Friday, November 20, 2009

Insurance news

The Seattle Times reports on the clash over rates between Swedish Medical Center and Regence BlueShield in Washington:
The largest hospital system in the Puget Sound area is threatening to end its contract with the state's largest health insurer unless it receives higher payments for medical services.
(Here's the state insurance commissioner's take on the issue.)

The Times also reports that Democratic moderates in Congress are now the pivot point for health-care legislation.

Also in Washington state, KUOW radio reports that the number of people with no health insurance is on track to hit a million soon.

West Seattle man charged with 28 counts of theft in insurance fraud case

Edward Charles Bailey, 59, of West Seattle, has been charged in King County Superior Court with 28 counts of theft for allegedly committing insurance fraud.

Bailey, who reported an on-the-job back injury to his employer in 2006, was placed on temporary total disability and received disability pay from his employer’s insurer, Alaska National Insurance. Doctors subsequently ruled him unable to return to work.

Five weeks after the injury, investigators working for the insurance company videotaped Bailey working vigorously on his sailboat at a Seattle marina. The sanding, painting, climbing and moving of machinery were all contrary to the physical restrictions imposed by Bailey’s doctors, according to the Washington insurance commissioner’s Special Investigations Unit.

When shown the video, the independent medical examination doctors who had originally seen Mr. Bailey reversed their original opinion as to his ability to work.

According to the charges, Bailey was paid more than $26,000 in unnecessary medical expenses and disability benefits that he wasn’t entitled to.