aTypical Joe: a gay New Yorker living in the rural South
Friday, November 09, 2007
On the health insurance industry practice of “Recisions”
Lest you suspect that Michale Moore was making things up in that interview with the former healthcare insurance worker about insurance companies finding excuses to deny coverage after the customer gets sick and files a claim (if you missed the movie, win a DVD copy of Sicko here) the LATimes reports:
Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.
The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.
These cancellations have been the recent focus of intense scrutiny by lawmakers, state regulators and consumer advocates. Although these “rescissions” are only a small portion of the companies’ overall business, they typically leave sick patients with crushing medical bills and no way to obtain needed treatment. [...]
Health Net had sought to keep the documents secret even after it was forced to produce them for the hearing, arguing that they contained proprietary information and could embarrass the company. But the arbitrator in the case, former Los Angeles County Superior Court Judge Sam Cianchetti, granted a motion by lawyers for The Times, opening the hearing to reporters and making public all documents produced for it.
At a hearing on the motion, the judge said, “This clearly involves very significant public interest, and my view is the arbitration proceedings should not be confidential.”
The documents show that in 2002, the company’s goal for Barbara Fowler, Health Net’s senior analyst in charge of rescission reviews, was 15 cancellations a month. She exceeded that, rescinding 275 policies that year—a monthly average of 22.9.
More recently, her goals were expressed in financial terms. Her supervisor described 2003 as a “banner year” for Fowler because the company avoided about “$6 million in unnecessary health care expenses” through her rescission of 301 policies—one more than her performance goal.
In 2005, her goal was to save Health Net at least $6.5 million. Through nearly 300 rescissions, Fowler ended up saving an estimated $7 million, prompting her supervisor to write: “Barbara’s successful execution of her job responsibilities have been vital to the profitability” of individual and family policies.
Via Kevin Drum:
Health Net is neither unique nor evil. If healthcare is provided on an individual basis in a free market, this kind of behavior is inevitable. The only way to avoid it is to provide health insurance on a group basis regardless of past history, and the bigger the group the better since it spreads the risk more evenly. It’s one of many arguments in favor of national healthcare.
The Wisdom of the Clouds
WHAT IS THE IDEA? I COULD BORE YOU WITH BUZZWORDS SUCH AS AGGREGATION, PREDICTION MARKETS, AND THE WISDOM OF THE CROWDS, BUT THE REAL POINT IS TO TAKE ADVANTAGE OF THESE TYPES OF THINGS IN ORDER TO GIVE YOU SIMPLE AND ACCURATE WEATHER IN A WAY THAT YOU CAN BOTH USE DAY TO DAY, AND ALSO PROVIDE A WAY TO MAKE IT A MORE INTERACTIVE AND INTERESTING EXPERIENCE.
FIRSTLY, THE SITE WILL COMBINE AS MANY POSSIBLE SOURCES OF WEATHER FORECASTS AS POSSIBLE. NO ONE SOURCE IS EVER RIGHT ALL THE TIME, SO THE IDEA IS THAT IF YOU AGGREGATE THEM TOGETHER, YOU DON’T NEED TO CHECK SEVERAL SOURCES AND YOU GET A SAFER, MORE ACCURATE FORECAST. IF YOU ALSO TRACK ALL OF THESE SOURCES AND CHECK THEIR ACCURACY OVER TIME, YOU’LL BE ABLE TO ACTUALLY SEE WHICH ONES ARE MORE ACCURATE THAN THE OTHERS.
SECONDLY, YOU CAN PREDICT THE WEATHER YOURSELF. WHEN YOU MAKE PREDICTION FOR A PARTICULAR TIME AND PLACE, THE SITE WILL GO CHECK ALL OF ITS DATA SOURCES AND RECORD WHAT REALLY HAPPENED, AND GIVE YOU A SCORE BASED ON HOW RIGHT YOU WERE. IT COULD TURN OUT THAT A RANDOM PERSON IS A BETTER PREDICTOR OF THE WEATHER THAN A PROFESSIONAL METEOROLOGIST OR ORGANIZATION. THAT PERSON COULD EVEN BE YOU. SINCE THE SITE WILL BE TRACKING THE ACCURACY OF ALL OF THIS, YOU’LL BE ABLE TO SEE WHO IS MORE RIGHT, AND FOLLOW THEM.
