Wednesday, November 11, 2009

Anthem's Response

So, apparently I annoyed Anthem/WellPoint, Inc with my Op/Ed. My reply might not be posted in the paper, so I'll post it here.


I am writing to clarify claims I made in my Op/Ed dated October 30, 2009. On November 8, a WellPoint, Inc. spokesman called into question some of the claims I made in my Op/Ed, and alleged that I had been dishonest. I would like to take the opportunity to reply to these comments, and to show why I believe I have accurately represented some of WellPoint, Inc.’s business practices.

I would like to start by acknowledging my misstatement regarding WellPoint’s profit. This error was pointed out to me by one of the Richmond Times-Dispatch readers, and the newspaper printed a correction on October 31. I apologize for this error, and am glad that it was addressed.

I would also like to note that my Op/Ed represents my personal opinion. I do not speak for VCU Health Systems, and VCU Health Systems has not requested, endorsed or approved of my comments. My employment there was mentioned only because I understood the Richmond Times-Dispatch required it to be noted.

Moving forward, I would like to demonstrate some examples of why I believe that WellPoint’s business model actively seeks to deny care to patients. Mind you, in my Op/Ed I never accused individual employees of improper conduct or of refusing care for patients. Rather, I draw attention to corporate policies that I believe harm patients. Some examples of these policies are:

• During a June 16, 2006 hearing of the Oversight and Investigations Committee of the House Energy and Commerce Committee, subcommittee Chairman Rep. Stupak noted that the committee's investigation has "found that at least one insurance company, WellPoint, evaluated employee performance based in part on the amount of money its employees saved the company through retroactive rescissions of health insurance policies. According to documents obtained by the committee, one WellPoint official was awarded a perfect score of five for exceptional performance based on having saved the company nearly $10 million through rescissions." Therefore, it is not only me but also a subcommittee of the U.S. House of Representatives that asserts that Anthem rates employees based on their ability to retroactively deny care to policyholders. It is also striking that Anthem’s representative at this hearing would not commit to ending rescissions and stop retroactively canceling patients' insurance--even if the reasons for revoking the policy had nothing to do with any intentional fraud on patients' parts or any connection with the patients' insurance claims. I could provide numerous examples included in this subcommittee's report, but do not have the space to do so. The transcript of the hearing and its supporting documents can be viewed at

• An article in the Los Angeles Times (February 13, 2008) reports on Blue Cross of California’s decision to stop asking physicians to search through patients’ medical records to seek information that might be used to cancel patients’ insurance coverage. To quote from the article:
Blue Cross sent physicians copies of insurance applications filled out by new patients, along with the letter advising them the company had a right to drop members who failed to disclose “material medical history.” That could include “preexisting pregnancies.”

The letter asked physicians to “immediately” report any discrepancies between their patients' medical condition and the information in the applications.
Again, this sounds like a practice designed to find patients whose health insurance can be terminated—after they have applied for the policy and paid premiums. At least some of those interviewed in this article raise concerns whether these letters violated privacy laws.

In closing, allow me to make it clear that I did not accuse Anthem’s associates of any wrongdoing. Instead, I believe that a great deal of what is wrong with our current health insurance system is related to the activities of for-profit companies and the steps they take to ensure that profits are made. It is WellPoint’s and Anthem’s corporate policies that I am critical of. Considering the information I have provided above, I believe that I have good reason to be critical.

A public option would provide a counterbalance to policies such as these described—although it would still face fraud and abuse, it would at least be answerable to the people and not to stockholders seeking profit. Once WellPoint and other for-profit insurance companies choose to engage in an honest public discussion, we should welcome it. We should also ask them to explain the harmful policies I have outlined above.


Mark H. Ryan, M.D., F.A.A.F.P.

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