Reader comments: How to deal with health plan misbehavior


In a previous editorial, I took the position that no matter how many fines you impose on health plans that behave improperly, you just can't slow them down that way, particularly given that most fines don't do them any long-lasting financial damage. Then I asked my readers what steps they think state governments ought to take to address inappropriate actions by health plans. Here are some of their comments:

"While not the entire answer, a single payer bill is now progressing slowly through the California Legislature. While the pressure from the organized insurance companies is immense, at some point informed leadership of this state is going to have to address the economic ruin of the current medical reimbursement system, private insurance debacle and the impact to physicians who have little economic incentive to work with the insurance companies." - Consumer

"I see many benefits to a one-payer system. I think this would resolve many of our healthcare management issues. Insurance companies could compete and one contract would be awarded to cover admin costs for all national claims. A predetermined fixed cost could be assigned to all services and procedures with transparency to the consumer. Consumers would know what they are really paying and the insurance companies would get a fixed payment. VOILA! After a few passes insurance companies will find something more profitable to do [than game the system]." - Nurse, Six Sigma consultant 

"In Florida, the state agency responsible for regulating insurance companies has the authority to bar a company from writing new coverage or continuing to do business in the state if it violates the law. Perhaps California might want to consider something like this, which may have a far greater impact on health insurer behavior than your current system of nominal fines." - Industry professional

Of course, this is hardly an objective sample, and I'm not suggesting, by including these responses, that the whole healthcare industry is dying to see single-payer reforms enacted. In fact, as this week's Amerigroup settlement demonstrates, government-contracted health plans can do plenty that's questionable or even illegal. 

That being said, I think we need to have an ongoing conversation, as an industry, on how to handle the shrinking pool of people insurers actually want to cover--and how to see to it that patients have adequate access to care. Let's keep bouncing these issues around, folks! - Anne

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.