Friday, March 23, 2007

Medical Insurance and the English Language

George Orwell would be astounded at the abuse of the English language committed by WellPoint spokeswoman Shannon Troughton who makes "objectively pro-fascist left deviationism" sound as clear and coherant as "the sky is blue."

Blue Cross parent WellPoint said in a statement Thursday that it continued to disagree about what the law requires.

"California law is clear that rescission generally does not require a showing of intent to deceive or willful misrepresentation," WellPoint spokeswoman Shannon Troughton said. "All that is required for misrepresentation to be 'intentional' is that the true facts be known to the applicant.
Thus "intentional" does not imply "willful" and "intentional misreprecentation" does not imply an intent to deceive.

I assume it is possible to find some way to make some sense out of Troughton's statement. My guess is that it is based on the argument that people know what is in every document they have been given to read whether they understand it or not. I doubt Ms Troughton would like to be interrogated under oath about the contents of a document written in Arabic she was given. By her standard, she knows what it says so false statements about its content and the statement that she doesn't know what it says would both be perjury.

This unatributed quote is also beautiful

"Indianapolis-based WellPoint disputed the findings, saying it acted legally and that some rescissions are necessary to combat fraud.

"The vast majority of Blue Cross' rescissions are unquestionably proper under any criteria," WellPoint said."

Which would be like a serial killer saying "the vast majority of days last year I didn't kill anyone" were it not for the fact that the investigation showed 0 of 90 proper rescissions and 0% sure doesn't sound like the vast majority to me.

Via Kevin Drum who wrote


BEST HEALTHCARE IN THE WORLD....PART 87....The state of California has fined Blue Cross $1 million for illegally cancelling policies:

The investigation found that Blue Cross used computer programs and a dedicated department to systematically cancel the policies of pregnant women and the chronically ill regardless of whether they intentionally lied on their applications to cover up pre-existing medical conditions, a standard required by state law for canceling individual policies. Regulators examined 90 randomly selected cases of policy cancellations and found violations in each one.

Italics mine. According to the LA Times, the fine came about as the result of an "unprecedented investigation" prompted by a story they ran a few months ago. Maybe next time state regulators shouldn't wait.

14 comments:

Anonymous said...

Read wilfully as knowingly. In other words, no specific intent is required.

Anonymous said...

http://www.aflcio.org/corporatewatch/paywatch/db_console_r.cfm?f=0&ind=Insurance%20Health%20%26%20Disability

Larry C. Glasscock
Chief Executive Officer
WellPoint Inc.

In 2005, Larry C. Glasscock raked in $16,277,139 in total compensation including stock option grants from WellPoint Inc..

And Larry C. Glasscock has another $55,936,000 in unexercised stock options from previous years.

anne

Anonymous said...

http://www.aflcio.org/corporatewatch/paywatch/db_console_r.cfm?f=0&ind=Insurance%20Health%20%26%20Disability

Insurance: Health & Disability

William W. McGuire
Chief Executive Officer
UnitedHealth Group Incorporated

In 2005, William W. McGuire raked in $37,665,645 in total compensation including stock option grants from UnitedHealth Group Incorporated.

And William W. McGuire has another $1,776,547,635 in unexercised stock options from previous years.

....

John W. Rowe
Chief Executive Officer
Aetna Inc.

In 2005, John W. Rowe raked in $17,709,543 in total compensation including stock option grants from Aetna Inc..

From previous years' stock option grants, the Aetna Inc. executive cashed out $27,367,351 in stock option exercises.

And John W. Rowe has another $265,503,766 in unexercised stock options from previous years.

....

H. Edward Hanway
Chief Executive Officer
CIGNA Corporation

In 2005, H. Edward Hanway raked in $16,998,300 in total compensation including stock option grants from CIGNA Corporation.

From previous years' stock option grants, the CIGNA Corporation executive cashed out $16,447,500 in stock option exercises.

And H. Edward Hanway has another $28,881,000 in unexercised stock options from previous years.

....

Larry C. Glasscock
Chief Executive Officer
WellPoint Inc.

In 2005, Larry C. Glasscock raked in $16,277,139 in total compensation including stock option grants from WellPoint Inc..

And Larry C. Glasscock has another $55,936,000 in unexercised stock options from previous years.

....

