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My quote in the LA Times!!

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SBD
Admiral

Joined: 19 Aug 2004
Posts: 1022

Posted: Wed Oct 31, 2007 1:30 am Post subject: My quote in the LA Times!!

I thought the quote I gave the LA Times was just going to be used in another Health Insurance story. Boy was I pleasantly surprised, especially with the last line of the article!! Laughing

Quote:

Insurers taking risk out of the equation
October 26 2007

You buy a Band-Aid. You get a scrape. You use your Band-Aid. And the next time you go to the drugstore, you're told that you have to pay more for Band-Aids. Or maybe they won't sell you another Band-Aid at all.

That, in essence, is what seems to be happening in the insurance business.

This week we've had two stark reminders of how screwy this industry has become. First, of course, there are the fires that have devastated parts of Southern California.

As I reported Wednesday, any claims filed will end up in vast, privately run databases and result in "insurance scores" that could influence rates paid by homeowners for years to come.

Then there's the matter of health insurers canceling coverage for people after they submit claims for medical treatment. The practice has become so prevalent that state regulators this week announced measures to crack down on what they termed acts of cruelty by insurers against patients.

Spring Valley resident Sal D'Anna says he knows all about that. He took out a health insurance policy with PacifiCare Health Systems Inc. in February 2006. D'Anna, 35, was subsequently diagnosed with kidney cancer and had to have one of his kidneys removed.

In August 2006, he was informed by PacifiCare that his coverage was being canceled.

"They said I knew I had kidney cancer when I applied for insurance and didn't tell them," D'Anna said. He said he applied for the insurance before learning of the cancer.

Tyler Mason, a PacifiCare spokesman, responded that as the case proceeds through arbitration, "it will become clear that our actions related to Mr. D'Anna's case were appropriate."

As for the fires, it's too soon to say whether the blazes will result in higher rates for policyholders. But with damages estimated to be running north of $1 billion, you've got to figure that insurers will seek to recoup that money somewhere.

State Insurance Commissioner Steve Poizner declared an "insurance emergency" this week but said he believed insurers had enough cash to pay all claims.

Statistics, however, suggest that policyholders aren't getting as much bang for their buck as they used to. At issue is what's known in insurance circles as a loss ratio -- the relationship between the amount of money paid by consumers in premiums and the amount paid out by insurers to address claims.

According to the California Department of Insurance, the average loss ratio in 2000 was nearly 52%. That means insurers paid about 52 cents in claims for every dollar spent by consumers on premiums.

The loss ratio rose to almost 64% in 2001 and was about 59% in 2002. In 2003, the year Southern California's horrific Cedar Fire destroyed more than 4,800 structures, the loss ratio jumped to nearly 74%.

Just a year later, though, the loss ratio plummeted to about 31%. In other words, insurers were suddenly paying out just 31 cents for every dollar in premiums.

The loss ratio was 34% in 2005 and about 33% last year.

Andrew Barile, a Rancho Santa Fe insurance industry consultant, said the plunging loss ratios reflect higher premiums charged by insurers after the Cedar Fire and reduced payouts for claims.

He said the loss ratio should increase this year as claims spill in for the current fires, although this could be mitigated by even higher premiums.

"After every catastrophe, there's always been a rise in rates in the area that had the problem," Barile said. "That's how the industry survives."

Insurance is a risky business -- no one disputes that. But that's always been the case.

These days, it seems like insurers are doing everything they can to minimize risk by increasing premiums or lowballing claims. Or they're cherry-picking customers to avoid those who pose the greatest threat to their bottom lines.

"The private insurance business is a business, first and foremost," said Fernando Torres-Gil, acting dean of the UCLA School of Public Affairs. "As a business, the goal is to minimize payouts and maximize profits."

Yet the insurance industry always has been predicated on risk. Why are things different now?

"There's less regard for consumers and more emphasis on profits," Torres-Gil replied.

Robert Hartwig, president of the industry-backed Insurance Information Institute, said this was an unfair characterization of insurers.

"I don't know where that idea comes from," he said. "The insurance industry honors every claim under its contracts."

Hartwig said premiums were dropping in California and policyholders were being fully compensated for their losses.

"There's absolutely no substance to the argument that there's less bang for the buck."

As long as it's not your home, or kidney, that's on the line.

Consumer Confidential runs Wednesdays and Sundays and frequently in between. Send your tips or feedback to david.lazarus@latimes.com.

As long as it's not your home, or kidney, that's on the line. LOL

SBD

Navy_Navy_Navy
Admin

Joined: 07 May 2004
Posts: 5777

Posted: Wed Oct 31, 2007 6:30 am Post subject:

Quote:

Tyler Mason, a PacifiCare spokesman, responded that as the case proceeds through arbitration, "it will become clear that our actions related to Mr. D'Anna's case were appropriate."

Weasel-speak. Confused

I wonder how he thinks he's going to make his case? Where are all the medical bills for diagnostics to find that cancer? He knows they have nothing regarding that cancer until the body scan, which makes his comment a bald-faced lie.

