In my last post, I highlighted litigation launched by Anthem, a subsidiary of WellPoint, against the state of Maine. This case raises a number of questions for further investigation of private health insurers' conduct in the U.S. health care services market:
What legal and other strategies are undertaken against state regulatory agencies to promote acceptance of annual rate revisions? How do state agencies respond to these initiatives. What public expenditures are required for these defensive regulatory actions? What proportion of premium revenues is spent on such litigation by private insurance companies against public authorities?
Why are individual policy holders more vulnerable to discriminatory rate increases than other classes of insurance purchasers? What issues and practices restrict the choices and mobility of individual policy holders among insurance alternatives? Consider the discovery of pre-existing conditions making it impossible for individuals to seek other coverage. In general - how do confidentiality and privacy laws prevent publication of systematic information on health insurance performance to guide individual choices?
Why should any rate of profit be guaranteed in a "free market economy"? How is this demand at the state level correlated with the insurer's dominant position in the state economy?
Further examination of WellPoint's record reveals other cases of public interest - for example:
Last year the California Department of Managed Health Care reached agreement with Anthem Blue Cross on contentious cases of rescission. (Accessed October 12, 2009)
Lawsuits filed over health insurers’ payments
for out-of-network care:
A group of health insurers have been named defendants in
multiple lawsuits stemming from payments made to
One lawsuit was filed by the American Medical Association.
It claims thatWellpoint Inc. and others conspired to pay
reduced rates to out-of-network providers. Another lawsuit
was filed by Michael Roberts. Roberts’ lawsuit claims that as
a result of the scheme, consumers were forced to pay increased
costs associated with their care. The lawsuit filed by
Roberts names Wellpoint along with UnitedHealth Group
Inc., Ingenix Inc. and Blue Cross of California.
Roberts v. UnitedHealth Group Inc., No. 09-1886 (C.D.
Cal. complaint filed Mar. 19, 2009)
Counsel for Roberts: Christopher M. Burke, Kristen M. Anderson, Scott
& Scott L.L.P., 213-985-1274, Los Angeles.
Am. Med. Ass’n v. Wellpoint Inc., No. 09-2039 (C.D.
Cal. complaint filed Mar. 25, 2009)
Counsel for AMA: Edith M. Kallas, Joe R. Whatley Jr.,W. Tucker Brown,
Laurence J. Hasson, Whatley Drake & Kallas L.L.C., 212-447-7070,
New York; Stanley G. Grossman, D. Brian Hufford, Robert J. Axelrod,
Pomerantz Haudek Block Grossman & Gross L.L.P., 212-661-1100,
New York; Raymond P. Boucher, Helen Zukin, Michael Eyerly, Kiesel
Boucher Larson L.L.P., 310-854-4444, Beverly Hills, Cal.
Source: http://media.straffordpub.com/products/insurance-law-and-litigation-week/free-sample.pdf (Accessed October 12, 2009)
See also AMA Implicates WellPoint in Price-Fixing Plot at http://www.law360.com/articles/93856 (Accessed October 12, 2009)
An American Psychological Association Practice Update describes a class-action suit brought by state governments and solicits information from psychologists affected:
The complaint seeks damages under the Employee Retirement Income Security Act (ERISA), the federal antiracketeering law known as RICO and antitrust law for past underpayments. Further, plaintiffs will seek changes to make WellPoint’s out-of-network rate setting fairer and more transparent. (Accessed October 12, 2009 )
An investigative report- Underpayments to Consumers by the Health Insurance Industry - was published on June 24, 2009, by the SENATE COMMERCE COMMITTEE in its federal roles of oversight on interstate commerce and regulation of consumer products and services. This report found widespread reliance on Ingenix medical charge databases for calculation of out-of-network reimbursement rates as well as contract arrangements between Ingenix and insurers providing rate data specifically prohibiting disclosure of such information to consumers or doctors. Ingenix does not have any systematic procedures in place for validation of information included in the databases. More than 2 million federal employees and military families are enrolled in health plans affected.
(Accessible publications including what should be the public record are very difficult to find.)