Dan Gottry - Blog

Dan Gottry's Blog

Wednesday, September 20, 2006

A Cynical Perspective

I have read with interest the ongoing Linkia/Opnet/Cigna postings. Follows is my somewhat cynical perspective.

Lets' look at this from the insurance company perspective. Perhaps it is Cigna's strategic intent to rid themselves and their plans of "adverse selection beneficiaries". This means they want to rid themselves of the high-cost beneficiaries. Amputees and other disabled populations fit this description. Amputees frequently have multiple other health issues and have a high incidence/frequency of health care resource utilization.

So.....if they (Cigna) severely limit access to providers, maybe those high cost beneficiaries just might get fed up and leave Cigna. They might then enroll with a plan that offers easier provider access and more open choice.

Cigna just solved their problem - having too many patients that have a high utilization rate and improvement their bottom line. (Every insurance benefit dollar that remains unspent flows directly to Cigna's bottom line - with no increase in admin costs or fixed internal overhead costs and no reduction in premium! Shareholders smile!)

Linkia now becomes stuck servicing a low paying plan with decreasing member enrollment as beneficiaries jump to other carriers.

Since O&P represents such a small percentage of the health care dollar it is an easy target. Unfortunately O&P is not a benefit that can be deferred. Services will remain necessary to the patient and will be provided at a later date at higher cost.

Name Withheld

posted by Daniel Gottry at 3:27 PM