Lawsuits filed by RAM attendees make me HOT

[ChriswUfGator]

While browsing in the "new non-fiction books" section of the downtown library this past week, I picked up a copy of "Delay, Deny, Defend" by Jay M. Feinman, a distinguished law professor at Rutgers University who has written several books on the law for non-lawyers.  I would not have picked up this book except for our discussion in this thread.

His writing is simple, clear and direct.  He traces the change in insurance companies policies and procedures back to the early '90's when they began to regard the claims offices as profit centers.

Instead of making their insured whole as they have promised to do they are now evaluating their employees on how much they can reduce the claim amounts as established by computer programs.  Claims adjusters are no longer experienced professionals, but clerical types who enter data into "expert" systems that are tuned to make any claim as inexpensive as possible.

He points to State Farm and Allstate as pioneers and worst offenders in this recent effort and has many examples to illustrate the methods used to deny, delay and defend (litigate) as many claims as possible.  He also includes a chapter on the inflated charges of "insurance fraud" and shows how if you have three or more family members in an older car who are injured in an accident the computer program will flag your claim as fraud and their fraud unit will investigate you.

The book and subsequent reading on various web sites has turned my head around completely about the probity of the insurance companies and I didn't have a high regard for them in the first place.  I had no idea that they had changed so much in so short a period of time.

Chris's opinion of them is fully justified.

The "industry" was formed by the development of unethical insurance adjustment practices that force a disproportionate number of claimants to retain an attorney just in order to get a claim paid.

I'm glad you came around, I was frankly a little surprised to see you on the other side of this debate. Normally I find myself agreeing with you, and your views have always seemed well-thought out.

The puzzling thing about tort reform is that the actual data on the subject is so completely opposite to the picture that the insurance companies and politicians have painted for the public. The insurance lobby is behind all of it, and this shouldn't be a shock, since the judicial system is the only fly in the ointment when it comes to wrongfully denying and lowballing claims. The sad thing is that so many believe that nonsense without researching any of it. The real data is 180 degrees opposite from the right-wing tort reform nonsense, it doesn't take very long to spot the scam once you look at any real info.

The real-world data proves dispositively that malpractice lawsuits have nothing to do with healthcare costs. The insurance companies simply played the "blame the lawyer" game with the AMA when they started catching flak for jacking premiums without justification, and the medical lobby bought it hook line and sinker. The insurance industry has successfully managed to have everybody blaming lawyers whenever they get a rate increase notice on their dental insurance.

The whole thing's a giant scam, and the true problem in healthcare, casualty, malpractice, and pretty much everything else, is the greed of the insurance companies. Despite the line of B.S. everyone has been fed, there isn't anyone else to blame. The marketplace has been largely deregulated, and now you have thousands of insurance companies all competing for the same customers. Then each and every one of them has to turn around and show their investors an 8%-10% annual increase in profit, or the market considers their financial performance unsatisfactory.

The problem is that the population isn't growing that fast. The industry, in return, has resorted to business practices that amount to nothing more than the routine disregard of their contractual obligations to policyholders. Profits skyrocketed when claims adjusting became nothing more than fraud-with-a-smile, but that only further fueled market expectations of future growth.

In return, the companies resorted to all sorts of other tacts, e.g. eliminating virtually all customer service, outsourcing jobs, that kind of thing. People ignored all of this with the typical "Well who cares, it's not me!" logic, but eventually the industry had no option but to start jacking premiums. When people demanded to know "why?" the true answer would have been "because I reported an $XXX operating profit last year and so this year I need to report $XXX +10% or my share price gets killed and I can't cash in on my $100mil worth of stock options".

But rather than saying that, it's easier to blame lawyers and point back to some anecdotal one-in-a-million case against McDonalds from 1993 as evidence of "runaway juries" and the need for tort reform. Nobody ever mentions the millions of cases annually where an insurer wrongfully denied a claim, or refused to pay the full value of the loss for no good reason, despite being contractually obligated to do so, and the policyholder was then forced to sue the insurance company to collect what they were rightfully owed. I guess the public isn't so fascinated when things work like they're supposed to. Which is what happens most of the time.