THIRDLY (IS THAT EVEN A WORD?) THE SITE WILL GIVE YOU INFORMATION ON THE REAL REASON YOU CHECK THE WEATHER: TO FIND OUT WHAT YOU SHOULD WEAR. AS PEOPLE SUBMIT WHAT THEY ARE WEARING, IT GOES INTO THE AGGREGATION OF WHAT EVERYONE IS WEARING IN ORDER TO SUGGEST TO OTHER PEOPLE WHAT THEY SHOULD WEAR.
Search Engines Every Web Developer Should Bookmark
Christina Laun has cataloged 17 of them for us:
Google, Yahoo, MSN and Ask.com aren’t the only search engines out there. There are many smaller, more customized search options that can help you quickly find what you’re looking for by only searching through a few sites rather than through everything. After all, you’ve got enough on your mind with hosting, design and programming to do. Try out these 17 search engines designed with Web developers in mind.
1. Ergonosearch: This search engine, created by SÃƒÂ©bastien Billard, searches through sites on accessibility and usability, helping you to find the resources, blogs and forums you need to make your web pages as user friendly as possible.
Redstone: ‘If Content Is King, Copyright Is Its Castle’
It’s a fun quote:
He may look his age when he’s not speaking, but when Sumner Redstone, the 84-year-old chairman of Viacom and CBS, starts talking about the shifting media landscape, you forget he was born when radio was a novelty.
Making the keynote speech at Dow Jones and Nielsen’s Media and Money conference in New York on Thursday, he dug at Yahoo! (nasdaq: YHOO - news - people ), championed the accomplishments of the media properties he owns and offered a vigorous defense of copyright. “If content is king, copyright is its castle,’’ he said. “Copyright compels creativity, it furnishes the incentive to innovate. If you limit the protection of copyright, you stifle the expression of self.”
I doubt anyone reminded the old man of how few kings in castles we have left today. Or how little of the globe they rule.
Online Photoshop coming this year
Adobe Systems has committed to shipping a beta version of its online image-editing tool, Photoshop Express, this year, and said it will be complete in 2008.
“By late this year, we anticipate having a beta version,” said John Loiacono, senior vice president for Adobe Creative Solutions, speaking at the 6sight digital imaging conference here. And next year, the online service will be “available to anyone,” he said. [..]
For Adobe, the project is the spearhead of a transformation from a seller of boxed software to a provider of services in an increasingly rich Internet experience. And for the industry overall, it signals that Internet technology is maturing enough that companies are willing risk extending the brand of respected PC software to the network.
Tim Wu: phone geek
Business Week has a profile of Columbia Law School professor Tim Wu:
Wu’s offbeat ideas are entering the mainstream. In February, he published a paper in the International Journal of Communication proposing a radical new vision of freedom for the U.S. wireless industry. He argued that the Federal Communications Commission should mandate that providers allow consumers to use any cell phone with any wireless operator, and install any programs they want on their phones as long as they were not illegal or harmful. “It would make a huge difference in the wireless industry,” says Wu. “It will blow open the wireless market.”
The paper spread like juicy gossip around the Googleplex. Wu’s vision resonated because Google had become frustrated with phone companies that were blocking some Google applications from being used on phones attached to their networks. Like Wu, Google believes an alliance based on openness will trigger a new wave of innovation. “Tim helped us catalyze a strategy,” says Chris Sacca, head of special initiatives at Google. “He’s a singular force in this space. You’re just seeing the start of what he’s going to accomplish.”
Wu, 35, has emerged this year as a key influencer in telecom. He rose to prominence by popularizing “Net neutrality,” the notion that network service providers should not be allowed to deny people access to certain Web sites or prioritize certain content… Wu has had a surprisingly large influence on telecom policy on Capitol Hill. In 2006, he was invited by the FCC to help draft the first-ever Net neutrality rules that were attached to the merger of AT&T and BellSouth. They required the company for 30 months to allow consumers to access any content or service of their choice, while barring AT&T from providing faster service to any content or service provider. Over the summer, the FCC adopted two of Wu’s proposals for an upcoming auction of wireless airwaves. The rules require network operators to support any device or application on the spectrum they buy. Now, Wu is pressing for network neutrality throughout wireless computing.