Insurance industry: We’ll go after fraud in Obamacare as long as it takes
The industry is taking the fight against fraud to court as it prepares to fight the ACA’s latest incarnation of its Obamacare insurance law.
But the industry’s biggest fight is a war on fraud.
“We’re going to go after the fraud that is driving up costs,” said Matt Schott, president of the Insurance Institute for Highway Safety, which has been working with insurers to help them improve their business.
That means more aggressive marketing and fraud detection strategies, he said.
The industry has already started to make changes.
The National Association of Insurance Commissioners, which represents insurers, issued a report last month highlighting its findings about fraud.
It said it had found more than 100 fraudulent claims, and more than 3,300 claims that were denied.
But many of those are minor claims, meaning the insurers have little incentive to look for them and do anything about them, said Gary J. Anderson, the chief executive of the National Association for Insurance Commissioners.
Insurance companies are taking steps to address fraud as well, including changing their business models.
Companies like Blue Cross and Blue Shield of Alabama and Aetna Inc. have been expanding their outreach to consumers about the new law and using it as an opportunity to show how it is working for them.
Aetn has also rolled out a new website, which includes more detailed information on how the law is affecting its members.
In addition, several major insurers, including UnitedHealth Group Inc., have made changes to their policies.
UnitedHealth said in a statement it is “making progress” in addressing the law’s challenges, but it is concerned about “unacceptable increases in health care costs and other adverse effects that may arise from the implementation of this new law.”
The industry also is taking steps in response to new data.
The Institute for Healthcare Improvement, a nonpartisan group, released a report this month showing that health insurance premiums rose by 5.5 percent for all people with incomes above 200 percent of the poverty level last year.
But a report released by the nonprofit Consumers Union found that health plans that offered comprehensive benefits — including maternity care and prescription drugs — were more likely to be subsidized than plans that only provided coverage for birth control.
The findings have prompted a number of health insurance companies to re-evaluate their plans.
Blue Cross said it will revise its plan to provide coverage for contraception.
Anthem Health plans will offer preventive care services in addition to health insurance.
Blue Shield said it is also reviewing the cost-sharing for people who get subsidies.
“With so many different policies and programs being offered by the private market and the federal exchanges, it is important to take into account that a large percentage of people who have coverage through their employer are eligible for federal subsidies to help pay for coverage,” the company said.
Consumers Union, which helped compile the report, said in its report that the health insurance industry is also preparing for a “possibility” that people will opt out of the ACA.
“Many people may choose to continue their employer plans, but others will decide to enroll in a marketplace exchange plan and pay for their coverage themselves,” the report said.