[stjr]

You will like this article, Chris.  Lawyers, insurance companies, and medical providers - maybe everyone is leaching off of the consumer.  Add the politicians who are enriched by all their special interest groups plying them with campaign monies and its no wonder things are getting worse instead of better.

Sutter Health's Market Power Is Questioned
Insurers say the Northern California hospital chain uses its market clout to raise prices

By Peter Waldman

After Dr. Mark Logsdon tore a ligament in his knee skiing at Lake Tahoe in March, he returned home to Sacramento and had an MRI scan at Sutter Davis Hospital. Sutter's price for the knee scan was $1,271, payable by Logsdon and his insurer. The same MRI at a local office owned by Radiological Associates of Sacramento would have cost $696, or 45 percent less.

Logsdon didn't know something his insurer does: Sutter Health, the nonprofit that owns Sutter Davis, charges 40 percent to 70 percent more than its rivals for a typical procedure, and it requires insurers to keep its rates secret. Sutter, with 2009 revenues of $8.8 billion, can charge these prices because it has acquired more than a third of the medical-care market in the region from San Francisco to Sacramento. The company has taken over more than 20 hospitals in the past 30 years, according to executives at Aetna (AET), Health Net (HNT), and Blue Shield of California who asked not to be named because their agreements with Sutter ban such disclosures. The executives say operating so many of an area's most popular hospitals, doctor groups, and testing facilities gives Sutter the ability to stare down insurers and employers.

The pricing power of local hospital systems has received little attention in the national health-care debate, says Stanford University economist Alain Enthoven. In 2009, as consumer prices fell for the first time in 54 years, the U.S. health bill rose 5.7 percent, to $2.47 trillion, a record 17.3 percent of the economy. "Provider consolidation is driving up health-care costs," Enthoven says.

Sutter Chief Executive Officer Patrick Fry says his company conducts itself properly in a competitive envi ronment. "I don't see Sutter Health as having market power, given the choices that employers can make," he says. "The market has a lot of room to make a lot of decisions."

Federal investigators in five statesâ€"Connecticut, Massachusetts, Ohio, Pennsylvania, and New Hampshireâ€"are probing proposed hospital takeovers and consolidating medical practices for evidence of antitrust violations. "The enforcement pendulum has now swung back to where it should be," says Matthew J. Reilly, assistant director of the Federal Trade Commission's competition bureau.

Sutter spokesman William Gleeson says Sutter knows of no antitrust investigation of the company. While it may have higher "unit" prices than its competitors, it is not the most costly for patients over the long run because its integration of hospitals and doctor groups allows it to provide more efficient care, says CEO Fry.

The U.S. has 5,800 hospitals, divided about evenly between nonprofits and for-profits. Nearly 3,000 changed owners from 1994 through 2009, says research firm Irving Levin Associates. Most were rolled into regional chains like Sutter.

The new health-reform law aims to achieve $500 billion in savings over the next decade to help pay for extending coverage to 32 million uninsured Americans. Yet it doesn't address the problem of market concentrationâ€"and may make it worse, says Dr. Robert Berenson, a physician and analyst at the Urban Institute. The clout of hospital and physician groups in California is a "cautionary tale for national health reform," he adds, because incentives in the reform law to improve treatment by promoting doctor-hospital alliances could strengthen providers' bargaining leverage.

Higher prices for medical services stemming from hospital mergers that took place from 1997 to 2006 add $12 billion to annual health costs, according to a study last year by Cory Capps, a former Justice Dept. economist. Capps, now a private consultant, says that because of the ability of powerful hospitals to encourage the use of additional medical procedures and the merging of doctors' groups, he might have underestimated the impact by $6 billion to $10 billion annually.

