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ACEP Takes Issue with Statements Made Today by Insurance Giant Health Net, Inc ...

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"The nation's emergency physicians take issue with the efforts of health insurance companies to prevent emergency visits.  It may save some money for them, but it's bad for patient health and potentially life threatening.  It also violates the spirit of the prudent lawperson law, which requires insurance plans to pay for emergency care based on whether an average person would believe they have the symptoms of a medical emergency.

"In addition, emergency care represents less than 2 percent of the nation's health care dollar, so preventing emergency visits will never put a significant dent in the nation's soaring health care costs.

"The fact is; most emergency patients appropriately seek emergency care.  Less than 8 percent of emergency visits are classified as nonurgent by the National Center for Health Statistics, which also says 'nonurgent' does not mean unnecessary.  Nonurgent visits can include broken bones and kidney infections that require treatment within two to 24 hours.  

"These health plan tactics are dangerous because it puts people in situations of having to self-diagnose their medical conditions — out of fear the plans won't pay, for example, when their chest pain turns out to be heart burn.  Health plans send messages to their beneficiaries not to make any 'unnecessary' emergency visits.  But it's not that simple — I've seen people with mild symptoms turn out to have life-threatening emergencies.  Many people also wait too long to seek medical care, which can be life-threatening with headaches that turn out to be strokes or stomach aches that turn out to be aortic aneurisms.

"This is a very simple message we want to share with all Americans — if you think you're having a medical emergency, go to an ER immediately.  Leave the diagnosis to the experts:  emergency physicians.

Health Insurance Underwriting Guidelines | Life Insurance Health

Happened when I started getting inundated with harassing phone calls and emails from the insurance companies for posting underwriting guidelines in my website.  I don’t know why these documents are so secretive and guarded but I can say I was threatened with losing contracts and lawsuits if I didn’t pull them.  As a result I caved in, sort of. I left the guidelines up but with no real way of navigating to them.  The links were down in other words.

Most companies do not pay attention what I do over here so it seemed odd that I was getting ganged up on a daily basis during this period.  What had happened was Blue Cross Blue Shield of Florida had found my postings and literally ratted me out to everyone.  Usually, these companies would murder each other given a chance, but they were working together to protect their awful secrets.

Well, what has changed? Not a whole heck of a lot though we have grown both in size and stature in the industry and my blog (where you are reading this) is not really part of a commercial website so if you are wondering, I am going to republish at least a few of them.  This blog doesn’t sell health insurance or make attempts to represent the carriers we work for in our professional lives so I am pretty sure it will fly unnoticed.

Why are these documents so carefully protected?  I am not sure as it is not like most agents and carrier personnel don’t have easy access to them, but for some reason if they got into the hands of the general public who gets declined it could potentially be used in a lawsuit?  I don’t know this is mostly conjecture.

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