$1 Million-Per-Month Patient Highlights How One Pricey Case Can Sink An Insurer
Wellmark Blue Cross & Blue Shield cited the Iowa teen's case as a reason it is pulling out of the individual marketplace in the state. "Everyone is trying to avoid the $12 million-man," Duke University research associate David Anderson told the publication PolitiFact. "Because whoever catches him basically can’t make money."
USA Today:
Iowa Teen’s $1 Million-Per-Month Illness No Longer A Secret
Somewhere in Iowa, a teenager with a severe bleeding disorder holds the answer to a nationally debated riddle: How could anyone rack up more than $1 million per month in medical bills? Iowa’s largest health insurer, Wellmark Blue Cross & Blue Shield, has cited the case as an extreme example of exploding health care costs. Wellmark has said the single member’s bills amplified fast-rising premiums among tens of thousands of other Iowans who buy their own insurance. (Leys, 5/31)
In other news on insurers and the marketplace —
The News & Observer:
Blue Cross And Blue Shield Of NC Execs Get $1 Million-Plus Bonuses Despite Technology Snafu
Blue Cross and Blue Shield of North Carolina reported a dramatic increase in profit in 2016 and paid two top executives bonuses of more than $1 million despite a technology fiasco that triggered complaints from thousands of customers and a record fine from the North Carolina Department of Insurance. The state’s largest health insurer, which is based in Durham, reported Wednesday that it generated net income of $185 million last year, up from $500,000 in 2015. This year’s profit amounted to 2.4 cents for every dollar of premium received. (Ranii, 5/31)
California Healthline:
When An Insurer Balks And Treatment Stops
In 2015, Washington filed a breach of contract lawsuit in Orange County Superior Court against his insurer, Aetna, arguing that the company had improperly denied him the medication. The case is set for trial this month. From 35,000 to 50,000 people in the U.S. are estimated to be dependent on medications to treat primary immunodeficiency diseases — about 300 rare conditions in which the immune system doesn’t function properly, or at all. The medication, known as immunoglobulin replacement therapy, replaces antibodies that the body doesn’t make. It can cost tens of thousands of dollars each year. (Gorman, 6/1)
The Wall Street Journal:
How The Molina Brothers Got Bounced From The Family Health-Care Firm
On May 2, J. Mario Molina walked into the boardroom of Molina Healthcare Inc., the company founded by his father, which he had run for more than two decades, ready for a routine meeting. The first shock came quickly. A board member made a motion to remove Dr. Molina as chairman. The rest of the board, except Dr. Molina and his brother, John Molina, agreed, and the vote passed. They weren’t finished. Next came a motion to fire Dr. Molina as CEO of the health insurer, one of the country’s biggest players on the ACA marketplaces. And then, to dump John Molina as CFO. Both motions carried, with only the Molinas opposed. (Wilde Mathews, 5/31)
CQ Roll Call:
Insurers Seek Increases For Obamacare Premiums In Early Filings
Insurance companies in about half a dozen states have filed for premium increases ranging from 6 percent to 58 percent for 2018, citing rising medical costs and taxes as well as uncertainty surrounding the new Trump administration's implementation of the health care law. The increases would only affect plans sold on the marketplaces established by the 2010 law (PL 111-148, PL 111-152). They are still preliminary. Federal and state insurance review rate requests throughout the summer and fall and often negotiate different increases — sometimes lower, sometimes higher. Federal subsidies also blunt the impact on consumers of high rate increases. (Mershon, 6/1)
Bloomberg:
Aetna Says It May Move Out Of Hartford, U.S.'s Insurance Capital
Aetna Inc., whose founding more than 150 years ago helped turn Hartford, Connecticut, into the insurance capital of the U.S., is thinking about leaving. The health insurer is in negotiations with several states about relocating its headquarters, and will make a decision by early summer, T.J. Crawford, an Aetna spokesman, said in a statement Wednesday. Luke Bronin, Hartford’s mayor, called the insurer’s departure “a hard blow for the state and for the greater Hartford region.” (Tracer, 5/31)