Basic economic theory suggests that competition should narrow big price gaps for the same service. In the U.S., which spends more on health care than any other nation, Sutter and other large local providers show why the theory fails in a system where insurers or third parties foot most of the bills. As it grew, Sutter pursued a strategy to raise prices and make itself "indispensable" to insurance plans, internal company documents produced in a 1999 California state antitrust suit show. Sutter has 24 hospitals, 17 outpatient surgery clinics, and a 3,500-doctor network, making it the largest provider in an 11-county region that is home to 10 million people.

Sutter boasts 35 percent of the revenue and 36 percent of beds in the region, according to a state database. The tallies of 2008 data exclude Kaiser Permanente, whose hospitals are only available to plan members. "They are able to dictate terms," says Jeff Emerson, head of managed care for Aetna, the nation's third-largest health insurer. "Sutter says to all of its payers, to the best of our knowledge, 'These are the terms by which you will deal with Sutter. Take it or leave it.' "

Some business groups agree. "Instead of leveraging its system to be more cost-effective, we've seen Sutter leveraging its system for monopoly pricing," Peter V. Lee told Bloomberg in May, while he worked at Pacific Business Group on Health, a coalition that includes Chevron (CVX), Walt Disney (DIS), General Electric (DIS), and Wells Fargo (WFC). Lee in June became director of health-care delivery system reform for the federal Health & Human Services Dept.

Sutter charges more than many rivals for a wide range of services, from colonoscopies to births (table), according to prices posted on an Aetna website in May, before they were removed. After the removal, the site responded to inquiries about Sutter prices with the message: "Facility does not permit Aetna to disclose fees." Sutter spokesman Gleeson says the company doesn't allow its prices to be disclosed because the data are often misleading and don't reflect the variables of each patient's case.

Cost never occurred to Logsdon, the Sacramento doctor who wrecked his knee skiing. He says he was "shocked" to discover later that the MRI cost nearly twice as much at Sutter Davis as it would have at Radiological Associates, where he is chairman of the oncology division. He says he went to Sutter Davis for convenience. "I guess I'm a textbook case of why policymakers say they need to make patients feel the cost of these things."

The bottom line: The big hospital chain controls a third of health-care resources in parts of Northern California. Insurers worry that lets it control prices



http://www.businessweek.com/magazine/content/10_36/b4193015983853.htm

[ChriswUfGator]

While browsing in the "new non-fiction books" section of the downtown library this past week, I picked up a copy of "Delay, Deny, Defend" by Jay M. Feinman, a distinguished law professor at Rutgers University who has written several books on the law for non-lawyers.  I would not have picked up this book except for our discussion in this thread.

His writing is simple, clear and direct.  He traces the change in insurance companies policies and procedures back to the early '90's when they began to regard the claims offices as profit centers.

Instead of making their insured whole as they have promised to do they are now evaluating their employees on how much they can reduce the claim amounts as established by computer programs.  Claims adjusters are no longer experienced professionals, but clerical types who enter data into "expert" systems that are tuned to make any claim as inexpensive as possible.

He points to State Farm and Allstate as pioneers and worst offenders in this recent effort and has many examples to illustrate the methods used to deny, delay and defend (litigate) as many claims as possible.  He also includes a chapter on the inflated charges of "insurance fraud" and shows how if you have three or more family members in an older car who are injured in an accident the computer program will flag your claim as fraud and their fraud unit will investigate you.

The book and subsequent reading on various web sites has turned my head around completely about the probity of the insurance companies and I didn't have a high regard for them in the first place.  I had no idea that they had changed so much in so short a period of time.

Chris's opinion of them is fully justified.

The "industry" was formed by the development of unethical insurance adjustment practices that force a disproportionate number of claimants to retain an attorney just in order to get a claim paid.

I really have to say you are an honorable person. I sometimes find myself in debates with folks about one thing or another, and sometimes it becomes clear after awhile that maybe their reasoning wasn't fully thought out, or else they just weren't aware of all the facts. Sometimes I am the one making that realization.

