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Blue Cross to Doctors: Help Us Get Rid of New Patients With Pre-Existing Conditions


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Blue Cross to Doctors: Help Us Get Rid of New Patients With Pre-Existing Conditions

 

LOS ANGELES ? Citing an effort to hold down costs, health insurance giant Blue Cross wants doctors in California to report conditions it could use to cancel new patients' medical coverage, it was reported Tuesday.

 

The state's largest for-profit health insurer is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," the Los Angeles Times reported on its Web site.

 

"Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," according to the letter obtained by the newspaper.

 

One of the conditions noted in the letter that could force a new patient to be dropped by Blue Cross ? pre-existing pregnancies.

 

WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said it was sending out the letters in an effort to keep costs at a minimum.

 

"Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members," WellPoint spokeswoman Shannon Troughton said in an e-mail to the newspaper.

 

"Blue Cross feels it is our responsibility to assure all records are accurate and up to date for HMO providers," she said. "We send these letters to identify members early on in the process who may not have been honest in their application."

 

Troughton added doctors are not required, but rather can volunteer, patients' information to Blue Cross.

 

Doctors were unhappy about the letter, warning that some patients might hide any medical history that could affect their prospects of receiving health insurance.

 

"We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Association.

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Just more evidence of you're damned if you do and damned if you don't.

Hopefully I'll be elected Warrior Princess of the United States of America, and together with all of you, we will change the world.

 

 

You go girl!!!!

 

That's really unethical.......we could get a group of us smart people in a room and come up with better ideas of how to reform medical insurance.......how about preventative care, etc?!?!

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Exactly! I just saw or read something today about the cost of taking care of a diabetic---$5,000 a year. The cost of taking care of a diabetic who hasn't been taken care of? $45,000 a year. I think this came from a spot sponsored by the AMA about having full medical coverage for everyone. One way or another, we all pay. Can you imagine how it would work in the courts, if you told your lawyer what you really did---and he shared the information with the judge, prosecuting attorney, cops, etc.???We'd definitely save some money on trials. Heck, why even lock them up? Just execute them. More of everything for the rest of us.

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This very thing has me a bit worried. I have wondered how some ins. companies might interpret things. I'm currently testing for Cushing's, but if my husband gets another job, and we get different ins., is that ins. going to be able to say that Cushing's is a pre-existing condition? I mean, technically it is, but I haven't been able to prove for certain that I have it. Does the fact that I have already been testing for it, even without a formal diagnosis, make this a pre-existing condition in their eyes?

 

I understand somewhat, what the ins. companies are saying, but they have to look at the bigger picture. If they are going to insure us, what is it to spend even $10,000 in testing if it is going to get us a cure, where if we don't get diagnosed, and we have, say a heart attack, and end up in ICU or have some other VERY expensive medically issue come up, what did it save them? They should be looking at it that this is basically preventive... testing for Cushing's and getting a dx before it does more damage to our bodies which is going to cost more money in the long run! Just my 2 cents worth.

 

Gracie

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I may be wrong---but I think as long as you've been paying insurance---and your husband changes his job and insurance, that the new job and their insurance carrier is required to continue coverage. As long as you keep paying the premiums each month.

 

Hopefully another of the smarties here will chime in and straighten me out if I'm wrong.

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I just heard on the news that after "outrage from doctors and patients" that this policy has been reversed! Woo Hoo!!!

 

Now if everyone had just been quiet, they would have gotten away with it. The squeaky wheel gets the grease!!!

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I just heard on the news that after "outrage from doctors and patients" that this policy has been reversed! Woo Hoo!!!

 

Now if everyone had just been quiet, they would have gotten away with it. The squeaky wheel gets the grease!!!

 

WHOOO HOOO! Glad to hear it. now if we could just ban HMOs entirely!

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I had an HMO when I was going thru diagnosis of cushings and saw so many incompetent doctor's. I have had Kaiser for 5 yrs. now and I also have Medicare disability so I can go outside of Kaiser if I want to see a specialist for second opinions which I have done. Kaiser is okay for an HMO as they don't worry so much about referrals. You just need a good PCP who is willing to work with you and you need to be a big squeeky wheel, I am, in order to get stuff done. My PCP lets Dr. F and me call the shots for the most part.

 

I hope they come up with a better health care system in this country. It's ridiculous the cost now. ANd you have to fight for everything you want or need. That's what kills me, with all the money we pay out, we still have to fight for tests, etc.

Valerie

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