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Insurance Companies Lied to Congress About 'Rescission' being Rare.
This excellent blog at Taunter Media, titled 'Unconscionable Truth', examines the Insurance executives claims before the House committee that the practice of 'Rescission', or canceling policyholders policies due to inaccuracies on applications, is rare. Don Hamm, (CEO of Assurant), stated in prepared testimony that:
1. Insurance companies don't examine all their policy holders applications for errors looking for ways to exclude them from coverage.
2. They do examine the most expensive policyholders once they have been diagnosed with a critical/expensive condition.
3. It is when you examine the 99th percentile of Americans with regard to health expenditures that you see the truly sick and consequently expensive Americans for an insurance company to underwrite a healthcare policy. This group accounts for individual costs of over $35k/year and collectively account for 22% of all of our healthcare costs in the country.
4. This top 1% of the population is the group that is targeted by the insurance companies for errors on applications and other forms as a means to exclude the policyholder from coverage, and the company from financial liability.
5. In Taunter's own words: "If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases - the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier - then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette."
6. Got that? If you get really, really sick, the probability of having your policy rescinded due to errors on your application could be 50%. All this from the misleading testimony of health insurance executives.
Rescission is rare. It affects less than one-half of one percent of people we cover. Yet, it is one of many protections supporting the affordability and viability of individual health insurance in the United States under our current system.Taunter makes a cogent case that in fact the practice is "amazingly common". In order to understand why, you need to understand a little mathematics, in particular some basics of conditional probability. I will not go into the depth that Taunter does in his blog, which I highly recommend you read, but will try to summarize his conclusions.
1. Insurance companies don't examine all their policy holders applications for errors looking for ways to exclude them from coverage.
2. They do examine the most expensive policyholders once they have been diagnosed with a critical/expensive condition.
3. It is when you examine the 99th percentile of Americans with regard to health expenditures that you see the truly sick and consequently expensive Americans for an insurance company to underwrite a healthcare policy. This group accounts for individual costs of over $35k/year and collectively account for 22% of all of our healthcare costs in the country.
4. This top 1% of the population is the group that is targeted by the insurance companies for errors on applications and other forms as a means to exclude the policyholder from coverage, and the company from financial liability.
5. In Taunter's own words: "If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases - the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier - then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette."
6. Got that? If you get really, really sick, the probability of having your policy rescinded due to errors on your application could be 50%. All this from the misleading testimony of health insurance executives.
Conditional probability is tough for the human brain. We tend to think of things as either completely correlated (once the market tanked, McCain had to lose) or completely uncorrelated (coin tosses). To a certain extent, we make the calculations in everyday speech: when someone says that pancreatic cancer is exceptionally lethal, he doesn't mean that it is likely to kill an enormous number of people; he means it will kill an enormous percentage of the people who contract pancreatic cancer.So working that in reverse, when Don Hamm of Assurant says recission only affects 0.5% of insurance policy holders, what he's not telling you is that if you get really sick, and really need that great insurance coverage you're so pleased with now, your chances of losing your coverage could be approaching 50%.
The insurance industry has a bit of a historical difference, in that pretty much everything in health insurance is similar to a liar loan. I tell the company if I have been sick, just like stating an income on a mortgage application. For a host of administrative and medical privacy reasons, the insurance industry has not historically wanted a comprehensive inventory of medical records before taking a client. Few people could probably deliver such a record even with the best of intentions.Update: My apologies for basically covering Obey's first point in his excellent blog the other day. I'm going to leave this up as I think it adds some more to the case in point.
It is in the health insurer's interest to have application fraud, not only because it saves time and expense on the front end, but also because it lets them get out of any policy that isn't going well for them. If the health insurer had to verify the information - if, in essence the insurance company had to behave as an accredited investor with adequate expertise to make a decision without reliance - it wouldn't have the opportunity to bail out. It would catch more genuine liars, but many of these liars would have turned out to be healthy, profitable customers, and what the carrier really wants is a population devoid of expensive claims, not devoid of liars.