But for whatever reason, most people today just refuse to acknowledge it, and refuse to question their own beliefs at all, which is rather silly and really makes you wonder why they wanted to discuss it in the first place. It takes character to keep an open mind, a quality I'm appreciating more and more as it gets ever harder to find.

This debate was so annoying I had dismissed this place as turning into another Jacksonville.com or News4Jax.com comments section, and had stopped visiting. I really don't enjoy people who relish being presented with every available fact before refusing to acknowledge any of it, and we have to deal with so much of that nonsense in daily life that there isn't any reason to ruin your free time as well. But when I was told about your post and got around to reading it, I was very pleasantly surprised. If it had gone the other way, I'd have done the same for you. That's what separates this site from the others, people who have open minds and the ability to learn from each other.

[ChriswUfGator]

You will like this article, Chris.  Lawyers, insurance companies, and medical providers - maybe everyone is leaching off of the consumer.  Add the politicians who are enriched by all their special interest groups plying them with campaign monies and its no wonder things are getting worse instead of better.

Great article, but it has nothing to do with lawyers or lawsuits.

Actually your article is exactly what I've been saying all along, namely that providers and insurers are jacking prices up unnecessarily for no legitimate reason, simply to make more money. The current issues with the healthcare system are caused by outsized corporate profits, anticompetitive behavior, and the "anything goes" pro-business legislative environment of the past decade, which have created an artificially bloated cost structure.

I'd love to see someone tackle the real problems, which are nicely outlined in the article. But the insurance and healthcare lobbies are probably too powerful to expect any real change. But still, as it relates to this topic, it's really quite obvious when you get into the real issues that lawyers have nothing to do with it. That's just propaganda.

[Dog Walker]

Thanks for the compliment, Chris.  I've been smacked in the face by reality enough times now that I try to stay open minded enough to be convinced by new information.  It hurts less than being smacked in the face.

I've been on both sides of litigation and from those experiences still think that some reform is needed to the system.  I can point to instances of problems and abuses on all sides, but don't know enough to propose systemic solutions.  Surely we can learn from other legal systems how they handle the same issues and incorporate the best practices.

[ChriswUfGator]

Thanks for the compliment, Chris.  I've been smacked in the face by reality enough times now that I try to stay open minded enough to be convinced by new information.  It hurts less than being smacked in the face.

I've been on both sides of litigation and from those experiences still think that some reform is needed to the system.  I can point to instances of problems and abuses on all sides, but don't know enough to propose systemic solutions.  Surely we can learn from other legal systems how they handle the same issues and incorporate the best practices.

I agree with you, it's just that from what I've seen the vast majority of litigation that people would consider "frivolous" tends to come in the form of bogus defenses, unnecessary motion practice, and discovery games played by corporate (and government) litigants. I do not believe a legislative agenda that curtails the right to sue insurance carriers will do anything other than ensure that nobody's claims get paid. That is something of a no-brainer. If a lawsuit is truly frivolous, it gets dismissed and the litigant gets taxed with costs and fees under F.S. 57.105. Granted that is only a Florida statute, so the federal courts and other state jurisdictions may work differently. But in this state, unsupported suits have been a virtual non-issue since 1999/2000 when that statutory revision went into effect.

Another problem you run into is that you can't change the law for each and every situation, and you have to understand that the vast majority of the time things work as intended. If you start restricting everyone's rights, you wind up throwing out more babies than bathwater. That 1993 McDonalds case and the anecdotal tidbits that people always bring up are statistical outliers that aren't representative of what normally happens. And the whole healthcare debate is just ludicrous, litigation has nothing to do with the current problems. The whole tort reform battle cry generally is a non-issue and a deliberate mis-laying of blame by the insurance lobby.

