Posted by Ritch on July 15, 2002, at 23:28:29
In reply to Insurance, Profitability, Utilization, Profiling, posted by fachad on July 15, 2002, at 11:08:36
> Your employer may provide health insurance for employees. In order for them to get quotes for this, you have to have each person that wants to be on the group plan fill out a questionnaire with their health problems, any regular meds, etc.I had a former small employer who changed insurance companies every year on purpose to get the cheapest quote.
> There are so many things wrong with this I can't believe it really happens. First, are you pleased that the HR staff of your employer knows your medical history, and your medications? That seems like an invasion of privacy.All I can say is (from what I understand to be true-anyhow), is that Clinton made only *written* documentation of insurance transactions potentially available to the employer. *Digital* filings between your doctor/pharmacist and your insurance company are supposed to not be disseminated information that your employer can be privy to. The "Flexible Spending Accounts" of late rely on a lot of *written* information, however....
I do know for sure that employers can get a breakdown from the insurance company of the *total* $$$ claims for specific meds. They were listed on the bulletin board where I work. I don't think the insurance co. can provide really employee specific info., but they *can* tell the employer everything about what drugs the *group* is taking and at what cost, etc.
Interestingly, generic hydrocodone and alprazolam (at very low cost) was high on the list (but not pricey). Patent antidepressants were also high on the list, but also had the highest cost factors. It seems they (the insurance co's.) are targeting patent AD's as their biggest cost factor.>
> Also, it means that if you have a "sickly" person on your staff, everyone has to pay more out of each paycheck for their health insurance. I joked to my business partner that we should hire only very healthy athletes until after we get a good quote for cheap insurance. I was only kidding, but an unethical company could (secretly, of course) terminate employees if their medical problems were jacking up the health insurance rates.Most new companies that start up want to do just exactly that (hire healthy young athletes). I have worked with "sickly" coworkers who have been terminated primarily due to their health problems. Of course the "objective criteria" used to terminate them was associated with the general need for them to use "medical leave"-which involves a higher statistical (objective) rate of absenteeism, etc. I am not talking depression here, but primarily "physical" chronic illnesses.
>
> But that would only work for one year, because the insurance companies do "utilization reviews" to determine the next year's premiums. They look to see how many claims were made, and how much it cost them. Then they adjust the rates for that group to be high enough for them to make money the next year. They actually look at how much each person cost.That doesn't surprise me. They *may* not know the *details*, but they DO know the $$$. They probably have a *ratio* of how much is paid out for each employee vis a vis the premiums paid in. Your privacy may be protected (as far as dx-specific meds, i.e.), but not your cost to the company.
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> So I am now in a position where I may end up on the street corner holding a cardboard sign that says “Will Work for Health Insurance”.
My take on that is similar to my position about the draft-If you don't tax, draft, or kill people in America nobody will give a damn about any policy consequences (thanks-John Irving). Fine and dandy if you have good private insurance-but what if YOU lose your job and have a health problem? The baby boomers are getting older and not as healthy as they used to be, but they aren't stupid and can VOTE. George W.'s prospects in 2004 seem to be getting a litt more distant...........
Mitch
poster:Ritch
thread:112416
URL: http://www.dr-bob.org/babble/20020709/msgs/112498.html