Policyholders assail Anthem premiums

Posted April 15, 2010, at 9:21 p.m.

AUGUSTA, Maine — Insurance Superintendent Mila Kofman brought the Anthem rate increase case on Thursday to the State House complex, where she continued to hear from individual policyholders about the severe impact the increasing cost of health insurance is having on their lives.

“You try to do the right thing, and you get priced out,” said Ann Wallace of Northport. “It comes down to do you start having to look at groceries or insurance.”

She said she has received no benefit from all of her premium dollars. She said the cost of her health insurance is increasing so much so fast she is worried she will not be able to continue to afford to buy coverage.

Like many individual policyholders under the Anthem HealthChoice and Lumenos plans, she has a high deductible before the insurance pays anything. Many who testified had a $5,000 deductible, and some had a $15,000 deductible.

Peter Beckerman of Sidney is retired and told Kofman that in seven years his individual health insurance premiums have soared 362 percent. He said his policy would increase 23.6 percent under the proposal. That is greater than the average increase of 22.9 percent the more than 11,000 customers with individual policies face under the Anthem proposal.

“It’s gone from outrageous to obscene,” he said. “The profit margins for Anthem, as I have mentioned and you have heard from other witnesses in recent weeks, are just enormous.”

Public testimony has been heard in Bangor, Portland and Gardiner. Some policyholders have testified at more than one hearing, and that led to a testy exchange between Kofman and Anthem lawyer Chris Roach.

Roach told a woman, who had complained at an earlier hearing that Anthem did not provide a way for policyholders to shop for the least-cost provider of various medical services, that the company recently set up a Web site providing that information. That provoked a question from Kofman.

“Do you also intend to provide information about other issues that consumers have raised, like billing irregularities, allegations of fraud not being investigated, profits reported in newspapers and other comments to that effect?” she asked.

Roach responded that the written testimony submitted by Anthem addressed the profit issues. He did not answer the other parts of her question. He did respond to several consumer complaints of never getting any benefit from their policy because of high deductibles. He said they do benefit from the lower prices for services ne-gotiated with medical providers.

“The fact — and it is in our pre-filed testimony as well — is that only 4 percent of members are responsible for 80 percent of claims in Maine,” he said.

Much of the day was filled with testimony by actuaries with conflicting technical testimony on the volumes of data used to attempt to project what costs will be in the future. The assumptions used in those projections are integral to the analysis that Kofman must do to decide whether any rate increase is warranted.

“I must find whether the filing meets the requirements of the Maine insurance code and insurance regulations,” she said. “Anthem will have the burden of showing that in fact … the rates they are proposing are not excessive, inadequate or unfairly discriminatory.”

Last year Anthem proposed an average increase in rates of 18.1 percent, but Kofman found only a 10.9 percent increase was warranted. Anthem sued over that decision and arguments in the case were heard last month in Superior Court.

The Attorney General’s Office is an intervenor in both rate cases and has proposed Anthem not be allowed any profit because of the “extreme financial hardship” that policyholders are facing during the recession.

The court could issue a ruling in last year’s case at any time, and it likely will have an impact on this case. The public can continue to file comments with the Insurance Bureau through the close of business today.

After all comments are received, Kofman will look at the analysis provided by the company, the attorney general and her own staff before issuing her ruling in the case. That is likely to take several weeks.

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