Another problem in these discussions is that a plaintiff thinks he should win and a defendant doesn't think he should have to pay, that's pretty much a universal. So just by nature, one of the two is going to leave feeling screwed, unless the case settles, then they both feel screwed. That is par for the course, and the truth is that we are adults and we don't always get our way. I guess what I'm saying is everyone really shouldn't be so convinced by limited anecdotal experience that the entire system is flawed. Just by nature, one party in every case is probably going to think the system sucks. You have to recognize this is the nature of a justice system, that's not a flaw, it's just how the system has to work in order to serve its purpose. Everyone doesn't always get their way.

This is like the old saying "Democracy is the worst form of government, except for all the others." Not sure that there is a "perfect solution" but what we have does tend to work out pretty well. People forget there are probably 10,000 lawsuits filed for every 1 that makes the news for one reason or another.

[RAMsecguard]

I was the security guard on duty that day.  I lied, there was no lawsuit.  Sorry for all the fuss I caused

[thekillingwax]

Ahahahaha!

[Noone]

Went to RAM last week and parked in the lot to the east of the market (the elevated lot). There is a public sidewalk that goes along the street, and another shady sidewalk that goes adjacent to one of the bank that is closest to RAM. It is open, not labeled as "no trespassing" and in good repair. As it was about 150 degrees in the shade, I took the shortest and shadiest walk between the parking and the market, and away from the fumes on Riverside Ave--the sidewalk closer to the office building.

A RAM security guard came running towards me and told me I had to walk on the streetside sidewalk--when asked why, she said--"people who walked on that other sidewalk fell, and now they are suing the company. So they want everyone to walk on the city sidewalk, so if they fall, they sue the city!"

I looked at both sidewalks, both are in good repair. If someone falls on either, it is obviously NOT because anyone is at fault. I'm glad that the companies on Riverside who are donating parking space have been so tolerant. Maybe just a tiny little sign that says "walk at your own risk!"-

So what is the status of the lawsuit with the city? 3 years later.
Shipyards-$36,500,000 taxpayer money gone.
The recent Jim Love, Kevin Kuzel Berkman Floating dock compromise next to Shipyards III misrepresented by OGC during the 2013 FIND grant application cycle. Our ad valorem property taxes.
Palms Fish Camp-WTF-ASK-RICO active lawsuit next to a FIND project.
Visit Jacksonville- Our child molesters get pensions too with Board approval and community support.

Weather should be breaking. Who wants to Make a scene, provide a spark by kayaking and fishing under the brand new No Fishing signs that was never before the Jacksonville Waterways Commission and launch at a kayak location that will be getting a Mayor Brown Kayak logo with the full support of councilman Don Redman and Dave Roman that will allow everyone to continue in joining Mayor Brown in Making Downtown a Destination and not a pass through on our St. Johns River our American Heritage River a FEDERAL Initiative in our new DIA zone?

[MEGATRON]

Went to RAM last week and parked in the lot to the east of the market (the elevated lot). There is a public sidewalk that goes along the street, and another shady sidewalk that goes adjacent to one of the bank that is closest to RAM. It is open, not labeled as "no trespassing" and in good repair. As it was about 150 degrees in the shade, I took the shortest and shadiest walk between the parking and the market, and away from the fumes on Riverside Ave--the sidewalk closer to the office building.

A RAM security guard came running towards me and told me I had to walk on the streetside sidewalk--when asked why, she said--"people who walked on that other sidewalk fell, and now they are suing the company. So they want everyone to walk on the city sidewalk, so if they fall, they sue the city!"

I looked at both sidewalks, both are in good repair. If someone falls on either, it is obviously NOT because anyone is at fault. I'm glad that the companies on Riverside who are donating parking space have been so tolerant. Maybe just a tiny little sign that says "walk at your own risk!"-

So what is the status of the lawsuit with the city? 3 years later.
Shipyards-$36,500,000 taxpayer money gone.
The recent Jim Love, Kevin Kuzel Berkman Floating dock compromise next to Shipyards III misrepresented by OGC during the 2013 FIND grant application cycle. Our ad valorem property taxes.
Palms Fish Camp-WTF-ASK-RICO active lawsuit next to a FIND project.
Visit Jacksonville- Our child molesters get pensions too with Board approval and community support.

