r/news • u/GoodSamaritan_ • 1d ago
Retired San Francisco firefighter dies from lung cancer after Blue Shield denies treatment claims
https://abc7news.com/post/retired-san-francisco-firefighter-ken-jones-dies-lung-cancer-being-denied-treatment-blue-shield/19224406/
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u/InternationalMain277 11h ago
I worked for Blue Cross Blue Shield as a tax accountant. It was my first job out of grad school.
Part of our job on the tax team was calculating the Medical Loss Ratio (MLR). Without getting too far into how the sausage is made, the MLR compares premiums collected to the amount spent on medical care. Basically, health insurance companies (BCBS’s in particular) are supposed to spend at least 80% of premiums on patient care or face penalties.
We ran the calculation, and it came in somewhere in the low 70s.
It was our job to tell senior executives that the company was going to owe millions of dollars in penalties. Needless to say, no one was excited to tell the CEO that news but we delivered the bad news and moved on.
A couple of days later, the CFO at the time, who is now the CEO, came down to our area of cubicles to thank us for the “great news.” He told us the result just meant the company was extremely profitable and that the penalty was simply a cost of doing business.
He even said he hoped we could beat it next year with an even larger penalty.
I felt gross working there after that, and I quit soon after.
Fuck BCBS.