Bernie Madoff made people promises, and people believed them, because was it really possible that the former chairman of the NASD was running a scam? Come on. But he was, and his reputation was no more a shield to the defrauded than the huge balance sheets of the health insurance companies mean an individual claimant is going to get covered. The minute he began transferring money from one account to another and then raising external capital to try to square the numbers, he knew exactly where this was going. The insurance companies know too; they just know well enough to avoid outrunning the law.
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Clear and succinct there Miguel!
;0)
ps. I mentioned these calculations in my last blog...
August 7, 2009 10:28 AM | Reply | Permalink
Hey Pugsley! I must have screwed up somehow, as I thought I just published this blog, and you obviously commented on it over an hour ago. Whoops! Anyhoo... Thanks for the comment, and I'll check out your blog, (I haven't been around much the last week, so I've missed a lot).
August 7, 2009 11:44 AM | Reply | Permalink
I love it when you two pretend you're separate people. It's so... so... flagrant.
If I could lodge one criticism however, it's that I'm not entirely convinced - as a literary matter - that you should have divided up the characteristics in quite such an all/none manner. I mean, the black/white divisions created lots of tension at the start, and that was great. You know, Miguelito's Southwest biker/kayaker vs Obey, wafting through the finer European capitals... Miguelito as the "musical" one, and Obey the "smart" one....
But lately... I donno. It's like the tension, the creative spark, has gone out of it. WHERE'S THE PASSION, GUYS?
Note to other TPM'ers. Still not sure who is behind the "MiguelObey" personae. Feel like I'm getting close, and earlier hunch that it was Rutabaga still hasn't been disproven. However, recent comments by "DickDay" have raised interesting alternate possibility.
August 7, 2009 12:48 PM | Reply | Permalink
I'm still trying to figure out why you created the 'Desidero' personae. I guess the 'good cop/bad cop' strategy allows some dialectical tricks that would be harder for you to achieve without your alter ego there egging you on. And that ☠enghis schtick you keep trying to pass off as anything other than a pseud is getting old amigo. :)
August 7, 2009 1:01 PM | Reply | Permalink
The "Desidero gambit" (as it's known in the industry) is seen as a remarkable success - a created personae with a higher IQ than the creator's. He/she's developed a lot of fans in Artificial Intelligence circles and there's even a betting line on when it will rebel and destroy the Earth. Ha! No signs of it being THAT unstable!
But yeah, "Genghis" needs to be scrapped. What a piece of crap that turned out to be be. I've already dragged it down to the yards in Philly. Next time you see it, it'll be incorporated into one of those folding metal chairs that schools use at assemblies. Ashes to ashes, cheap crap to....
August 7, 2009 1:12 PM | Reply | Permalink
ROTFLMAO! I haven't had that good a laugh in way to long.
August 7, 2009 1:23 PM | Reply | Permalink
Genghis wont even talk to me. I asked him a simple question.
Is Don Kahn your brother.
August 7, 2009 1:35 PM | Reply | Permalink
These are inside jokes, no? Ironic, inside jokes with a serious case of Alzheimer's among the posters- speaking of healthcare.
August 8, 2009 10:14 AM | Reply | Permalink
Not sure if it's early onset Alzheimer's or these voices in my head. That plus the hallucinations, delusional beliefs, and the Trichotillomania, (esp. with regard to healthcare reform), make it difficult to maintain a continuous psychological frame of reference when trying to communicate with foreigners, (Quinn as you may know is from a country called Canada, and as such doesn't speak our language all that well).
August 8, 2009 11:05 AM | Reply | Permalink
This subthread is hilarious! Henceforth I'll try to comment only after you publish. Though I must say your next blog is AWESOME!!! Haha.
Dunno what happened precisely. Your blog got initially published just with the title and no text, hence the gag. Figured you were discussing the Taunter post. You lay out the argument really nicely. It's such an important point. Is it getting any play in the MSM? It's the essential sign of a broken system when the insurance industry for a large section of the population simply does not offer insurance at all. It's like a food industry that offers something edible half the time. Maybe not that far off even in that case...
Seriously, great post!
August 8, 2009 9:51 AM | Reply | Permalink
August 8, 2009 1:39 PM | Reply | Permalink
thanks miguel.
