Administration bolsters patients against 'insurance company abuse' A BIG FUCKING DEAL!

[Beetwasher]

WASHINGTON – Three federal agencies have combined to announce new regulations that would allow patients to appeal health plan denials and "help support and protect consumers and help end some of the worst insurance company abuses."

The regulations, issued Thursday by the Departments of Health and Human Services, Labor and Treasury, are part of new patient consumer rights mandated under the Affordable Care Act. They give patients the right to appeal decisions made by a health plan through the plan's internal process and, for the first time, the right to appeal decisions made by a health plan to an outside, independent decision-maker, no matter what state a patient lives in or what type of health coverage he or she has.

Insurance companies say they already offer a review process. According to Robert Zirkelbach, press secretary for America's Health Insurance Plans, "Health plans have a long track record of supporting third-party review to give patients greater peace of mind about their health care coverage."

"We support the National Association of Insurance Commissioners external review model," Zirkelbach said, "and we are currently reviewing the new regulations to see how they compare to existing state programs.”

--snip--

http://healthcarefinancenews.com/news/administration-bolsters-patients-against-insurance-company-abuse

As I've said all along, the Feds now have their foot in a door that was sealed shut to them in the past. They are IN THE MIX NOW for GOOD. Oversight and regulation NOW on the Federal level IS a big, big deal folks. Yes it is.

[dmallind]

1. He's just like Bush. No difference at all. NT

[Winterblues]

52. Black and white just like Bush*

None of that in between stuff allowed around here is there? Escalating the "War on Terror" just like Bush*.. check..Gitmo still open..check.. assassinations approved by Administration..check..actually there is quite the list of close simularities,

[dmallind]

63. And Hitler made the trains run on time and was nice to dogs. So what?

Most of us are capable of working out harm or benefit of a totality of actions.

[jah the baptist]

106. so just exactly WHO is hitler in your analogy? nt

[dmallind]

114. Analogy? More of an example surely

It's quite simple. Just because somebody causes some harm but more benefit, does not stop them being a much better option and the sound moral choice over someone who causes some benefit but much harm.

Hitler would be the latter BTW.

[jpak]

160. So Obama is Hitler?

I'm confused

[Gordan Shumway]

215. Sometimes

this (:sarcasm:) is necessary. Even when comparing to Hitler sometimes it's tough to tell who is being serious or not on this site.

[Tracer]

136. Mussolini "made the trains run on time", not you know who.

NT

[flamingdem]

2. Yay nt

[Pirate Smile]

3. K & R

[BootinUp]

4. Mr. Zirkelbach, your industries abuses in this regard

are documented to infinity. Please stop.

[sinkingfeeling]

5. So you don't think patients should have a right to appeal insurance company decisions? You also

call for 'oversight and regulation' while complaining about the federal government allowing such appeals and also providing $$$ to have state personnel to assist?

[Beetwasher]

6. What?

:shrug: Are you talking to me? Where did I complain about anything?

[KansDem]

13. It may have been a misinterpretation of your "BFD!!!"

It might have been read as sarcasm and not as an approval of the announcement...

[sinkingfeeling]

22. Exactly as I took his meaning.

[depakid]

7. Now you get an "appeal" to arbitrator!

That'll show 'em.

btw: this one was also predicted:

Some insurers stop writing new coverage for kids
Ahead of requirement to cover kids with medical problems, some insurers drop out

http://finance.yahoo.com/news/Some-insurers-stop-writing-apf-1129458619.html?x=0&.v=1

[Beetwasher]

8. You're Right, Much Better We Taze Insurance Comapanies Into Submission

When there's a dispute. Or maybe we should send you to talk to insurance companies on behalf of everyone who has disputes. You'll figure it all out right and proper because you have all the answers.

In fact, why have arbitration, or courts or any type of systems in place to settle disputes? Everyone should just ask Dapakid what to do! And the people he hates will all get banished into his little dark place where he keeps his beasties.

[depakid]

10. The only thing that will deter is consequences for bad faith denial of claims

this is just another hoop to jump through that wears the patients down in order to maybe (eventually) receive the treatment they were entitled to in the first place. Provided they can make their case in time.

[Beetwasher]

12. Line 'Em Up Against The Wall! How's Them Consequences!

They don't meet Depakid's standards!

Serial infractions will at least get them booted out of exchanges if not fined. Still waiting on those regs.

[depakid]

15. You resort to obnoxiousness because you don't know what else to do

Your "big fucking deal" is a big fucking joke and anyone with experience in the field knows it.

[Beetwasher]

16. Cuz Depakid Says So! The Amazing Depakid!! Can Write Better Regulations With A Single Crayon

Than a whole buidling filled with Health Care professionals and OMB Circulars!

[depakid]

17. Again, all you've got is middle school behavior-

That and the hope and faith based thing that's worked out so well in other areas of public policy.

[Beetwasher]

19. I've Got Brand New Shiny Fed. Regulations That Will Protect Patients Against Abuses

With streamers.

You? You've got hate.

[depakid]

24. LOL- you have nothing but an arbitrator and bag full of juvenile insults

-nothing whatsoever to deter bad faith claims denials. As long as there's nothing to lose, and money to be saved by denying treatments- it will continue.

For those few with the time, ability, money, expertise and fortitude to deal with the hassle and see a case through, they may actually receive some of what they'd otherwise be entitled to. For those few, better than nothing- though insulting (and potentially deadly) to all the rest.

But hey! We can't have corporate accountability for insurance companies that might actually cost them big money, now can we? Better take whatever peanuts we can get- since we won't get effective public policy at their expense.

[Beetwasher]

25. It's Amazing The Hatred That These New Federal Regulations That PROTECT People Brings Out In You

New, federal regulations to protect patients really rub you the wrong way. Incredible.

[depakid]

28. dupe

[Beetwasher]

30. It's Bursting Out Of You So Much You Had To Post It Twice!

Relax, pal, you'll break your keyboad. :rofl:

You'd think you were allergic to Federal Regulations that protect patients the way you hate them.

[depakid]

35. Makes one curious as to how old you are- I pegged it at middle school- but that might simply be EQ

Yep, we hates regulations- hates 'em hates 'em!

You go on now and enjoy being wrong yet again...and acting like a fool.

[Beetwasher]

36. Awww, Poor You, So Disgruntled Over These Terrific New Regulations

Whatever shall you do? :rofl:

[depakid]

44. Actually, the one's doing the laughing at your mischaracterizations are the insurers

...all the way to the bank.

It's the patients in the US who won't be laughing at the policy failures. I doubt you care much about that, though.

[Beetwasher]

47. Just Take Depakid's Word For It! He SAYS So! It MUST Be True!

It's his "gut" you know. These regulations really suck, cuz Depakid says so!

[depakid]

53. What it does is continue to protect insurers from liability for the tort of bad faith claims denial

and breach of fiduciary duty- which for years deterred companies from engaging in this sort of behavior.

All that's done here is to give another hop to jump through for those healthy, wealthy, and educated enough- or with the time some slight means to maybe, eventually get a claim (and not every claim in a series) that they're already entitled to paid.

That will deter no one with competent bean counters on board.

[Beetwasher]

55. " which for years deterred companies from engaging in this sort of behavior."

Oh, well, then why change anything, we should just leave things as they were since the insurance companies were already deterred, for years from engaging in this sort of thing, right? :rofl:

You mean, in the past people could sue? And now, somehow they can't? On what planet?

