February 22, 2008

Los Angeles Sues Health Net for Insurance Cancellations

Rocky Delgadillo, the Los Angeles City Attorney, is suing the insurance company Health Net. Delgadillo accuses the company of using misleading forms to get customers to make errors or admissions that could then be used as an excuse for canceling their insurance policies when they need expensive treatments. From the article:

The suit states that the Woodland Hills-based insurer used untrained salespeople to collect people's medical histories, used purposefully misleading forms and did not review the information until after they filed claims....The city attorney says Health Net went as far as to create a secret unit in its organization to cancel policies, and that it provided benchmarks -- including goals for numbers of rescissions per year and dollars in claims denied -- and bonus payments to employees for reaching company goals.

Interestingly, Delgadillo is pursuing a criminal investigation of individuals involved in these cancellations, in addition to filing a civil suit. If his allegations are substantiated, this is a very good thing. There should be strong disincentives against such dishonesty on the part of insurers.

August 1, 2007

Healthcare System Disadvantages Patients with Low Literacy Levels

The ScienceDaily pointed out recently that illiterate patients are at a serious disadvantage when it comes to getting proper healthcare, even to the point of having a higher mortality rate than literate patients. Another good discussion of the topic can be found in a July 24th, 2007 essay in the New York Times Health Section on illiteracy and the healthcare system by a Dr. Erin Marcus. As the ScienceDaily article and Dr. Marcus make clear, lliterate and semiliterate patients face many grave problems when confronted with the healthcare bureaucracy.

Dr. Marcus points out that health educators recommend that patients be given materials at an eighth-grade reading level or lower—but most consent forms and HIPAA forms and other such documents are at a much higher reading level. This has obvious, and negative, consequences for patients and can be a reason for patient “noncompliance” with doctors’ recommendations.

Patients with low literacy levels should, if possible, seek out doctors they trust to explain these materials to them and should not hesitate to ask for clarification.

The people with the real power to change this, however, are not the patients. Rather, it is the healthcare administrators who can arrange for patients to be given accessible information in accordance with the advice of health educators.