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Blue Shield Not Listening to Insurance Commish in CA-Time for Mr. Jones to Hit Up the CA CIO for Some Auditing Algorithms

Posted Jan 14 2011 5:22pm

Ok, so what’s the reason for this title?  The only leg apparently there is to stand on here is to prove that Blue Shield paid less than 70% on healthcare.  Guess what image you need some audit algorithms and not take them for their word as there might be mistakes and errors.  If you read the news, data is full of errors today.  Some of the insured may get hit with 3 increases at once. 

You know what is even better here is that our California CIO has a digital literacy series and is working on educating citizens of California as this office is absolutely one of the very few that’s doing anything, everybody else is pretty much magpie and repeats the fact we need education and in their own back yard, they do little or nothing for their own IT literacy. Just listen to the news today with some more “duh” unintended consequences that make for good OMG stories.  We can’t always wait until Kathleen Sebelius at HHS jumps in to help, even though she offered as HHS is building their own data sets and algorithms at this time to audit, as that was just in the news a couple weeks ago and really should have been stared 2 years ago, but that’s not what we have today. 

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Here’s an example below on the closing of a data center in California and the Feds are up to doing the same and consolidating data center, take notice of the power being saved with some cloud use and remember our US Senate didn’t understand this and did not fund the feds for cloud services .  Every member of Congress needs some Algo men to get the analytics and less dependency on lobbyists. 

In reading this some policy holders had contracts that guaranteed no raises for a year and those are going to be the ones hit with the highest increase all at one time.  Now compared to Blue Cross, Blue Shield is a non profit and quite a bit smaller but it’s still a lot of people.  The only way right now in California to block the increase is if the insurer pays less than 70% on claims. 

So after reading this, the Insurance Commissioner better go find some Algo Men over at the CIO and CTOs offices and create some auditing algorithms and call them to task to ensure accurate data has been given for the rate increase and that they are in fact within the 70% as we don’t know who the outside expert is that Blue Shield has agreed to use for their own audit and a lot of this as IT infrastructure is built needs to come in house.  BD

Defying California’s new insurance commissioner, Blue Shield of California has refused to delay controversial health insurance rate hikes for 60 days that prompted an uproar among customers who are seeing successive increases over the last five months of up to 59%.

The nonprofit San Francisco-based insurer said it would submit its latest increase -- effective March 1 and averaging 15% -- for review by an outside expert. It pledged to issue refunds to customers if errors are found in its paperwork.

Insurance Commissioner Dave Jones immediately condemned Blue Shield’s move, saying the company acted on its own without consulting him. Jones discounted Blue Shield's characterization of its action as “unprecedented,” noting that a new state law requires all insurance rate hikes to undergo scrutiny by outside actuaries.

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