Actually, this is better than torts for denail of claim, this is immediate arbitration by the Feds instead of being held up in court. The law now mandates that services will have to be rendered, no need to wait it out in court. And there's nothing that prevents someone for still bringing it to court too if they want.

[depakid]

60. Since you're clueless- here's a hint (probably from before you were born):

PILOT LIFE INS. CO. v. DEDEAUX

http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=481&invol=41

Easy enough to change that and the various other decisions across the country. If one were serious about deterrence- and stopping abuses, which this administration and Senate were not.

[Beetwasher]

Not Relevant

n/t

[depakid]

236. LOL- fail. The case and it progeny are what prevent patients from holding insurers accountable

in tort for denial of claims or treatment(s).

Before that, if you or a family member was denied or delayed in bad faith- and died, suffered a poor outcome (or went bankrupt) as a result, there was hell to pay at the hands of a jury.

You want to talk about a BFD -PilotLife was a BFD- for the insurance industry and still is.

[Beetwasher]

241. They Are Now Held Accountable By Federal Law

I see that concept escapes you.

You do understand what the term "FEDERAL REGULATION" implies, don't you?

[depakid]

245. You can keep repeating that over and over like propaganda but it doesn't and won't make it true

nor will it restore any of credibility that you've lost (assuming that you had any left).

Fact is- and it's right here for everyone to see, you don't know what you're talking about- hence the resort to shallow canards and insults.

[Beetwasher]

246. The Actual Federal Statutes Make It True, You Know, Federal Law, Enforced By Federal Agencies

You realize that when you break federal laws you can be prosecuted, right? Like, in federal courts. You've heard of that, right? You've heard of the DOJ I assume? They prosecute people and corporations all the time when they break Federal laws. You've heard of such things, yes? That makes this true.

You see, before this brand spanking new Federal law came into effect, the DOJ had nothing on which to prosecute, since no laws were being broken. But now, guess what?! There's a law, that if broken, can be prosecuted and enforced with.................that's right! PENALTIES!

[depakid]

247. Repeat, repeat shallow substanceless (and factually inaccurate) statements-

LOL- you just don't know when to quit. Reminds me of the wails from the other side of the aisle: "they're going to take our guns!" "we're being taxed to death!"

Same hysteria and lack of grounding in reality.

[Beetwasher]

248. So You Don't Believe In Federal Laws??? They Are Not Real Enough For You?

Oh my. You and Ruby Ridge.

[depakid]

251. Let's look at it this way: even if your statements were true (and they're not) THIS administration

doesn't even prosecute food poisoners like Peanut Corp., despite knowingly distributing contaminated products, killing nine people, sickening tens of thousands of others- and despite mountains of written evidence in their own words.

This administration won't prosecute coal mining companies for wilfull violations of safety regulations that repeatedly kill their workers.

This administration won't prosecute thousands of banksters and fraudsters despite stealing trillions and collapsing the economy and irreperably harming 100's of millions of people both here and abroad!

And you think they're going to go after insurance companies in 10's of thousands cases where claims and treatments have been denied?

:rofl:

Not only are you clueless about this and other laws- or about how insurers, arbitrators regulatory agencies and federal courts and prosecutions work- you lack any common sense!

[Beetwasher]

252. Well Then! Let's Get Rid Of All Federal Laws And Regulations Because Depakid (The AMAZING!!) Says

They won't be enforced anyway!

Hey everyone! Get that?! Why BOTHER!? Depakid says they won't be enforced, so, what the hell? Let's just scrap all Federal Regulations. They're just a colossal waste of time!

Oh, and understand, nothing I say is true because Depakid SAYS SO! He says it's not true, so therefore, it's NOT! Get it? Good!

[depakid]

253. Snide remarks & factually inaccurate assertions about matters you know nothing about is all you got

Bill O'Reilly, is that you out there?

Because it sure sounds like you.

[Beetwasher]

254. See? Depakid SAYS I'm Factually Innacurate! Therefore, Even Though He Doesn't SHOW ANYTHING

that is, err, actually factually inaccurate (yeah, went there), he SAYS it is! And we all know that Depakid is never, ever, ever wrong about such things. Ever. Nope. Never. And of course, he never actually has to back up his bullshit, because, well he SAYS SO!

[depakid]

262. You're the poster making all of the broad, bold and bogus claims without any backup

and then throwing fits when you're called on it.

btw: I take back the middle school comment(s) -this is primary school stuff.

[Beetwasher]

268. Well Then, Should Be Easy To Point One Out!

:shrug:

[Mimosa]

291. ^ Exactly! ^

Depakid, thanks for putting this into words.

[Mimosa]

290. But we the people will be MANACLED to the insurance companies more than before HCRA 2010

That's what the mandate did. It manacled us -and our health- to private corporations!

[depakid]

29. Oh, the hatred, the hatred!

:rofl:

Here's where you file this: under the don't piss down my leg and tell me that it's raining department.

[Name removed]

43. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Beetwasher]

45. Yeah, I Lost You

Sure I did.

[Marr]

46. Yes, you did.

I wanted to read the reasoned response. Apparently you don't have one.

[Beetwasher]

48. Response To What? Depakid's Opinion That These Regs Suck?

How do you think insurance disputes should be settled? With shotguns?

[Marr]

50. His point is still listed above. I see no reason to re-type it.

You can read it and respond rationally if you like.

The fact that you're restating that dishonest "anti-regulation" strawman leaves me with the impression that you can't offer a meaningful response. Maybe there isn't one.

[Beetwasher]

51. Umm, And There Are Responses To That

Which I guess YOU don't want to read. That's YOUR problem.

"Serial infractions will at least get them booted out of exchanges if not fined."

Those ARE consequences. Anything else, dearie, or are you all straightened out now?

[depakid]

54. No- there aren't responses to that

and there AREN"T effective consequences that will be used to get insurers to pay what they'd already have to pay in the first place.

Your problem is that you have no clue whatsoever how these processes work- and so are left with foot stamping and playground taunts.

[Beetwasher]

56. Depakid's Definition Of "Effective Consequences"=?

Shooting them in the face?

[depakid]

62. Same with any other corporation

Make it certain to cost them a ton more money than the abusive practices they engage in. Simple enough even for middle schooler (or a bean counter) to understand.

[Beetwasher]

65. That's What Federal Regulations Are For AND Courts!

The regulations are STILL being written and being kicked off exchanges WILL cost them a ton of money as will fines for serial deniers.

So, there you go! It WILL cost them a ton of money.

[depakid]

68. No one's going to get "kicked off" these limited exchanges- and there's no right to sue

because, among other things ERISA preemption is still in place.

Not only are you factually challenged here- but you have no idea how big insurers, arbitrators and regulatory bodies work.

All you've got are more faith based assertions without any grounding in reality. Hopey, changey stuff- the same stuff that's held countless other corporate criminals, torturers and corrupt public officials accountable since this administration came into office.

