Tuesday, October 28, 2008

Insurance Commissioner Jane Cline: A Shameful Situation

Tuesday’s Tirade
An infestation of poisonous snakes

The world is a dangerous place to live, not because of the people who are evil, but because of the people who don't do anything about it." ~Albert Einstein

The state government of West Virginia is allowing a large health care insurer to rip off the public. West Virginians suffer. Our state has the highest rate of depression and obesity, among many other ills.

The Offices of the Insurance Commissioner “offer a variety of services for both the consumer and the insurance industry to ensure that quality coverage exists throughout the state.” It is the duty of Jane L. Cline, Insurance Commissioner, to insure health plans provide quality service to West Virginia consumers. For Cline, however, injustice has become the law over an unsuspecting public.

See unitedforjustice.blogspot.com for a partial list of grave allegations I make in a claim filed on January 18, 2008 against the Commission at the West Virginia Court of Claims.

As the West Virginia Insurance Commissioner, Cline is a member of the National Association of Insurance Commissioners (NAIC). As such, Cline has a duty to follow NAIC’s Codes and Bylaws, which include the following:

A state regulator's primary responsibility is to protect the interests of insurance consumers, and the NAIC helps regulators fulfill that obligation.

The mission of the NAIC is to assist state insurance regulators, individually and collectively, in serving the public interest and achieving the following fundamental insurance regulatory goals in a responsive, efficient and cost effective manner, consistent with the wishes of its members.

Conflict of Interest Policy:
In furtherance of the Mission of the NAIC, it shall be the policy of the NAIC that all member (i.e., Commissioners, Directors, superintendents or other chief insurance regulatory officials) shall act in a manner that reflects the highest standard of ethical conduct and members shall avoid any activity or situation where their personal interest could conflict, or give the appearance of a conflict, with their fiduciary duties to NAIC. All members shall follow this Conflict of Interest Policy unless subject to a more stringent state policy.

NAIC members are obligated to avoid “any activity or situation where their personal interest could conflict, or give the appearance of a conflict, with their fiduciary duties to NAIC.” Return to my tirade dated October 14, 2008: West Virginia Insurance Regulation AWOL.

So what do we think about Cline? Cline frightens me.

Dale B Wolf, CEO Coventry Health Care, Inc of Bethesda Maryland

We West Virginians have poisonous snakes in our midst. Snakes that control our health care so CEO’s like Coventry’s Dale Wolf can earn a $32 million salary package in 2004 while consumers are blocked from receiving their rightful benefits. You read it correctly - Thirty Two Million Dollars!

Snakes that have so infested government, business and professional leaders in West Virginia that we must carefully and cautiously remove them one by one. Many times in the last three years I have heard the outcry, “the West Virginia Insurance Commission is owned by the insurance industry.”

And now a poisonous snake is infesting yet another regulatory agency, an agency that is formed to provide protection to the consumer.

And, herein lays a perplexing problem.

In an improbable twist of fate, Jane L. Cline is the President-elect for 2009 of NAIC. Yes, a Commissioner who refuses to enforce a significant final order she signed in 2006 to regulate how HMOs must now do business in the state of West Virginia, will wield her power and control over a national body of regulators. Is there a national scheme of the special interest groups supporting the insurance industry to get away with murder? This alarming news has dreaded ramifications.

Two weeks ago I wrote the President of NAIC, Ms. Sandy Praeger, a certified letter requesting an investigation of Jane Cline. To date I have received no reply. (You may read my letter on unitedforjustice.blogspot.com) Have the snakes already poisoned NAIC?

Unbelievable. Incredible. Shocking. What next?

Good news I believe. The troubling news about our economy brings with it some good news. Lack of government oversight is being blamed for much of our economic collapse. The future will demand much more regulation over the present display of self interest at the cost of the common good. In time, the light of justice will shine on Cline. It has to. The public will learn the truth and at that time our many, many voices will be loud, clear, and demanding.

The tide is changing. It has to.

Tuesday’s Tale
Insurance Horror Stories

“When Steve and Leslie Shaeffer’s daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs.” But “shortly after Selah’s medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively.”

So begins a recent report in The Los Angeles Times titled “Sick but Insured? Think Again,” which offers a series of similar horror stories, and suggests that these stories represent a growing trend: more and more health insurers are finding ways to yank your insurance when you get sick.

This trend helps explain something that has been puzzling me: why is the health insurance industry growing rapidly, even as it covers fewer Americans?

Between 2000 and 2005, the number of Americans with private health insurance coverage fell by 1 percent. But over the same period, employment at health insurance companies rose a remarkable 32 percent. What are all those extra employees doing?

Now we know at least part of the answer: they’re working harder than ever at identifying people who really need medical care, and ensuring that they don’t get it. In the past, they mainly concentrated on screening out applicants likely to get sick. Now, it seems, they’re also devoting a lot of effort to finding pretexts for revoking insurance after they’ve already granted it. They typically do this by claiming that they weren’t notified about some pre-existing condition, even if the insured wasn’t aware of that condition when he or she bought the policy.

… The fact is that cruelty and injustice are the inevitable result of the current rules of the game. Blue Shield of California is a nonprofit insurance provider, yet as a spokesman put it, if his organization doesn’t follow the for-profit practice of selectively covering only the healthiest people, “we will end up with all the high-risk people.”

~Economist Paul Krugman, New York Times, September 22, 2006

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