Blue Cross Blue Shield of Michigan: Something's Rotten in the State of Denmark

Mega insurance company Aetna, ranking as one of the country's largest health care plans with 35 million members, filed a lawsuit in recent days in Detroit's federal court, alleging Blue Cross Blue Shield of Michigan violated federal antitrust laws. Aetna claims BCBS increased rates for Michigan consumers during the last four years and then used the money to reward hospitals with higher payments if they charged Blues' competitors equivalent, or higher rates.

Bill Berenson, president of the Michigan market for Aetna, was quoted as having said: “When we started to be a threat, Blue Cross picked up the strategy.” Aetna's suit also alleges that Michigan Blues violated antitrust law “at the very time when Michigan employers and consumers were suffering from the crushing effects of the recession and increasing health care costs.”


BCBS spokesman Andy Hetzel fired back, calling Aetna's claims “sour grapes.”

Berenson also explained that Aetna made the decision to sue Michigan Blues because it still intends to build its Michigan business prior to 2014. That is when the largest portion of federal health reforms will go into effect. By establishing their business now, they hope to create state insurance exchanges from which consumers and small businesses can purchase reasonably priced, standardized health insurance.

Aetna's suit comes after a pending Justice Department lawsuit, filed in 2010, alleging the “Michigan Blues demanded the lowest costs for hospital services at the expense of its competitors.”

In addition, BCBS appears to have reached a contractual impasse with Beaumont Hospital System of Royal Oak. Beaumont has said it will no longer treat an estimated 100,000 patients who are insured by Blue Care Network if the insurer does not agree to pay an increased rate.

You put it all together, and it seems there's something rotten in the state of Denmark, er, Michigan.

And, while on the surface, it appears noble that Aetna is actually attempting to touch on a higher moral ground with its lawsuit by mentioning the recession, it's quite difficult to find anything positive to say about the whole health insurance industry racket, and that includes all the players, from the government, to the insurers, to the hospitals. It seems there's one huge detail that everyone has overlooked – the consumer, a.k.a. the patient.

And, ironically, these very same highbrow health insurance executives, and others, who willfully and knowingly wheel and deal their insurance packages, and by so doing, victimize those in need of medical care, are in fact shooting themselves in the foot. For, it appears they are human beings like the rest of us, just as vulnerable as us, and perhaps just as in need of medical care now, or someday from now. Perhaps the ultimate justice will be served, not through any punitive damages as determined by a judge and jury, but when said executives and others become pawns in their own game.