:sarcasm:

[Beetwasher]

70. So Says The Mighty Depakid!!! Everyone Just Take His Word For It Because...Well Just Because!!!

Don't bother actually reading the law and the regulations! Depakid tells you everything you need to know!

http://dpc.senate.gov/healthreformbill/healthbill49.pdf

(q) Requires the Office of Personnel Management (OPM) to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through Exchanges in each State. Requires OPM to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP), and allows OPM to prohibit multi-state plans that do not meet standards for medical loss ratios, profit margins, and premiums. Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan; States may require multi-state plans to offer additional benefits, but must pay for the additional cost. Multi-state plans must comply with 3:1 age rating, except States may require more protective age rating. Multi-state plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the PPACA. Guarantees that FEHBP will maintain a separate risk pool and remain a separate program.

[depakid]

71. What does that have to do with claims or remedies?

Not a damn thing.

But it does demonstrate yet again that you know nothing about the law or how insurers, arbitrators or regulatory bodies work.

There's a reason we have (or in most situations like this had) tort damages (i.e. punitive and compensatory damages for things like pain and suffering) for certain behaviors.

[Beetwasher]

73. Why Do You Have A Problem With Insurance Being Forced To Provide Coverage

and being fined by the Federal gov't if they don't? That's better than going to court and having to wait and wait and wait. And there is nothing stopping anyone from still suing their insurance company if they want. If you say there is, prove it.

[Marr]

57. Is that true, or just speculation?

I haven't found any details on that claim with a few cursory web searches. It isn't mentioned in the article you posted.

You're saying that insurers will be booted out of the exchange if they lose a certain number of arbitrated decisions, which seems unlikely to me. You're also implying that this independent arbitrator's decision is legally binding. Is it?

[Beetwasher]

58. It's Law Of The Land Now

Have you read the law?

[Marr]

61. Not the whole thing, no. Did you?

If so, you could direct me to the pages that support your claim.

[Beetwasher]

64. Yes, I Did Read The Whole Thing

Here's a good summary:

http://dpc.senate.gov/healthreformbill/healthbill49.pdf

See page 61 (q)

[Marr]

137. I don't see anything in paragraph (q) that says

insurers will be dropped from the exchange if they engage in bad-faith denial of claims.

It says the OPM is allowed to prohibit insurers who don't meet certain standards, but that doesn't mean they will, and it doesn't define the standard on the subject of claim denial.

[Beetwasher]

140. To Be On The Exchanges They MUST Meet The Requirements

If they stop meeting the requirments, they cannot be on the exchanges.

[Marr]

146. Yes, but who says those requirements include

losing a low number of arbitrated claim denial cases? Or even a low percentage of them?

[Beetwasher]

148. DHHS

Is busy writing the regulations and requirements. When they are finished, we will have the answers.

[Marr]

204. Then you're arguing that something exists when it does not. n/t

[Beetwasher]

207. No, I'm Explaining How It Works

Regulations need to be written before they can be enforced.

This thread was about new regulations that are completed, and there are more coming.

[Marr]

212. You do not know what these requirements will be.

They could simply be general guidelines for what constitutes a health insurance provider.

You are asserting that there will be a maximum amount of cases that an insurance provider can lose by third party arbitration and still remain in the exchange. There is nothing to support that claim.

[Beetwasher]

214. I Know Who's Writing Them; Kathleen Sebelius' DHHS, And I Know I LIke What's Been Completed So Far

And I know there's a lot more coming.

But don't let that stop you from attacking what doesn't exist yet.

[Marr]

217. You are making an unsupported claim.

I am simply pointing that out. If you choose to interpret that simple fact as a personal attack, that is your choice.

[Beetwasher]

219. Uhh, No, I'm Not Claiming Anything Except That More Regulations Are Coming, Which Is Not Unsupported

And that plans that don't meet the requirements (which have yet to be written) will not be allowed in the exchanges. That's not unsupported. It's fact.

[Marr]

220. Now you're saying you never made that claim?

You do understand that this is a message board, and your previous comments are still on the page, correct?

[Beetwasher]

221. So Point Out The Claim You're Talking About That's Unsupported

The claims I made are all supportable.

"Requires the Office of Personnel Management (OPM) to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through Exchanges in each State. Requires OPM to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP), and allows OPM to prohibit multi-state plans that do not meet standards for medical loss ratios, profit margins, and premiums. Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan; States may require multi-state plans to offer additional benefits, but must pay for the additional cost. Multi-state plans must comply with 3:1 age rating, except States may require more protective age rating. Multi-state plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the PPACA. Guarantees that FEHBP will maintain a separate risk pool and remain a separate program."

Routinely denying claims will mean they are NOT meeting the requirement to cover essential health benefits and therefore will not be eligible for the exchanges.

[Marr]

223. It doesn't mean that at all.

Denying claims is a part of legitimate insurance practice. Not all claims are valid.

The sentence you highlighted sounds more like establishing a general guideline as to what constitutes a health insurance provider as opposed to say, an auto insurance provider.

[Beetwasher]

226. YOU Are Talking About Denial Of VALID Claims

Valid claims ARE part of essential health benefits. If they routinely deny valid claims, they will NOT meet the requirements to provide essential health benefits.

[Marr]

227. That's your assumption.

Someone else might consider this third-party arbitration all the improvement that's needed.

[Beetwasher]

230. If They R Forced To Pay Their Claims And Do So Because Of It

I don't see the problem as long as it's efficient and fair. Under Sebelius it will be.

[Marr]

234. The problem is it's not removing bad faith claim denial from the process.

It's just adding another factor to the industry's calculation. When they're deciding where the maximum profit margin lies in claim denial, they'll look at the success rate of claimants in third party arbitration in addition to the factors they consider now.

Considering the fact that we're talking about largely broke, sick people here, third party arbitration seems like something that many won't be able to pursue, for money and health reasons.

If this really were a method for kicking out insurers who deny claims purely on a profit basis (which seems to be the norm), I'd be all for it. I seriously doubt that it will be, however, and it isn't at present.

[Beetwasher]

239. Baloney

Everyone will be able to pursue it because it doesn't cost them money, it's NOW the gov't's responsibility to DEAL with this issue and there's every indication in the Law that they will, because it now makes it a REQUIREMENT for ins. co's to Cover Essential Health Benefits (also know as PAYING VALID CLAIMS) and this requirement will be FEDERALLY enforced for the first time ever.

They will identify and FORCE them to pay the valid claims. Period.

[Marr]

242. You don't know that, and that's my whole point.

I'm saying these things are not in there now, and they are not. You have faith that they will be. That's fine-- but cheering seems, to me, very premature.

[Beetwasher]

243. The Regulations In The OP Alone Deserve Cheer

But please do continue to cherish yr cynicism.

[Marr]

261. It isn't cynicism. I'm talking about what *is*.

You're talking about what you hope will be, or what you assume will be.

[Beetwasher]

269. No Yr Expressing Yr Cynical Opinion Despite Contrary Evidence

[Marr]

281. No, you have no evidence.

That's what we just established. You have a hopeful interpretation of an ambiguous sentence. I seriously doubt that it means what you think it means.

[Beetwasher]

282. No, You Just Want To Ignore The Evidence And Play Semantic Games

And pretend the law doesn't say what it says.

Plans are required to cover essential health benefits. Period. It's very clear despite you're semantic gymnastics.

"Requires the Office of Personnel Management (OPM) to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through Exchanges in each State. Requires OPM to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP), and allows OPM to prohibit multi-state plans that do not meet standards for medical loss ratios, profit margins, and premiums. Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan; States may require multi-state plans to offer additional benefits, but must pay for the additional cost. Multi-state plans must comply with 3:1 age rating, except States may require more protective age rating. Multi-state plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the PPACA. Guarantees that FEHBP will maintain a separate risk pool and remain a separate program."

