Thursday, July 08, 2010

And The Hits Keep Right On Coming

I frequently criticize the Los Angeles Times, especially its "center left" editorial board, for wrongheadedness, fuzziness, and outright deceptive news coverage. However, I'm more than willing to admit that the paper's ongoing coverage of the health insurance industry, especially in California, has been excellent. An article in today's edition continues in that tradition. The focus today is on a pending lawsuit against Blue Shield.

A Los Angeles woman sued Blue Shield of California on Wednesday, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety-net insurance for people who were sick or jobless.

Amalia Lample said in her lawsuit that Blue Shield, the state's second-largest not-for-profit insurer, knowingly exceeded maximum insurance rates set by the state and falsely reported to regulators that the charges stayed within official guidelines.

Ms. Lample's law suit may be a difficult one to sustain, not because it is frivolous, but because state law is apparently ambiguous when it comes to how premiums are to be calculated, something that the state agency involved is urging the legislature to fix.

Blue Shield denied two refund requests by Lample, who filed a complaint with the California Department of Managed Health Care. Regulators said they could not conclude that Blue Shield had violated state law.

But Wednesday a department spokeswoman said the law's definition for calculating maximum rates was ambiguous, making it difficult to determine whether health plans were charging too much.

The department is sponsoring a bill in the Legislature to "eliminate any question" on rates insurers can charge, said the spokeswoman, Lynne Randolph.

The comment from the state agency makes it clear that not only Blue Shield has been playing around with the ambiguities, and the article also details some of the shenanigans of Anthem Blue Cross in the same arena.

While I am appalled that the health care insurers continue to gouge the public, I am pleased by the coverage the L.A. Times has given the issue the past couple of years. Now, if the editorial board would just get the picture right and call for the obvious cure for this public malady (a single-payer system), I just might re-subscribe.

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