Wednesday, April 26, 2006

Blue Cross, Reggie Bush, Pro Football Stories Mark Today's LAT

Today's L.A. Times is an outstanding paper, in large part because of fascinating investigative stories in the Business and Sports sections. All of these stories brought attention to some normal backwaters of public attention.

Lisa Girion's story in Business on whether Blue Cross is cancelling sick people's policies in an illegal way put the huge medical insurance company under some much-needed scrutiny.

This company has long wanted to have it both ways -- selling a lot of policies, but, at the same time treating its less healthy policyholders in a cavalier way. It is a complicated subject, and Blue Cross has some other practices, not written about today, that should also get the spotlight.

I found when I wrote a consumer column for the Times for three years that Blue Cross is extremely hard nosed when it comes to negotiating with hospitals on its reimbursement policies. Often, these reimbursements are shamefully low, depriving the hospitals of fair payments for their services. Although some of the savings are passed on to policyholders, the question still arises whether hospitals are being cheated out of fair reimbursement. Blue Cross is just barely forthcoming in such matters.

Today's Girion story discusses whether the cancellations of sick people are done in accordance with state law, and implicitly raises the question of whether the stste is under-regulating this company. Much of the information that is coming to light on the topic is coming as a result of lawsuits by the cancelled policyholders, not any revelations by regulators.

Although this story does not get into the topic, there is also a question as to whether Blue Cross is complying with federal rules on the government drug benefits for the elderly. For one thing, it takes Blue Cross a very long time to answer many phone calls. Often, they are rejected altogether, and often callers are put on hold for 30 minutes, much longer than allowed under the government rules.

I found out when I tried to enroll in a Blue Cross drug plan late last year that my application was ignored for weeks, and I was suspicious that the fact that I am diabetic and use a lot of medicines was keeping them from approving the application. As the Jan. 1 deadline approached, I could not get through on the phone lines and I finally transferred to the AARP plan out of fear I wouldn't have any plan at all.
The Blue Cross policy had sounded more liberal on first inspection, but if they are discriminating against those with health problems, they should be reined in, no mistake.

In any case, I hope the Girion story is only a start. This company needs more attention. Right now, it is a vast profiting making enterprise. The Business section in general should be paying more attention to the vital health care issues that afflict us.

Meanwhile, Sports this morning has a story and a Bill Plaschke column on whether Reggie Bush, the Heisman Trophey winner, violated NCAA rules by dealing under the table with agents during the season. His parents may have lived rent free in a house and if that is shown to be the case, USC may end up sanctioned by the NCAA, and even have to forfeit some of its games, even if the school and its coaches knew nothing about any transgressions.

The Plaschke column questions in the writer's usual pungent style whether Bush had to know if his parents were living in a rent free house as a result of payments made by the agents.

This is a worthy subject. If Bush was in violation, perhaps his Heisman should be taken away, in addition to other penalties.

Also in Sports is a story by Alan Abrahamson reporting, for the 1,000th time it seems, on whether the National Football League will return a team to Los Angeles.

I used to cover this subject too for the Times and I came to the conclusion at that time that NFL football was not worth the price in new stadiums and franchise fees to many of the cities that have teams, and certainly not to Los Angeles.

The story this morning again quotes the double-talking NFL commissioner, Paul Tagliabue, on the subject, but the story is very lean when it comes to divulging the details of the proposed deals that would cost so much.

This is a matter of considerable importance, and Los Angeles officials, if not the NFL, should be very out front about what all this is going to cost Los Angeles or Anaheim, depending where the new stadium, costing as much as $800 million, is going to be developed.

The reason for all the secrecy, I strongly suspect, is that Mayor Villaraigosa and the other officals know that if the people of Los Angeles knew how much this were going to cost, they would never go for it.

Maybe, the team should go to China, a fast developing country that can afford one. Or to Iraq, whose inhabitants scarcely get much entertainment now.

But in the meantime, Abrahamson needs to enlighten us on more of the details. He knows as well as I did that big time sports is hardly above board.


Anonymous terence said...

Blue Cross has been doing these illegal rescissions for years. So long, in fact, that they can not understand what all the fuss is about. It takes someone like William Shernoff to give them a lesson in how to PROPERLY handle claims. For years I battled with Blue Cross when I was with the Department of Insurance--but my suggestions for a Market Conduct Examination was never acted on. Perhaps now their 1950's style of claims processing with be stopped.

6/15/2006 2:02 PM  

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