[Marr]

283. We've already gone over that point.

Your interpretation seems unlikely at best. I think you're just so anxious to believe something that you can't appraise the situation objectively.

I think I'm done here. I see no reason to rehash points we've already covered. Good luck to you.

[Beetwasher]

284. And Obviously The Point Went Over Your Head Or You Just Choose To Ignore It

It's not my interpretation, it's the requirments of the law. The fact is the LAW REQUIRES the plans to cover essential helath benefits. Period. That's not an interpretation, it's plain and clear in the law:

"Requires the Office of Personnel Management (OPM) to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through Exchanges in each State. Requires OPM to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP), and allows OPM to prohibit multi-state plans that do not meet standards for medical loss ratios, profit margins, and premiums. Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan; States may require multi-state plans to offer additional benefits, but must pay for the additional cost. Multi-state plans must comply with 3:1 age rating, except States may require more protective age rating. Multi-state plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the PPACA. Guarantees that FEHBP will maintain a separate risk pool and remain a separate program."

[phleshdef]

182. LOL!

[unapatriciated]

97. This is a small step one that California took in the early 90's.

Fair Claims Practice Act of California
Even before the 1994 Northridge earthquake, insurance company claims practices often confused
policyholders. Furthermore, many policyholders, following the Loma Prieta earthquake and the Oakland
Firestorm, had “gut” feelings that their adjuster or insurance company, while extremely friendly and
seemingly helpful, was not treating them properly or fairly.
In 1992 a group of Allstate Insurance Company policyholders in the Oakland Firestorm put these “gut”
feelings into substantial documentation and written complaints to the Department of Insurance, the state
agency which regulates the activities of the insurance industry. The Department of Insurance, because of
the documentation and the significant number of written complaints provided by policyholders, was able to
sanction Allstate and fine the insurance company $750,000 for violations of the Unfair Claims Practices
Act.
It is important, then, that you know what the California Insurance Code considers "unfair.” Section 790.03
of the Insurance Code outlines UNFAIR claims settlement practices. Paraphrasing the code section, these
unfair practices include:
• Misrepresenting to claimants any pertinent facts or insurance policy provisions.
• Failing to acknowledge or act reasonably promptly upon communications with respect to claims.
• Failing to affirm or deny coverage of claims in writing within a reasonable time after “proof of
loss” requirements are completed.
• Failing to act in good faith to effectuate prompt, fair, equitable settlements.
• Compelling insureds to institute litigation to recover amounts due by offering less than the
amounts ultimately recovered.
• Attempting to settle a claim by an insured for less than the amount to which he/she is reasonably
entitled by reference to advertising material accompanying an application.
• Attempting to settle a claim on the basis of an application which was altered without notice to the
insured.
• Failing, after payment of a claim, to inform insureds, upon request by them, of the coverage under
which payment was made.
• Making known to insureds or claimants a practice of the insurer of appealing from arbitration
awards in favor of insureds of claimants for the purpose of compelling them to accept settlements
or compromises less than the amount awarded in arbitration.
• Delaying the investigation or payment of claims by requiring a preliminary claim report and then
requiring subsequent submission of formal proof of loss forms, both of which submissions contain
substantially the same information.
• Failing to settle claims promptly under one portion of the insurance policy coverage in order to
influence settlements under other portions of the policy coverage.
• Failing to provide a reasonable explanation of the basis relied on in the insurance policy, in
relation to the facts or applicable law, for the denial of a claim or for offer of a compromise
settlement.
• Directly advising a claimant not to obtain the services of an attorney.
• Misleading a claimant as to the applicable statute of limitations.
For the full text of the California Fair Claims Practice act, call the California Department of Insurance at
800-927-4357 (from within California) or 213-897-8921 (outside California) or go to
http://www.insurance.ca.gov/LGL/Regulations/Fair-Claims-Amendments.pdf

California finally filed suit and settled with blue cross regarding these issues. What they paid was a small portion of the profits they reaped by denial of claims between 1994 and 2004, ten years of profits on the backs of the most vulnerable.

http://www.medicalnewstoday.com/articles/138914.php

As part of the agreement, which was announced on Wednesday, the state will drop outstanding charges against Anthem that the company failed to comply with state laws in the way it rescinded members' PPO policies. In 2008, Anthem agreed to pay a $10 million fine to the state Department of Managed Health Care to settle a similar charge that the company canceled HMO-type policies of 1,770 members (AP/San Francisco Chronicle, 2/12). In both cases, Anthem agreed to overhaul its insurance policy sales and management practices and simplify the application process, which is expected to reduce the number of policy rescissions.

I have debated this issue with you before and you basically called me stupid. I worked from 1991 to 1994 in California to get legislation regarding wrongful denials of claims. From 1994 to 2005 I again worked to get some sort of penalties regarding those practices.
When California finally filed the above class action suit they negotiated away many of us (1994-2004 after the fair Claims Practice Act went into effect) who were financially devastated (not to mention those who died are had their health compromised during those years) by Blue Cross when they failed to comply.
You can legislate a ton laws regarding denials of claims, but if there are no penalties regarding those wrongful denials the Insurance Companies will continue business as usual.
I know first hand how they get around these laws, it's called delay and since there are no real penalties for delaying payments it is more profitable for them to do so.
Show me where there is any meaningful penalties in this legislation for wrongful denial of claims. I have been waiting for almost twenty years for the insurance cartel to be held accountable for their greed.

[Beetwasher]

98. This Has Nothing To Do With Settling Suits, This Is Third Party Arbitration

And insurance companies are require to adhere to the decisions. Period. There's no waiting this out in courts.

[unapatriciated]

107. jesus, you just don't get it.

http://www.vaagelaw.com/newsarticles/NA053020031221.asp

You have a right to have denials of treatment by your health plan or physicians' group reviewed by an external, indpendent medical review organization.
You have the right to sue your health plan in some circumstances -- when a health plan interferes with the quality of care you receive and you are injured by the delay or refusal of the health plan to provide the care.

We fought for and got this too in California and the state still had to sue in order for the Insurance Companies to comply with state regulations.
I will say it again, without meaningful $$$$$$ penalties, it will be business as usual. How much history regarding this issue do you need to understand that.

[Beetwasher]

120. The Feds Are A Whole Different Matter, This Is NOW Federal Law

You just don't get it.

[unapatriciated]

139. same regs with the same penalties.... NONE

What you don't get is I want this to work and for that to happen we have to look at the problems California encountered with the same type of legislation and fix it. You want Fed Regs to be better and stronger than State Regulations
So if you care than you would be lobbying for strong $$$$$ penalties that would insure compliance to these Regulations.
Instead you engage in mocking (they may of been deleted but not before they were seen) comments about those who have a different opinion on what is needed for Federal Regulations to actually keep the Insurance cartel for doing business as usual.

[Beetwasher]

141. Wrong-They Can Be Removed From Exchanges, For Starters

And the regs are STILL being written.

[unapatriciated]

150. so if they are still being written....

I can count on you to write and call your reps and ask for strong $$$$$ penalties to insure compliance?
That's what I will be doing. That's what many of us have been doing for years.

