In 2009, Anthem Blue Cross and Blue Shield decided to jack premiums in the state of Maine by a whopping 18.5%, helpfully explaining their profits weren’t high enough in the area. You be the judge: According to Maine’s attorney general, Anthem made $5.4 million from individual consumers over the past two years, paid $75.7 million in dividends to their parent company WellPoint, and pays their top nine employers an average of $500,000 a year. Legislators in Maine blocked the hike, so the insurance company is suing the entire state.
Anthem Blue Cross was forced to pay $15 million for dropping 2,300 members after they submitted medical bills. The first million was a fine; the other $14 million was reimbursement for the medical expenses the 2,300 were left facing after Anthem kicked them out for getting sick.
In the first suit of its kind, in 2000 Humana had to pay $14.5 million to settle allegations that it defrauded state and federal Medicare and Medicaid programs. “Most of the disputed charges occurred in Florida, but investigators? also found problems with Humana bills in Arizona, Illinois, Kentucky and Missouri.”
The California Nurses Association took advantage of the fact that insurance companies in California must provide a record of claims denials to study how frequently insurance companies refused to honor a claim. They found the six largest insurers in the state denied an average of 21% of all claims in the first six months of 2009. PacifiCare denied “an astonishing” 39.6%, followed closely by Cigna, which denied 32.7%.
In 2005, 700,000 doctors brought a racketeering lawsuit against Humana for cheating them out of proper pay; Humana was forced to pay $40 million to settle the suit. And in 2009, the American Medical Association sued Cigna and Aetna for using “rigged data” to underpay doctors and force patients to pick up excessive costs for over a decade.