Transparency: Insurance companies talk it but do not walk it.

 

Webster’s Dictionary defines transparency as a picture made visible by light from behind. If that is the case, then the insurance companies must be using the lowest voltage manufactured. Vital steps toward health insurance reform will be needed to happen to include standardization, comparability, disclosure, and honesty of language. Maybe we need a Consumer Facts, label, similarly modeled after the FDA’s Nutrition Facts label.

 

Insurance companies throw out the word transparency like it is something new. First, try and read an insurance policy. Have a medical dictionary and legal dictionary there as you attempt to read it. Even if you are able to get through it with some basic understanding, wait until you have to use it and see how confused you are when you get your claims statement and see what they paid for and what the statement of eligibility of benefits says it paid the provider and what was not paid. This will help shed some light on a major problem that needs to be addressed regarding health care reform. Let me start with standardization. While working with a group of physicians on providing standardization and transparency on the treatment of diabetes, I spoke with three different medical directors of major medical insurance companies that market their product here in Memphis. I explained how the standardization for protocols and patient education which has been accepted by the national accrediting organizations and by which the insurance companies are suppose to be measured, would decrease costs (both to the employer and the employee) and increase health benefits for the patient. After presenting data, in the end, the insurance companies said, “Well, we are looking at our own standards to use.” What about cooperation and standardization by the insurance companies to be transparent and comparable? The only form of cooperation to the insurance companies is their cooperation with each other on having enough lobbyists to influence lawmakers to make sure that they do not have to compete like other companies in our free market, and remain exempt from falling under federal anti-trust laws (the only group to be exempt from these regulations except for baseball). A couple of weeks ago I watched an interview between Bill Moyers and a retired vice-president of Cigna on public television. He said there would never be any kind of real reform as long as there was the exemption and insurance companies had plenty of money to tie these discussions up for years. 

 

With regard to honesty and disclosure, a physician group that I work with received a letter from United Health Care recently that stated it will be auditing this group because of a report from the company Ingenix (a company owned by United Health Care) questioning some of the group’s claims. Ingenix was sued by the attorney general of the State of New York a couple of years ago. United settled out of court for millions of dollars. Apparently they are testing the laws again to see who might call them on their honesty.