[Beetwasher]

151. Of Course!!

Wouldn't have it any other way, and now is the best time to apply pressure. Though Sebelius doesn't need much pressure, I believe she's intent on doing the right thing and I like what I've seen so far of what's been produced.

[unapatriciated]

183. good lets start it here on Du.

We can thank them for giving the six states who do not have arbitration laws, a federal regulation that protects them. We must ask that they immediately include $$$$ penalties for those companies that abuse the process for the sole purpose of dening claims and delaying payment or care.

[Beetwasher]

186. Go For It

n/t

[unapatriciated]

228. I have been doing it since the early 90's. Something you take delight in mocking.

The ball is in your court, if you are sincere post an op advocating what you claim to support in post 151

141. Wrong-They Can Be Removed From Exchanges, For Starters
And the regs are STILL being written.

150. And the regs are STILL being written.
so if they are still being written....
I can count on you to write and call your reps and ask for strong $$$$$ penalties to insure compliance?
That's what I will be doing. That's what many of us have been doing for years

151. Of Course!!

Edited on Wed Jul-28-10 03:01 PM by Beetwasher
Wouldn't have it any other way, and now is the best time to apply pressure. Though Sebelius doesn't need much pressure, I believe she's intent on doing the right thing and I like what I've seen so far of what's been produced.

[Beetwasher]

231. So U Keep Saying

That's "yer Majesty" to u.

[unapatriciated]

249. you know you might think you are cute,

but you are not and it shows how shallow you really are. Your snide remarks may have been deleted but you still can't resist poking fun at others who have suffered at the hands of the Insurance Industry
You can mock the pain my family went through, and what I did to help change laws in California, sad that you are so callous.
You will not do a thing to help change the problems we face under this current system of health care, that's ok, I am willing to do your share of fighting.
so much for truth in your post @151.

[Beetwasher]

250. I Know I'm Cute, My Mom Says I'm The Cutest Guy In Town

Please be my friend, my whole evening is ruined now because some stranger on the internet doesn't like me. How about a hug, dumplin'? :hug:

[unapatriciated]

257. whatever, get back to me when you sincere.

so much for truth in what you post.
This is not about like or dislike its about honesty something you seem to be lacking.

[Beetwasher]

258. I Just Got Off The Phone With Kathleen Sebelius

She's aware of your concerns. We're doing lunch next week to discuss them.

[unapatriciated]

259. Is she also aware of how you treat people with concerns.

funny thing is I don't believe you. I'm not your mother so cuteness doesn't make it true.
Damn you are just way to important for common folks like me, having late night chats with Sebeilus and still finding time to post on the net.

edited to add: still having trouble with honesty and now you are telling stories how cute.

[Beetwasher]

270. Hey! Just Got Word!

Obama's coming too!

[unapatriciated]

274. you do enjoy middle school taunts.

When you can't backup your talk with action you resort to mocking shows how serious you are about this issue. Maybe you should spend some time with one of your billers or those patients being denied. It might give you a different perspective.

[Beetwasher]

276. Obama Says Hi!

:hi:

[Mimosa]

292. You don't understand that sick people don't have the energy to fight to get care

I'm sure others here might be able to get you to understand that very sick people -some whose cases may be terminal- simply don't have the energy to f wrangle and fight denials of claims or even insurance's typical refusals to cover treatments and medicines. Big insurance has an expertise of wearing people down to the state where they give up. Sickness can cause confusion and depression as well.

BC/BS is the meanest of all. :lol:

The administration and Congress has now manacled the population to the for profit insurance corporations.

[tridim]

9. And those insurers wont be allowed on the exchange

and will likely go out of business after the exchange is implimented.

It's called corporate suicide.

[depakid]

11. Right.. LOL

you're naive.

[tridim]

20. You don't have a clue what the new law entails.

Just like my Republican parents.

They don't know, because they don't want to know.

[depakid]

26. I know that no insurer is going to be denied access to an exchange because they lose a case

You'd run out of insurers in less than six months if that were the case!

As I said. Naive. Goes with the hope & faith based thing.

[Beetwasher]

27. You Really Hate Federal Regulations

It's amazing.

[CBR]

14. K&R nt

[Phoebe Loosinhouse]

18. The real issue has always been NO PENALTY for insurers denying coverage

They deny your coverage. You appeal. Takes forever. Costs you time and money. They lose. The only thing that happens to them is that they have to pay for the coverage they should have paid for in the first place. Plus, they could always luck out and have you die due to lack of medication or treatment before a decision is made

Until there is a PENALTY for wrongful denial of coverage - like 10x the amount denied, you'll just continue to see the denials. There is no down side for them.

So let's see some penalties! Make it risky for the insurers to deny treatment they should be providing.

[Beetwasher]

21. There Are Penalties

Including getting booted out of the exchanges and there are more regulations coming.

[jaxx]

23. It is a BFD Beetwasher.

The unhappys are going to talk in circles, but you know you are right about this. This health bill is going to make a huge difference for people. Thanks for posting and don't give up.

[depakid]

33. What's a BFD?

Someone who understands what the law does and doesn't do- and doesn't worship at the temple of Obama?

btw: no insurer is going to "get kicked off the exchanges" for losing appeals.

[Beetwasher]

38. Poor Poor Depakid, All It Takes Is Some New Federal Regulations To Wind Him Up

And watch him go! Vroooom! :rofl:

[Oregone]

40. Way to cut straight to the strawman

Sure...its the regulations that is upsetting! Taking intellectual dishonesty to an all new low

[Beetwasher]

42. Vrooooooom!!!!!!

Wheeeeeeeee! :rofl:

[Name removed]

49. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Mimosa]

293. People will die from lack of care before 2014.

I guess it doesn't matter that there is still no help for adults who aren't poor enough for medicaid?

[enlightenment]

59. Could you please provide a link to that information?

I'm certainly not seeing it in the article, so I assume you have another source that indicates the insurer would be 'booted out of the exchange' if they improperly deny an appealed procedure. Is this in the health care bill itself? I don't recall seeing it, but it has been awhile since I read it.

Thank you.

[Beetwasher]

66. Here

http://dpc.senate.gov/healthreformbill/healthbill49.pdf

Page 61, (q).

[Phoebe Loosinhouse]

94. Here is the text of q page 61

Requires the Office of Personnel Management (OPM) to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through Exchanges in each State. Requires OPM to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP), and allows OPM to prohibit multi-state plans that do not meet standards for medical loss ratios, profit margins, and premiums. Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan; States may require multi-state plans to offer additional benefits, but must pay for the additional cost. Multi-state plans must comply with 3:1 age rating, except States may require more protective age rating. Multi-state plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the PPACA. Guarantees that FEHBP will maintain a separate risk pool and remain a separate program.

for those who would like to see what Beetwasher is referring to

[enlightenment]

95. Thank you.

I admit I'm a bit confused . . . which clause in this section contains the stipulation that an insurance company can be removed from the exchange for failing to pay on a claim?

q) Requires the Office of Personnel Management (OPM) to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through Exchanges in each State. Requires OPM to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP), and allows OPM to prohibit multi-state plans that do not meet standards for medical loss ratios, profit margins, and premiums. Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan; States may require multi-state plans to offer additional benefits, but must pay for the additional cost. Multi-state plans must comply with 3:1 age rating, except States may require more protective age rating. Multi-state plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the PPACA. Guarantees that FEHBP will maintain a separate risk pool and remain a separate program.

Is it this part: "Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan" ?

