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Beware of your own HMO

For those on Medicare – some worries are about the schemers who promise the moon and deliver nothing while taking your money. And for those insured through HMO’s there is an additional set of worries.

For starters it is often difficult for an insured to get some care covered – and covered in full – as the HMO keeps looking for loop holes.

Well it seems at least one California HMO gives it’s employees bonuses to do such things!

From SFGate.com

Health Net Inc., one of the state’s largest health insurers, tied rewards and savings to its employees’ ability to cancel policies based on misrepresentations in members’ applications, according to documents in a lawsuit against the company.

The documents showed Health Net saved $35.5 million in “unnecessary” health care expenses for rescinding more than 1,000 policies between 2000 and 2006. At the same time, a Health Net analyst received about $21,000 in bonuses for her work, which included exceeding company goals for policy rescissions.

Full article HERE.

This does not surprise me as I had heard it before – but this came out during an arbitration hearing and was made public….widely public! As a one-time provider for an HMO, I dropped off their list of providers as decisions about people’s mental health were being made by gum chewing office workers who continued to have loud conversations with their friends while speaking to me on the phone about clients!

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15 May, 2008

Ouch

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