PNHP

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009
(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.
For many Texans, it hasn’t worked out that way.
“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.
Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.
Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.
“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.
“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”
Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.
Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.
“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”
The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”
http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.
Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?
And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.
Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009

(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.

For many Texans, it hasn’t worked out that way.

“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.

Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.

Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.

“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.

“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”

Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.

Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.

“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”

The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”

http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

Comment:

By Don McCanne, MD

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.

Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?

And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.

Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?