Insurance Industry Insider Instructs Providers

Sep 16, 2020 | CMS, Editorial | 0 comments

September 16, 2020

by Wendell Potter

(Adapted with permission from an article posted on the author’s Twitter feed. –Editor)

Wendell PotterMy former colleagues in the health insurance industry claim they are waiving all costs of testing and treatment for COVID-19. This is a lie.

I will explain the reality that this promise does not apply to everyone, in fact to a fraction of covered lives, and there is no enforcement mechanism to ensure that it will. Here is the truth: When insurers and the Trump administration say insurers are “doing their part” to end the pandemic, they are counting on Americans to be fooled by industry lingo, to believe that COVID-19 health expenses are covered. When I worked as VP of PR for Cigna, I would have gotten a bonus for achieving this deception.

In reality, this is world-class propaganda on display. To see how the industry is pulling the wool over our eyes, go to the website of its trade group, AHIP (America’s Health Insurance Plans). It is, intentionally, close to impossible to follow what each insurance company is actually doing.

A secret: The main purpose of insurers’ web sites and documents is to provide a space to crow about their “charitable” donations, which are a tiny percentage of their revenues. I know firsthand! One of my roles at Cigna was to head the company’s meagerly-endowed foundation.

An example: To see how they mislead regarding actual COVID-19 costs, let’s examine the hidden caveat in one company’s claim. Aetna says it

“will waive co-pays for all diagnostic testing related to COVID-19… That includes all member costs associated with diagnostic testing for Commercial, Medicare, and Medicaid lines of business. Self-insured plan sponsors will be able to opt-out at their discretion. Aetna is also offering zero co-pay telemedicine visits for any reason, and extending [additional benefits] to all fully insured members.” 1

Notice the catch? They mention “self-insured” plan sponsors. Nearly 80% of Aetna’s health plan members are in these types of plans. If you get your coverage through your employer, you likely are one of them. Aetna does not consider these people “fully insured.” Therefore, their promises may only apply to 20 percent of their members.

Of course, most folks probably have no idea whether they are in a “fully insured” or “self-insured” plan, but it makes a world of difference, especially during this pandemic. And believe me, these companies are thrilled by your confusion. It could save them millions.

Maybe we should expect private insurers to be dishonest by now, or rely on government watchdogs to take care of us. That is the other problem. There is no watchdog at any level of government monitoring this deceptive practice. In other words, there are no consequences to insurer deceit. And they know it. Again, I know it because I used to be one of them.

The answer? All insurers should be required to state exactly what percentage of their members actually benefit from their “promise” to fully cover COVID-19 testing and treatment. And Congress should look into this ASAP.  It would be a great chance for Representative Katie Porter (D-CA) to embarrass the insurers yet again.2

Wendell Potter is a former insurance industry PR executive and the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans” and “Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It,” both published by Bloomsbury Press. He is the founder of Tarbell™ a non-partisan news publication of To Be Fair, Inc., an IRS-approved 501(c)3 non-profit organization. He also serves as senior analyst at the Center for Public Integrity, one of the nation’s oldest non-partisan, nonprofit investigative news organizations, and is a contributor to The Huffington Post and His work has also appeared in NewsweekThe Nation and The Guardian.