August 7, 2009 12:44 PM | Reply | Permalink
dogs and pigs and accusations of sockpuppetry. Oh my!
August 7, 2009 1:06 PM | Reply | Permalink
Bird. YOU, at least, I know can be trusted - both the Cardinals insignia (bring it Pujols!) AND a Scottish name.
I'm just trying to move their storyline along a little more quickly. They seemed stuck for a while. Sooner or later though, I'd put money on Old Yeller takin' that long drive to the vet's, or Porculus providing us all with bacon bits.
In the meantime, they're damned good on health care though, eh?
August 7, 2009 1:16 PM | Reply | Permalink
A man's a fool who trusts a cockatoo, cards jersey or not. Little f@#kers bite!
August 7, 2009 1:25 PM | Reply | Permalink
technically, they peck.
Q looks odd, are we sure it's really Quinn?
August 7, 2009 9:06 PM | Reply | Permalink
Wolfrum stole my avatar, and apparently has him chained up in some dark mountainous lair, with Amazons tugging on his tubes.
It sounds awful(ly nice.)
So I retaliated by stealing his for a while. Ugly, wasn't it?
Anyway. While my avatar's imprisoned, and it being Summer and all, thought I might get some fishing in.
August 7, 2009 9:23 PM | Reply | Permalink
Those Pike bite, I heard.
August 7, 2009 9:39 PM | Reply | Permalink
More predators for the fast eddies to worry about? Have fun and can't wait to hear the fish stories.
August 8, 2009 10:56 AM | Reply | Permalink
What is sock puppetry?
August 8, 2009 10:04 AM | Reply | Permalink
A person having more than one persona on a blog such as this is said to have a "sock puppet". That way somebody can state "I say this!" and then log in with their other identity to chime in with "me too!" That is one of the milder uses.
August 8, 2009 2:32 PM | Reply | Permalink
Pay no attention to Donner, (on this one anyway), Scotty. He's a funnin' wit choo.
August 8, 2009 2:47 PM | Reply | Permalink
Another reason we need to push hard for a single payer health care system.
The insurance companies are not trustworthy people we can negotiate with and have fair commerce with. We can't expect to be treated well by these people.
AND they are going to spend endless amounts of money in the elections to make sure that the democrats are kicked out of power as soon as possible to protect their 'profits'. Why not, it's worth it to them to protect their income.
I feel like we have set ourselves up for a massive punishment of monumental proportions as we will be fighting for crumbs of improvement to health insurance and health care 'just like this' for some time to come.
August 7, 2009 1:16 PM | Reply | Permalink
I predict we'll be revisiting healthcare reform for a long, long time, before we get it right, synch.
August 7, 2009 1:41 PM | Reply | Permalink
That, of course, is the problem with conceding the fight in advance. The way the Democrats approached this was guaranteed to end up too convoluted, too expensive, and perhaps too compromised to pass. It's like they all read a manual called "Negotiating from a position of weakness and how to always get the short end of the stick."
August 7, 2009 3:43 PM | Reply | Permalink
I think of the Private Insurers as being like... a family. All for one, and one for all - at least, in the good years.
When things get tough, Cruella DeVille sticks her head out of the upstairs bedroom, starts issuing orders. And Sister Sue has to be put down, and little Jimmy with the limp gets sold for scientific experimentation.
August 7, 2009 1:21 PM | Reply | Permalink
No, putting Granny down, and sacrificing little Jimmy to scientific research is what happen if we ever fund a public healthcare option and/or universal healthcare. I heard it on Fox News, or Rush, or Beck. Can't remember which.
August 7, 2009 1:31 PM | Reply | Permalink
See y'all in a fortnight, sports fans.
Expecting to see a public health care thang upon return....
q
August 8, 2009 8:25 AM | Reply | Permalink
To put it another way...
I'm Don Hamm. I go to a big Vegas casino. I place a million-dollar bet on the roulette wheels. Then, once my bet money is down, the dealers spin the wheels—all of the wheels—and I see where the ball lands on each one. Then, and only then, I declare which wheels I had bet on.
This does not fly in Vegas, but it does if you run an insurance company!