Daniel P. Amos
Chief Executive Officer
AFLAC Incorporated

In 2005, Daniel P. Amos raked in $12,806,251 in total compensation including stock option grants from AFLAC Incorporated.

From previous years' stock option grants, the AFLAC Incorporated executive cashed out $24,011,800 in stock option exercises.

And Daniel P. Amos has another $110,915,022 in unexercised stock options from previous years.

...

J. Barry Griswell
Chief Executive Officer
Principal Financial Group Inc.

In 2005, J. Barry Griswell raked in $11,095,699 in total compensation including stock option grants from Principal Financial Group Inc..

From previous years' stock option grants, the Principal Financial Group Inc. executive cashed out $3,529,225 in stock option exercises.

And J. Barry Griswell has another $13,577,390 in unexercised stock options from previous years.

....

Dale B. Wolf
Chief Executive Officer
Coventry Health Care Inc.

In 2005, Dale B. Wolf raked in $9,725,931 in total compensation including stock option grants from Coventry Health Care Inc..

From previous years' stock option grants, the Coventry Health Care Inc. executive cashed out $13,103,944 in stock option exercises.

And Dale B. Wolf has another $69,514,075 in unexercised stock options from previous years.

....

Mark S. McAndrew
Chief Executive Officer
Torchmark Corporation

In 2005, Mark S. McAndrew raked in $8,805,171 in total compensation including stock option grants from Torchmark Corporation.

From previous years' stock option grants, the Torchmark Corporation executive cashed out $9,212,776 in stock option exercises.

And Mark S. McAndrew has another $2,709,795 in unexercised stock options from previous years.

....

Michael B. McCallister
Chief Executive Officer
Humana Inc.

In 2005, Michael B. McCallister raked in $5,383,515 in total compensation including stock option grants from Humana Inc..

From previous years' stock option grants, the Humana Inc. executive cashed out $778,903 in stock option exercises.

And Michael B. McCallister has another $60,865,194 in unexercised stock options from previous years.

....

Anthony M. Marlon
Chief Executive Officer
Sierra Health Services Inc.

In 2005, Anthony M. Marlon raked in $5,142,630 in total compensation including stock option grants from Sierra Health Services Inc..

From previous years' stock option grants, the Sierra Health Services Inc. executive cashed out $14,213,325 in stock option exercises.

And Anthony M. Marlon has another $8,497,674 in unexercised stock options from previous years.

....

Michael F. Neidorff
Chief Executive Officer
Centene Corporation

In 2005, Michael F. Neidorff raked in $4,665,233 in total compensation including stock option grants from Centene Corporation .

From previous years' stock option grants, the Centene Corporation executive cashed out $8,334,974 in stock option exercises.

And Michael F. Neidorff has another $9,646,123 in unexercised stock options from previous years.

....

Michael F. Neidorff
Chief Executive Officer
Centene Corporation

In 2005, Michael F. Neidorff raked in $4,665,233 in total compensation including stock option grants from Centene Corporation .

From previous years' stock option grants, the Centene Corporation executive cashed out $8,334,974 in stock option exercises.

And Michael F. Neidorff has another $9,646,123 in unexercised stock options from previous years.

....

Jay M. Gellert
Chief Executive Officer
Health Net Inc.

In 2005, Jay M. Gellert raked in $1,787,682 in total compensation including stock option grants from Health Net Inc..

From previous years' stock option grants, the Health Net Inc. executive cashed out $9,852,152 in stock option exercises.

And Jay M. Gellert has another $50,484,500 in unexercised stock options from previous years.

Anonymous said...

Use what you wish or nothing, but the thought did occur. Notice though the UnitedHealth executive who made $37 million in 2005 with more than another $1.75 billion left.

Say what?

anne

Anonymous said...

How many health care polices would $1,776,547,635 pay for, and if I remember correctly I think about 12 UnitedHealth officers accounted for about $2.4 billion in stock options in 2005. Guess how the options were dated, or why guess?

anne

Anonymous said...

Nice work if you can get it.

Anonymous said...

I have no idea what any of this means, by the way, but what the heck it's better than Pajama Game and "seven and a half cents" of raise and there we have it. Sever and a half cents doesn't mean a heck of a lot, tra la.

