Sunday, February 03, 2008


Rep. Bob Herkes introduces pro-HMSA bill that will hurt state and county workers, church employees, and others

by Larry Geller

Yes, here we go again. Bob Herkes, who used to have an "embedded lobbyist" from the HSMA Foundation (their Executive Administrator, actually) working as an "intern" right in his office, has introduced HB2836, a nasty bill that will hurt state and county workers, all church employees, and all persons whose health insurance is not provided by their employers.

And they will gain nothing from it in return. The biggest winner will be HMSA.

I invite you to do a Google search for the history of bills benefiting HMSA and Bob Herkes' CPC committee. Just click on that link and you'll have some interesting background to read.

So what's this bill about and why should you testify against it?

Right now, those who have HMSA employer-paid plans are barred by a federal law, ERISA, from appealing denials to Hawaii's Insurance Commission. That means that health insurers can just turn you down again and again, and the only recourse is usually to take 'em to court. The trouble with that is, you could be dead before the case comes up. And in most cases, lawsuits are too expensive to bring, more than the denied treatment itself.

Except for those on employer insurance plans, everyone else has that right of appeal. State and county employees (including legislators!), church employees, individual insurance purchasers, all can appeal. So if you are turned down, or HMSA refuses to pay for some medication or life-saving treatment, you can file an appeal to the Insurance Commission. It's not easy to go up against HMSA, but you have the right to do it. That is, you do now.

Bob Herkes wants to take away that right. His buddies at HMSA will thank him.

Denials happen, all the time. Most never make the news, of course. This famous case did: HMSA denials nearly cost
Paauilo man his life.

Dealing with cancer wasn't as painful for her husband as was the feeling that he wasn't worth the expense of treatment, says Melani Mendes of Paauilo on the Big Island.

His doctors requested a medical procedure that was denied four times by the Hawaii Medical Service Association, she said.

"He said, 'You know what it's like to have people deny medical treatment? They're telling me I'm not worth help. I might as well start preparing to die,'" she said.

HMSA ultimately paid all expenses, but not until after the couple spent their own money to go to Texas for medical help.

Mendes said her husband, Lloyd, 49, had had surgery three times in his neck for what was believed to be recurrent parathyroid cancer.

Five doctors agreed a magnetic resonant imaging study was needed to pinpoint the cancer.

Despite doctors' requests, HMSA refused to cover an MRI because medical directors gave an opinion "that an MRI would not detect recurrence of metastatic parathyroid cancer . . . "

Mendes is alive now. He paid his own expenses. Could you?

A patients Bill of Rights law was passed by the Legislature and signed by Gov. Ben Cayetano on July 15 that same year.

Bob Herkes now wants to snatch away the right of appeal.

In Herkes' CPC committee the bill will no doubt sail through, regardless of testimony. A chair simply directs the vote, and compliant committee members usually obey. But please don't give up. There are other committees.

Please check the status of the bill here. If you want to be notified of any hearings by email, click here. Submitting testimony became easier this legislative session, it's all done by email.

Please read the bill and I hope you'll take the time to submit testimony opposing it.

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