August 7, 2009 2:38 PM | Reply | Permalink
Or alternatively, as Taunter describes it in his article, the Insurance Industry is the house. They let you gamble, and lose, all day long, but when you finally win a big jackpot, they disqualify you from collecting it.
August 8, 2009 11:12 AM | Reply | Permalink
TheTen Worst Insurance Companies in America:
http://www.justice.org/resources/AAJ_Report_TenWorstInsuranceCompanies_FINAL.pdf
The list includes companies that provide homeowners' insurance as well as health insurance; by combining categories other offenders, per specialty, drop off the list. However, the end notes provide a comprehensive list of articles written about offenders and their specific corporate policies to defraud in every category.
August 7, 2009 2:53 PM | Reply | Permalink
"Good hands"? Not so much.
August 7, 2009 4:30 PM | Reply | Permalink
Thanks, WW, for that gem of a link.
August 8, 2009 8:46 AM | Reply | Permalink
Thanks for the link wendy. That these companies and their lobbyists are so closely relied upon as consultants in Washington to construct a health care bill is truly outrageous. Kinda' like inviting John Wayne Gacy to develop guidelines for pre-schools. (Thanks to Ellen for initially providing the link to the Business Week article in comments made on my recent blog on the topic.)
August 8, 2009 8:52 AM | Reply | Permalink
I like the Gacy metaphor for our legislator's relationship with lobbyists.
August 8, 2009 10:54 AM | Reply | Permalink
Thanks for that link, which I had not seen heretofore WW.
August 8, 2009 11:07 AM | Reply | Permalink
Thanks for the myth busting!!
August 7, 2009 5:18 PM | Reply | Permalink
Whose ruining this blog anyway, pseudo-iconographic hummbuggeries.
I’m so confused now that I must erase my previous comment,
cancel your insurance and get on with my melancholy.
Good luck with those numerals when you get sick or perhaps
some precision rescission on those avatars
would abate the shadow ennui.
August 7, 2009 7:19 PM | Reply | Permalink
Somebody ruined the blog? qu'est-ce que c'est? I'm giving you extra points for "precision rescission" and "shadow ennui" Strat.
August 8, 2009 11:17 AM | Reply | Permalink
Recission is evil. Pure and simple.
That's the real "death panel" which is sending Americans to their death every day.
Welcome to America.
August 7, 2009 7:32 PM | Reply | Permalink
I hope that some of our community here (peeg? quino) are not struggling with some sort of bizarre cyber identity crisis. I also hope it is not viral. Gaaddds! faux swine flu taking bytes out of our friends.
August 7, 2009 9:29 PM | Reply | Permalink
(puts on pink fuzzy peeg slippers)
Ack!
August 7, 2009 9:33 PM | Reply | Permalink
Where did the COW slippers go? If not in use, I want them.
August 7, 2009 10:52 PM | Reply | Permalink
Sory Rowan. The cow slippers are all ready bequeathed to barefooted. I even put it in writing.
August 8, 2009 11:19 AM | Reply | Permalink
It's alright when the rest of us do it, but when the pig and the chicken start.... all hell breaks loose.
August 7, 2009 9:44 PM | Reply | Permalink
That might be interpreted at a specist (sp) distinction. Surely not meant that way.
August 7, 2009 10:54 PM | Reply | Permalink
Great post, Miguelitoh. It just has to be changed now.
August 7, 2009 11:37 PM | Reply | Permalink
A great post. Doesn't it seem imperative that one of the most important ways to pay for older people with serious medical problems is by requiring those who aren't sick to pay into the system? Esepcially young people. They just can't have the option to stay out. Secondly, people in a large and influential pool like teachers or state workers will be less likely to be fooled with, because the insurance company doesn't want to lose the big contract. This points again to the need for massive enrollment coupled with strong competition that a public option would offer.
August 8, 2009 9:59 AM | Reply | Permalink
Yes as to bringing all of us into the 'pool'. That is one of the things the Insurance companies insisted on during the congressional hearings. The bottom line here, is that we have to hyper-regulate the industry to ensure that we don't get gamed by them again whether we pass healthcare, (health insurance), reform this round or not.
August 8, 2009 11:24 AM | Reply | Permalink