Anonymous said...

http://www.nytimes.com/2006/02/15/business/15drug.html?ex=1297659600&en=62aabaec5acffa8c&ei=5090&partner=rssuserland&emc=rss

February 15, 2006

A Cancer Drug Shows Promise, at a Price That Many Can't Pay
By ALEX BERENSON

Doctors are excited about the prospect of Avastin, a drug already widely used for colon cancer, as a crucial new treatment for breast and lung cancer, too. But doctors are cringing at the price the maker, Genentech, plans to charge for it: about $100,000 a year.

That price, about double the current level as a colon cancer treatment, would raise Avastin to an annual cost typically found only for medicines used to treat rare diseases that affect small numbers of patients. But Avastin, already a billion-dollar drug, has a potential patient pool of hundreds of thousands of people — which is why analysts predict its United States sales could grow nearly sevenfold to $7 billion by 2009.

Doctors, though, warn that some cancer patients are already being priced out of the Avastin market. Even some patients with insurance are thinking hard before agreeing to treatment, doctors say, because out-of-pocket co-payments for the drug could easily run $10,000 to $20,000 a year.

Until now, drug makers have typically defended high prices by noting the cost of developing new medicines. But executives at Genentech and its majority owner, Roche, are now using a separate argument — citing the inherent value of life-sustaining therapies.

If society wants the benefits, they say, it must be ready to spend more for treatments like Avastin and another of the company's cancer drugs, Herceptin, which sells for $40,000 a year.

"As we look at Avastin and Herceptin pricing, right now the health economics hold up, and therefore I don't see any reason to be touching them," said William M. Burns, the chief executive of Roche's pharmaceutical division and a member of Genentech's board. "The pressure on society to use strong and good products is there."

Studies show that Avastin can prolong the lives of patients with late-stage breast and lung cancer by several months when the drug is combined with existing therapies. Genentech expects to seek federal approval later this year to sell it specifically for those diseases. But even now, doctors, who are free to prescribe the drug as they see fit, are using Avastin for some breast and lung cancer cases — and finding its cost beyond the means of some patients.

"Avastin is a superb drug, but its cost is already discouraging patients and doctors from using it," said Dr. David Johnson, who heads the cancer unit at Vanderbilt University and is a former president of the American Society of Clinical Oncology. "I wish it were one-tenth the cost, and if it were I would be giving it to almost everybody."

With colon cancer, a year of Avastin treatment costs about $50,000. But the drug will be used at higher doses for lung and breast cancer, and Genentech does not plan to reduce the unit price, even though the additional cost of producing a higher dose is minimal....

anne

Anonymous said...

Notice, and notice several times over, there is philosophy here:

"Until now, drug makers have typically defended high prices by noting the cost of developing new medicines. But executives at Genentech and its majority owner, Roche, are now using a separate argument — citing the inherent value of life-sustaining therapies.

"If society wants the benefits, they say, it must be ready to spend more for treatments like Avastin and another of the company's cancer drugs, Herceptin, which sells for $40,000 a year."

Anonymous said...

Sorry :)

Anonymous said...

Now, what was that about 75% of new drugs being developed these last several years being "me too" drugs representing no particular advance for patients but a fine advance for drug companies? Really? Really.

anne

Robert said...

Thanks anonymous for trying to help me out with "Read wilfully as knowingly. In other words, no specific intent is required." I still don't get it. To knowingly say something false must imply the intent to deceive. Also, in context, it is obvious that the aim of the deceit is to get health insurance.

The only way to make sense of it is if California requires Blue Cross to prove that clients know that health insurance can be denied if they have a pre-existing medical condition. Everyone knows that, but it is usually impossible to prove that someone knows that. This would be crazy (and explain the 90 out of 90 result). I don't believe this is what is going on, but it is the only interpretation I can come up with which is not nonsense.

Robert said...

And many thanks Anne for the excellent comments and especially the corporate watch link.

I'd say if you or someone you care about has cutenous T-cell lymphoma talk to my dad Thomas Waldmann.

Anonymous said...

This is from a discussion of a different statute, but may help clarify the distinction between wilfully and specific intent:

"'Willfully' ... does not require an intent to violate the law, only an intent to engage in the act or conduct prohibited by the statute is required. Respondent acted voluntarily with an awareness of the nature of his conduct and therefore 'willfully.'"

Milner v. Fox, 162 Cal. Rptr. 584, 102 Cal. App.3d 567 (Cal. App. 1 Dist. 1980)(citations ommitted).