Weather should be breaking. Who wants to Make a scene, provide a spark by kayaking and fishing under the brand new No Fishing signs that was never before the Jacksonville Waterways Commission and launch at a kayak location that will be getting a Mayor Brown Kayak logo with the full support of councilman Don Redman and Dave Roman that will allow everyone to continue in joining Mayor Brown in Making Downtown a Destination and not a pass through on our St. Johns River our American Heritage River a FEDERAL Initiative in our new DIA zone?

Can someone translate?

[Noone]

/quote]

2010-604
2010-856
2011-364
2012-202
2012-273

Legislative actions over administrations and councils that leads to a conspiracy that could deny Public Access and Economic opportunity as it relates to our new DIA zone in picking and choosing the winners and losers and this can be shown through Trusts, Foundations, Boards, in an abuse of the PUBLIC TRUST that has resulted in direct personal gain of taxpayer money for family, friends especially as it relates to our St. Johns River our American Heritage River a FEDERAL Initiative.

Next Jacksonville Waterways Commission meeting 14 days out. Anyone care? Will be making a Donation to 2009 -442 The Artificial Reef Trust Fund. est. by ordinance. Is there just one MJ'er that wants to make a donation? I'll deliver it personally on your behalf. Right now there is an opportunity for 6 artificial reefs in the River south of the Fuller Warren Bridge. That's a fact. Economic Development with the snap of a finger. Numbers given a $100k or less with a lot of inkind donations. FDOT is aware of this.

RAM is just one piece of an economic puzzle as it relates to the TIF floating dock that is only opened when RAM is open. Is JEA building a dock on the Southbank.

Hope this helps. There is a lot more.

Ben- JCCI- We need to kayak Downtown before 2025.

[acme54321]

Went to RAM last week and parked in the lot to the east of the market (the elevated lot). There is a public sidewalk that goes along the street, and another shady sidewalk that goes adjacent to one of the bank that is closest to RAM. It is open, not labeled as "no trespassing" and in good repair. As it was about 150 degrees in the shade, I took the shortest and shadiest walk between the parking and the market, and away from the fumes on Riverside Ave--the sidewalk closer to the office building.

A RAM security guard came running towards me and told me I had to walk on the streetside sidewalk--when asked why, she said--"people who walked on that other sidewalk fell, and now they are suing the company. So they want everyone to walk on the city sidewalk, so if they fall, they sue the city!"

I looked at both sidewalks, both are in good repair. If someone falls on either, it is obviously NOT because anyone is at fault. I'm glad that the companies on Riverside who are donating parking space have been so tolerant. Maybe just a tiny little sign that says "walk at your own risk!"-

So what is the status of the lawsuit with the city? 3 years later.
Shipyards-$36,500,000 taxpayer money gone.
The recent Jim Love, Kevin Kuzel Berkman Floating dock compromise next to Shipyards III misrepresented by OGC during the 2013 FIND grant application cycle. Our ad valorem property taxes.
Palms Fish Camp-WTF-ASK-RICO active lawsuit next to a FIND project.
Visit Jacksonville- Our child molesters get pensions too with Board approval and community support.

Weather should be breaking. Who wants to Make a scene, provide a spark by kayaking and fishing under the brand new No Fishing signs that was never before the Jacksonville Waterways Commission and launch at a kayak location that will be getting a Mayor Brown Kayak logo with the full support of councilman Don Redman and Dave Roman that will allow everyone to continue in joining Mayor Brown in Making Downtown a Destination and not a pass through on our St. Johns River our American Heritage River a FEDERAL Initiative in our new DIA zone?

Can someone translate?

THE ST JOHNS RIVER AN AMERICAN HERTIAGE RIVER A FEDERAL INITIATIVE ETC ETC