Thursday, June 23, 2011

 

Have you been denied by your medical insurance company? You may have only this week to appeal to the Insurance Commission


by Larry Geller

This week is almost over.

It’s really down to the wire on external appeals of health insurance denials.

If SB1274 is not on Governor Abercrombie’s list of potential vetoes, which is due out next Monday, then the bill will become law and whatever your insurance company denies you will probably stick.

Anyone who had the right to appeal to the Insurance Commission will lose that right. Well, you might be able to take them to court, but it’s usually cheaper to pay for the treatment, even if very expensive, yourself. SB1274 will also be a windfall for insurers, who make their money through denials. As whistleblower Wendell Potter noted in his book Deadly Spin, “the denial of claims goes straight to the bottom line of insurance companies' profits.”

Odds are, you yourself have not been denied anything life-threatening by your insurance company. I know that. I’d just like you to think what would happen if you were. What would you be able to do about it? Just turn over and die as they expect?

How about calling the Governor’s office and asking that SB1274 be vetoed?  808-586-0034.

Though I’m not an attorney, it looks to me like if SB1274 doesn’t get on the potential veto list, the Insurance Commission would likely stop accepting external appeals because of the likelihood that they may be vacated on the basis that the Commissioner lacked jurisdiction to hold a hearing and enter a decision.

External appeals have saved lives. I know of someone personally whose life was saved this way.

There has been direct action on this. A remarkable meeting took place this week at the State Capitol inside the governor’s administrative offices.

On Tuesday about 30 people gathered in a room at the State Capitol to tell two representatives of the Governor why passing SB1274 is such a bad idea. There were doctors, lawyers, two law professors, Rep. Karl Rhoads (who voted against SB1274), about six registered nurses, eight parents with and without kids, and a social worker.

It was the parents’ stories that were most impressive. They brought with them three kids with cystic fibrosis, two medically fragile kids from Kauai, and one medically fragile kid from East Honolulu. Their message was, indeed, powerful. Some of their children would likely be dead except for the treatment they were able to keep because they have the right to appeal insurance company denials.

Would an insurance company deny life to children with cystic fibrosis? You betcha.

The Patients Bill of Rights is very powerful protection for Hawaii’s citizens and has been a model for other states. It works. One parent told the group how she had been denied by Medicaid. When she told them on the phone that she was going to appeal to the Insurance Commissioner, they caved immediately and reversed the denial. There was no need to go forward with it.

That demonstrates that the Patients Bill of Rights and Responsibilities is working. Take away the right of appeal, and where would the children be?

So please join the movement to protect our protections. Call the Governor right away (since Monday is the deadline for putting bills on the potential veto list) at 586-0034. Don’t worry, the Governor himself doesn’t answer that phone, just leave your message.

Or, if you live on Oahu, tell it to the Governor directly. There is a public forum this evening, June 23, from 6 to 7:30 p.m., at Washington Middle School. There should be plenty of parking. They want to talk about what they’re doing for (or to) the homeless. We can tell them what they should do about this very bad bill.

Please do something to protect the Patients Bill of Rights and Responsibilities today or tomorrow. Before it’s too late.



Comments:

I've had a chance to read both the revised federal regulations and the DHS technical guidance letter. The letter states "the transition period is modified to extend through December 31, 2011. As discussed below, HHS intends to issue determinations regarding State external review implementation no later than July 31, 2011."

There seems to me to be no reason at all for Governor Abercrombie not to veto SB 1274 immediately.
 


In Australia, there are so many private health insurance companies that denial of one doesn't mean the end of the world for an individual. The options are limitless.
 

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