2:02 PM Eastern - Thursday, September 24, 2009

Insurance Industry 101: Deny coverage to keep profits high

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Congressman Stupak and insurance industry whistle-blower Wendell Potter co-hosted a telephone press conference today to further discuss insurance industry abuses. While various Congressional subcommittees have held hearings on the topic, it's clear that we are only beginning to scratch the tip of the iceberg.

Stupak and Potter discussed two insurance industry processes by which they protect their profit margins: rescission and purging. Rescission, the more discussed of the two, is the process by while insurance companies terminate coverage for their customers in the personal insurance market if they become sick. Stupak noted that victims of rescission often pay their premiums for years, "lulled into a false sense of security" and adding to the insurance company's profits. Then, when they become ill, "these companies don't honor their agreements."

The call also touched on purging, rescission's lesser-known twin brother. Because of HIPAA, passed in 1996, it is illegal for insurers to rescind coverage from group policy holders. But don't worry: the clever insurance industry has found a way to get around that. Through purging, insurance companies raise the rates for small businesses to the point that they can no longer afford to pay and are forced to cease buying coverage, thus saving the insurance company money.

After discussing these twisted, profit-padding practices, Wendell pointed out that this is how insurance companies try to keep their "medical loss ratio" as low as possible. As a result, "we have in this country a Wall Street driven healthcare system."

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