You've sure had a tough row to hoe for the last couple of years. Having to deal with these con artists and shysters when you're fighting for your life is just unreal. Hope you're feeling good and have a very favorable prognosis.
_________________
~ Echo Juliet ~
Altering course to starboard - On Fire, Keep Clear
Navy woman, Navy wife, Navy mother

Uisguex Jack
Rear Admiral

Joined: 26 Jul 2004
Posts: 613

Posted: Thu Nov 01, 2007 3:25 pm Post subject:

Good to see you're getting somewhere SBD. The last line is a keeper.

dusty
Admiral

Joined: 27 Aug 2004
Posts: 1264
Location: East Texas

Posted: Thu Nov 01, 2007 5:56 pm Post subject:

Let me add my wishes for your good health also SBD. I know the fight is tough but I think it beats pushing up Daisies. Dusty _________________ Left and Wrong are the opposite of Right!

streetsweeper95B
PO2

Joined: 25 Nov 2004
Posts: 365
Location: Texas

Posted: Tue Nov 06, 2007 3:39 am Post subject:

Add my continued good wishes for your health as well, SBD. I love it, your quoted LOL _________________ "Proud Member of the Freak Show"

SBD
Admiral

Joined: 19 Aug 2004
Posts: 1022

Posted: Sat Nov 10, 2007 11:07 pm Post subject:

Thanks everyone for your wishes of good health. I am happy to say that I am still cancer free!! SBD

dusty
Admiral

Joined: 27 Aug 2004
Posts: 1264
Location: East Texas

Posted: Mon Nov 26, 2007 3:04 am Post subject:

Someone sent me this in an e-mail and I immediately thought of SBD and his HMO fight.

Quote:

HMO

INFORMATION YOU NEED TO HELP YOU CHOOSE YOUR NEXT HEALTH PLAN ..

Q. What does HMO stand for?

A. This is actually a variation of the phrase, "HEY MOE." Its roots go back to a concept pioneered by Moe of the Three Stooges,who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes.

Q. I just joined an HMO. How difficult will it be to choose the doctor I want?
A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. These doctors basically fall into two categories -- those who are no longer accepting new patients, and those who will see you but are no longer participating in the plan. But don't worry; the remaining doctor who is still in the plan and accepting new patients has an office just a half-day's drive away and has a diploma from a Third World Country.

Q. Do all diagnostic procedures require pre-certification?

A. No. Only those you need.

Q. Can I get coverage for my preexisting conditions?

A .Certainly, as long as they don't require any treatment.

Q. What happens if I want to try alternative forms of medicine?
A. You'll need to find alternative forms of payment.

Q. My pharmacy plan only covers generic drugs, but I need the name brand. I tried the Generic Medication, but it gave me a stomachache. What should I do?
A. Poke yourself in the eye.

Q. What if I'm away from home and I get sick?
A. You really shouldn't do that.

Q. I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his office?

A. Hard to say, but considering that all you're risking is the $15 co-payment, there's no harm in giving him a shot at it.

Sound familiar?

Dusty
_________________
Left and Wrong are the opposite of Right!

Navy wife
Research Director

Joined: 09 Aug 2004
Posts: 353
Location: Arlington, VA & Ft. Worth, TX

Posted: Mon Nov 26, 2007 3:18 pm Post subject:

Wonderful news, SBD! I'm so happy to see your quote and to receive the news that you are cancer free. That's incredible!!! Keep up the good work!

SBD
Admiral

Joined: 19 Aug 2004
Posts: 1022

Posted: Tue Nov 27, 2007 7:09 pm Post subject:

Navy wife wrote:

Wonderful news, SBD! I'm so happy to see your quote and to receive the news that you are cancer free. That's incredible!!! Keep up the good work!

Thanks Navy Wife!!

SBD
Admiral

Joined: 19 Aug 2004
Posts: 1022

Posted: Tue Nov 27, 2007 7:13 pm Post subject:

dusty wrote:

Someone sent me this in an e-mail and I immediately thought of SBD and his HMO fight.

Quote:

Sound familiar?

Dusty

LOL, here's another one on point!!

Quote:

An HMO CEO was given a ticket for a performance of Schubert's "Unfinished Symphony." Since he was unable to go, he passed the invitation to one of his managed care reviewers. The next morning, the CEO asked the reviewer how he had enjoyed it, and he was handed a memorandum, which read as follows:

MEMORANDUM

1. For a considerable period, the oboe players had nothing to do. Their
number should be reduced, and their work spread over the whole orchestra, thus avoiding peaks of inactivity.

2. All twelve violins were playing identical notes. This seems unnecessary
duplication, and the staff in this section should be drastically cut. If
a large volume of sound is required, this could be obtained through use
of an amplifier.

3. Much effort was involved in playing the 16th notes. This seems an
excessive refinement, and it is recommended that all notes should be
rounded up to the nearest 8th note. If this were done, it would be
possible to use paraprofessionals instead of experienced musicians.

4. No useful purpose is served by repeating with horns the passage that has already been handled by the strings. If all such redundant passages were eliminated, the concert could be reduced from two hours to twenty
minutes.

5. This symphony has two movements. If Schubert did not achieve his musical goals by the end of the first movement, then he should have stopped there. The second movement is unnecessary and should be cut.

In light of the above, one can only conclude that had Schubert given
attention to these matters, his symphony would probably have been finished by now.

SBD

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