 20 …

The California Department of Managed Health Care (DMHC) is bringing the hammer down on Blue Cross of California (BCC). The DMHC has fined BCC $1 million after finding that it systematically and illegally canceled policies held by chronically ill and pregnant policyholders. Under state law, California health plans may only cancel individual policies if a policyholder intentionally lied on an application to cover up a pre-existing medical condition. But BCC violated this standard …

It's always nice to see that there's light at the other end of the pay for performance tunnel, namely, a big fat pile of cash. In this case, a group of seven California health plans has paid big bonuses to high performers on their roster, which includes 35,000 physicians working in 210 medical practices. This year's $55 million payout, as in previous years, went to physician groups who performed best on clinical care, patient satisfaction and smart use of IT during 2005. Among the most …

The state of California's top health plan regulator, the Department of Managed Health Care (DMHC), is considering rules that might require health plans to get outside input before canceling an individual policy holder's coverage. The DMHC is already investigating policy cancellation practices of Blue Cross of California, Blue Shield of California and Kaiser Permanente, which have been accused of gaming the system by removing policyholders for innocent, unintentional mistakes in their …

The California Medical Association is mad as hell, and they're not going to take it anymore. Last week, the group began a campaign to bring patients into its class action lawsuit against Blue Cross of California. The suit, originally filed by a group of individual policyholders, alleges that Blue Cross of California has engaged in a pattern of dumping policyholders after approving expensive treatments, then refusing to pay the bills for those treatments. The state hospital association has …

Sometimes, it makes sense for the pot to call the kettle black. No stranger to accusations of unfair policy cancellations, Kaiser Foundation Health Plan has begun working with state officials to establish stricter--and fairer--rules under which individual health plans to be canceled. Kaiser itself was recently fined $100,000 by California regulators after dropping a policyholder it accused of concealing his epilepsy; it had canceled the member despite the fact that his condition had never …