Changes continue for di insurers

Article Abstract:

The insurance industry has been experiencing fundamental shifts due to efforts to cut expenses and increase profits. One major change has been the decrease in availability of disability insurance. Disability insurance has not been profitable because of heavy underwriting losses, changing economic conditions, and healthcare industry reform. Inadequate claims administration and lack of claims intervention have led to fraud and to customer misuse of insurance companies.

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Fraud-fighting efforts effect sizable savings

Article Abstract:

Disability insurers reported a net savings of $59.8 million as the result of anti-fraud activities in 1993, according to a survey by the Health Insurance Assn of America. The savings represent a $44 return for every $1 spent on anti-fraud efforts. Although that figure may not accurately represent industry-wide savings, insurers would do well to increase their anti-fraud programs. Fraud accounts for an estimated 10% of the $1 trillion annually spend on health care.

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Don't rush to mandate unproven therapy coverage; experimental treatments can hurt patients and often put insurers in a quandary over whether to reimburse

Article Abstract:

Insurers should exhibit caution regarding experimental treatments and drugs prescribed for off-label use outside of clinical trials. Unproven therapies often increase premiums and may worsen a patient's condition. Pressure from the medical community has caused a limited number of insurers to reimburse for experimental treatments.

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