A 'qualified health plan' is defined by meeting minimum requirements for essential benefits, cost-sharing (the new euphemism for co-pay and deductible) and four-tiered coverage structure (bronze, silver, gold, platinum - the new health care Olympics). It does not include a definition of what they can and cannot allow - so denial of payment for given procedures can (and probably will) continue apace. (page 4, subtitle D, part 1 in the link you provided)

I simply do not see where in this clause is the possibility of removing an insurance company from the exchange for failing to pay a claim - in essence, where the teeth are in this new agency? Perhaps you could clarify?
Thank you.

[Beetwasher]

96. If they don't meet the requirements, they can't be on the exchange. Period.

If they get on an exchange, they have to meet the requirements, if at some point they no longer meet the requirements, they can't be on the exchange anymore. It's not going to say "they get booted". That's now how regulations are written, but that's the meaning of having requirements. Once you no longer meet the requirements you can't be on the exchange, IOW, you get booted out.

"Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan"

[enlightenment]

122. I believe what I was asking is where does it say

that this is one of the requirements for a qualified health plan? That seems to be the disconnect.

I do understand what 'requirements' means - I'm just not finding the language that includes this as a requirement. What I do see is the creation of a new agency to assist health care consumers in the appeal process and the creation of a third-party board to mediate appeals, if necessary.

What you seem to be saying is that this new agency (and third-party appeal board) will become part of the actual regulatory mechanism that defines 'qualified health plan'. That's the part I'm not seeing, so if you could point out the specific language that makes that linkage, I would appreciate it.

Thank you.

[Beetwasher]

125. No, That's Not What I'm Saying

"Requires multi-state plans to cover essential health benefits and meet all of the requirements of a qualified health plan"

Repeatedly denying coverage would mean they are not covering essential health benefits and therefore are not qualified for the exchanges. That is what the oversight would determine. And, there are STILL regulations being written, including all the specific qualfications for health plans.

[dflprincess]

129. They will always have good reasons for denying a claim for services that are clearly covered.

Just like they do now.

[Beetwasher]

131. No, They Won't Since They Are Federally Mandated Now

And will face Federal penalties if they don't comply. For the first time ever.

But you've already decided it sucks, so it must suck! Cuz you say so!

[dflprincess]

135. And I'm suppose to believe it isn't a scam because you say so?

You're not even reading your own links - nothing is mentioned about what happens when the insurance companies continue to deny claims for covered services.

[Beetwasher]

143. No, We're Supposed To Believe It Is CUZ YOU Say So!

Despite evidence to the contrary. I have the new Federal Regulations, you, you have you're anonymous opiniion.

[unapatriciated]

177. There are no $$$ penalties and that is the problem

http://www.healthcare.gov/news/factsheets/protectconsumers_factsheet072210.pd

Internal Appeals
The internal appeals process will guarantee a venue where consumers may present information
their health plan might not have been aware of, giving families a straightforward way to clear up
misunderstandings. Under the new rules, new health plans beginning on or after September 23,
2010 must have an internal appeals process that:
 Allows consumers to appeal when a health plan denies a claim for a covered service or
rescinds coverage;
 Gives consumers detailed information about the grounds for the denial of claims or coverage;
 Requires plans to notify consumers about their right to appeal and instructs them on how to
begin the appeals process;
 Ensures a full and fair review of the denial; and
 Provides consumers with an expedited appeals process in urgent cases.
External Appeals
If a patient’s internal appeal is denied, patients in new plans will have the right to appeal all
denied claims to an independent reviewer not employed by their health plan. External appeals
have helped consumers get the care they deserve: one study found that – in States that had
external appeals – consumers won their external appeal against the insurance company 45% of
the time.2

This is great for the six states who don't allow for arbitration by an independent party, but there is no penalties regrading wrongful denial of claims. California has the strongest legislation regarding this and still many are devastated while waiting on the appeals process.
All we are asking is for realistic penalties to insure compliance.

[Beetwasher]

181. The Regs Are Still Being Written

The penalties will be in the completed regulations. Just as I knew these regulations were coming, I know there are more.

[enlightenment]

153. Ah. I see. Thank you.

The devil is always in the details. ;)

[Oregone]

31. If insurance companies are abusive, why are they still guarding the hen-house?

[Beetwasher]

32. They're Not, Now The Feds Are Regulating Them, For The First Time Ever

n/t

[Oregone]

34. Farmers should just "regulate" foxes

No need to kill them anymore

[Beetwasher]

37. That's What We Should Do! Kill All The Insurance Company Execs!

No need for these horrible regulations then, right?

[Oregone]

39. No need at all

A real BFD would of left them unemployed

[Beetwasher]

41. But That Would Still Leave You Thirsty

n/t

[Leopolds Ghost]

67. An unfortunate side effect is to reinforce the notion that buying a private plan is an obligation

Not a right or a privilege. After all, all this regulation can only mean one thing: These are the preferred providers for service and you, the citizen^H^H^H^H consumer can't claim you need bargaining rights at all, since the preferred providers are already heavily regulated (as the providers of choice) and not "allowed" to screw you over. And if they do, you have options. So you're not allowed to simply say "no, I won't accept that policy."

[Beetwasher]

69. Not True, There Will Be Non-Profits On The Exchanges

And the push is already re-starting for adding the public option.

This establishes that access to health care and it's oversight IS the gov't's job and duty. That's a big deal and big shift in perception and role of the gov't.

[Oregone]

72. This debate has never been about access to health care

Its about access to health insurance. And that only goes so far if your low actuarial valued plan leaves you out in the cold.

[Beetwasher]

74. It's About Whatever Oregone SAYS It's About!

Don't think for yourself, just listen to Oregone!

[Oregone]

75. Or listen to the "BFD" meme being parroted around

Oy, that'll do it for you!

[Beetwasher]

77. BFD With LINKS And ACTUAL REGULATIONS!!! But Of Course, Oregone's WORD is MUCH Better Than FACTS

Because he SAYS SO!!!

[Oregone]

79. Yeah, since Im making up such terms as "actuarial"

:rofl:

Oh God. If you don't want to get it, fine. You don't need to pull others down in the miserable hole that you're in though.

[Beetwasher]

81. Wow! You Used The Term "Actuarial"!!! That Means What You Say MUST BE TRUE!!!

No links, no regulations, no cites, no nothing. But "actuarial" is in there!

[Oregone]

86. Aside from your hysterical distractions, the concept of an actuarial value is to create...

an economic incentive to for individuals to ration care at point of service. Do you need a link to explain this?

You and I well know the exchange will have plans with low actuarial values. Do you need a link to explain this?

If the legislation provides universal insurance coverage but care still is individually rationed due to out-of-pocket expenses, it would follow that the bill primarily addressed insurance coverage and not access to care (deduction).

Really now...do you need me to link to a crayon drawing for you to get this?

[Beetwasher]

89. Yes, Use A Crayon If It Makes You More Comfortable!

Never mind MLR's or mandatory minimum care coverages and things like that. And now, Federal oversight for the first time ever. All useless cuz Oregone knows how to throw around the magic word "actuarial" which makes it all horrible and worthless.

[Phoebe Loosinhouse]

152. MLRs do not in and of themselves drive down costs.

If anything, they might have a perverse OPPOSITE effect. Think about it. You know you are allowed to earn 15%-20% of the costs as your medical loss ratio. You would earn more money if treatment costs 50,000 as opposed to 20,000.

Insurers are not actually paying for anything. They simply pass along the costs to the consumer and the government.

They make money, see? Lots and lots and lots of money. Enough money that one of their CEOs "earned" more than a BILLION dollars in salary and stock options in a single year. And yet, this is the "private delivery system" Dems chose to "preserve".

You know, I am getting more mad, not less mad as time goes on.

[Beetwasher]

154. MLR's, Mandatory Minimum Coverages, Third Party Independent Arbitration

And Kathleen Sebelius in charge of writing the regualatory requirements...It's all good and will only get better.

But feel free to cling to your bitter cynicism.

"You know, I am getting more mad, not less mad as time goes on."

[Phoebe Loosinhouse]

165. And what happens when a Repub is the HHS secretary?

The regulated will run roghshod over the regulators as per usual.

That's the problem when people look for answers in regulation as opposed to legislation. Robert Reich addresses this issue here:

http://robertreich.org/post/628324698/obamas-regulatory-brain

Obama’s Regulatory Brain
Monday, May 24, 2010

skip

It’s almost exactly like health care reform. Ideas for changing the structure of the health-care industry — a single payer, Medicare for all, even a so-called “public option” — were all jettisoned by the White House in favor of a complex set of regulations that left the old system of private for-profit health insurers in place. The final health care act doesn’t even remove the exemption of private insurers from the nation’s antitrust laws.

Regulations don’t work if the underlying structure of an industry — be it banking or health care — got us into trouble in the first place. Wall Street’s big banks are just too big, and their ability to draw on commercial deposits for investment banking activities, including derivatives, will make them even bigger. It will also subject the economy to greater and greater risks in the future. No amount of regulation can cure that.

Similarly, the underlying system of private for-profit health insurance is a key driver of America’s bloated and ineffective health care delivery. We can try to regulate it like mad, but no amount of regulation will cure this fundamental problem.

A regulatory rather than structural approach to deep-seated problems in complex industries like banking and health care is also vulnerable to the inevitable erosion that occurs when industry lobbyists insert themselves into the regulatory process. Tiny loopholes get larger. Delays get longer. Legislative words are warped and distorted to mean what industry wants them to mean.

[Beetwasher]

166. Well Then! Let's Not Have Laws Against Murder, Because Some People Get Away With It!

And some law enforcement officials allow them to do so. So, by your logic, that must mean laws against murder suck and are useless, right?

[Phoebe Loosinhouse]

170. Reductio ad absurdum .

Which I always enjoy and which you just don't see very much anymore. Thank you.

[Beetwasher]

172. It's Not My Problem That's Where Your Logic Goes

Yes, it's absurd, but that's your problem.

[Phoebe Loosinhouse]

174. Robert Reich and me. I pick him over you. nt

[Beetwasher]

175. Robert Reich Wants To Get Rid Of Murder Laws?

Pray tell.

[Phoebe Loosinhouse]

184. I can't decide if you are just acting idiotic or if . . . oh, never mind

Did you read post 165 with the excerpt and link to a Robert Reich article about regulation vs legislation?

Was it too difficult for you to comprehend? Maybe just read a little bit at a time.

Oh, there's my Mom calling me. Can't play anymore with you.

[Beetwasher]

187. It's Your Logic That's Idiotic, Why Have ANY Regulation???

Repubs will just ignore it, right? So, what's the point?

[unapatriciated]

275. He has used that before

when I pointed out the many flaws in this bill. The most glaring one is no $$$penalties for serial denial of claims in bad faith.
If that doesn't work he mocks you when you explain your experience in regards to wrongful denials and delays. I wonder how many he helped to get claims paid? My son spent many months a year over a ten year period at Children's from 1991-1996 was an outpatient until 2001.
I met many parents there who were fighting the same battle of denying and delaying of care that I was. During my son's first stay at children's, a hospital social worker advised me to liquidate everything and go on medi-cal. I had three other children so that was not an option. I began my fight with Blue Cross of California after that conversation. I learned the value of documentation and with the help of a local lawyer had most of the denials reversed. The most difficult claims to get paid were meds and physical therapy. I did so well at getting claims paid my son's doctor asked me to help other parents get through the maze of insurance claims. I started a letter and phone call campaign that span three administrations. Wrote many letters to the California Board of Corporations (they handled insurance disputes) as well as the Insurance Commissioners and told my story over and over again. It was because of many like myself that California enacted laws against denials for pre- existing conditions. The Fair Claims Practice Act was enacted to protect against the bad faith practices of the Insurance Industry in regards to health care and the many property claims that were denied after the Northridge earthquake. People were tired of losing everything even with cadillac insurance plans.

My son is permanently disabled because of the constant delays and I did eventually have to sell my home to pay for care during the many many denials and reviews. There is a positive note laws were changed, that at least allowed you to fight them. They still need work because even tho you can challenge a denial there is no $$$ penalty when the Insurance companies use this as tool to keep the money in their pockets for as long as possible.

For some reason this poster thinks my story is something to mock, has insinuated it is untrue and I should stfu. It was because we didn't stfu and told our stories over and over again (no matter how painful those memories were and still are) that laws were changed.

[Beetwasher]

278. I Think you Take Anonymous Posters On Internet Way Too Seriously

You should ignore me, I'm just some asshole on the internets.

[unapatriciated]

279. no I take HCR very seriously.

you on the other hand not really.

[Beetwasher]

280. Yes, Yes, I'm A Horrible, Horrible Person

I kick kittens too! I'm so crushed you don't like me. I promise, I'll change. Please be my friend.

[Mimosa]

285. You are laughing at situations of sick people

Who can take you seriously?

You want to push the insurance company bonanza bailout.

[Beetwasher]

287. Is That What I'm Laughing At? Thanks For Telling Me!

I had no idea what I was laughing at. But now that I have you to tell me what I'm doing, I got it all straight now.

[JoeyT]

76. It may indeed be a BFD.

Or it may just be more pointless arm waving.

It ain't the regulation, it's the will to enforce it. We've got tons of really good regulation on the books that would prevent all manner of bad things that happen on a daily basis: The problem is no one enforces any of it.

How steep are the fines? How often will they be used? Will they only be used if a company can be proven to be acting in bad faith? How hard is the appeals process? How long is the appeals process? How expensive is the appeals process? Do you have to hire a lawyer? Can you re-appeal if you lose? Who's the burden of proof on in those cases? Does it take a billion infractions before the company is removed from the exchange? Does that only happen if they can repeatedly be proven to be acting in bad faith? How much leeway will the regulators be given? Will there be someone above them you can talk to if they're obviously bought off? Will the regulators have enough teeth to make the billion dollar companies do more than laugh at them as they dance? Will the fines outweigh the money saved from denying everyone care and only paying for care and the fines for the ones that have the money, will, and knowledge to fight? (Edited to add: I think that last question is what Depakid was asking upthread.)

The answer to any single one of these questions could easily mean the difference between real change and posturing. Between building a house and repainting one that's already falling in and calling it new.

[Beetwasher]

78. Kathleen Sebelius Is In Charge Of Enforcement Of The Regs SHE Wrote, Do YOU Trust Her?

I do.

[Oregone]

80. Is she a lifetime appointment?

[Beetwasher]

82. Well Then! Better To Do NOTHING! Why Have Laws Against Murder?

They MIGHT not be enforced. In fact, sometimes they aren't and people get away with murder. Might as well get rid of 'em.

[Lydia Leftcoast]

83. A half-measure. Why not the German system in which ins. companies CANNOT deny payment

unless they absolutely prove fraud and are required to pay up in 14 days?

[Beetwasher]

84. Oh Boy, It's Not GERMAN!!! It MUST SUCK!

Well, let's do nothing cuz it's not German.

[Lydia Leftcoast]

85. That is a silly non-answer to my REAL question--Why the half measures?

Why not some regulations with TEETH in them? Why not make the insurance companies do the right thing in the first place?

The regulations you're talking about are like saying, "Sure, you can defraud your customers all you want, but we'll give them the right to appeal your fraud, and maybe we'll decide on their behalf and maybe we'll let your fraud stand."

My brother is a doctor in private practice. He spends hours on the phone each week arguing with insurance companies, because they will look at ANY excuse to deny or reduce payment. This includes cases where he has demonstrably helped the patient.

I wish I still had the New York Times article in which an insurance company executive admitted that his company routinely denied most claims the first time.

[Beetwasher]

90. Yes! They Forgot TEETH! We Should Shoot Them In The Face!

That's how you get them to pay!

[Oregone]

92. All the yelling, hand-waving, and exclamation marks are intended to...?

Make you look like a frustrated super cool authority that everyone should trust? How do you think that is working out for you?

If you want a rational discussion, you need to engage in one rationally. If you want to merely fling feces...is this really the best place to do it? What are you accomplishing by unloading this amount of excrement in this manner?

[Beetwasher]

93. You Don't Have Rational Discussion, You Have A Magic Word!

"Actuarial"! See! Now it's all horrible.

[Binka]

101. What I Know About Your Opinions Is Enough To Toss You In The IGNORE Pile

Didn't your mother tell you not to show your ass in public? BW you need to go back to 3rd grade and learn how to conduct yourself.

[Beetwasher]

102. LOL! Run Away!

:rofl:

[Lydia Leftcoast]

110. It looks like he's channeling Mr. Benchley

or taking lessons from him.

[Occulus]

116. Holy shit, that's apt

Look at the end of Beet's sig line.

[NJmaverick]

87. K & R!

[Spheric]

88. Just more window dressing to help prop up a system which is based on...

making people rich rather than making people healthy.

BFD? Meh.

[Name removed]

91. Deleted message

Sub-thread removed by moderator. Click here to review the message board rules.

[Scurrilous]

99. K & R

:thumbsup:

[inna]

100. "BFD", fucking ridiculous.

[Beetwasher]

103. What An Amazing, Astute Rebuttal!

Bravo!

[inna]

104. it's so ridiculous and intelligence-insulting, it's not fucking worth it. good bye.

[Beetwasher]

108. Chock Full Of Rational Response! Ignore The Regulations! Inna Says It's "Ridiculous"!

That's all we need ladies and gentlemen. Inna says it's "ridiculous".

[upi402]

105. We seem to celebrate not getting completely raped now

This is a token change when major reform is urgently needed. We were betrayed and/or let down but refuse to see the elephant in the livingroom. We are dysfunctional.

So I bet there WILL be catches and snags;
no enforcement, no penalties to discourage the abuses, delayed implementation (in the long run, we're all dead), etc...

And who represents people against these monoliths? Who has the time to do this? Will we be required to travel and maybe stay in a hotel -will the hearings be in the corporate headquarters, a courthouse, Starbucks?

[inna]

109. exactly. it's less than crumbs. the whole "bfd" was nothing short of a betrayal. nt

[Beetwasher]

113. So Now Federal Regulations Protecting You Are Actually Raping You???

:rofl:

[upi402]

134. You really don't get it?

I mean, did you read my post? I'd laugh right back atcha but this is the seed of ignorance that is fertilized by the DCCC and the TV propaganda media.

So here ya go...:banghead:

[Beetwasher]

144. I Get That You Think Federal Regulations Suck And Are Meaningless

You're entitled to your useless opinin.

[upi402]

266. You really *don't* get it, I guess

But you are capable of being pointlessly rude, as well as absolutely incorrect about me.

g/l

[Occulus]

111. Interesting that everyone who disagrees with you gets sarcastic, unrelated snark

and general abuse from you- even those with legitimate questions and rebuttals.

I don't think you posted this thread in good faith, Beetwasher. I think you only posted it so you could shout at something.

[Oregone]

117. Its interesting that this abusive snark is permissible

To be honest, this poster is being far more civil than on other occasions. Consider yourself lucky.

[Beetwasher]

121. It's Interesting That I've Seen Not A Single Credible Response

That doesn't boil down to "This sucks cuz I say so!"

[Spheric]

142. Grasshopper, he that wishes to see must first open his eyes. /nt

[Beetwasher]

149. Says The Blindman

:rofl:

[Spheric]

155. Just call me Master Po. /nt

:rofl:

[Beetwasher]

156. You Mean You're A Fictional Character?

Well, that makes sense.

[Spheric]

157. It's decided. You may not enter the temple. /nt

:rofl:

[Beetwasher]

159. Hey, It's Your Fantasy

But now we know why you're so detached from reality.

[Spheric]

161. What else is there left to do but have fun? You most certainly have shown...

that you don't wish for rational discourse. In fact, rational discourse appears to be anathema in this thread.

And, that has been your choice - no one else's.

You are starting to make me believe that the OP was a joke to begin with.

EDIT: Aw. You changed your post. You originally told me to have fun.

[Beetwasher]

162. LOL! Says Mr. "This Sucks Cuz I Say So!"

:rofl:

[Spheric]

164. Yeh, pretty funny coming from Mr. "This Is Great Because I Say So."

I do have to laugh with you. Nice joke you pulled with the OP.

:rofl:

Had me going for a while.

[Beetwasher]

167. Actually, I Posted The New Federal Regulations That Say So

You just posted your useless opinion.

[Spheric]

168. Oh, please stop. You're killing me.

:rofl:

I don't think I can take much more. My sides are splitting.

[Beetwasher]

169. That Sounds Like Incentive To Continue

I will amuse you to death. Sounds good to me, Cupcake!

[Spheric]

171. Damn, your devious. I can't compete with that.

Nothing I could say would be half as funny.

[Beetwasher]

173. You're Selling Yourself Short

You're very funny. And handsome, sugar plum.

[Spheric]

178. Okay, now you're starting to scare me. I haven't been handsome for twenty years.

Mods, are you watching this? It's recorded.

[Beetwasher]

191. Nothing Is More Attractive Than Self Effacement

*growl*

[Occulus]

196. [point_made] "blind man" "cupcake" "sugarplum" "sweet cheeks" [/point_made] n/t

[Beetwasher]

202. How About Sweet Cheeks?

n/t

[Spheric]

197. I take this as nothing less than a threat to stalk me if I don't STFU.

The fact that you have chosen to continue down that path after I have stated my concerns is extremely troubling.

Why in God's name is this shit allowed on this board? And, I'm not talking about shoving it into the memory hole to cover it up so that no one remembers it happened.

What the hell is wrong with you people?

[superduperfarleft]

199. It's not supposed to be allowed, but some people are more equal than others. n/t

[Beetwasher]

201. Calling You Handsome And Attractive And Funny Is A Threat?

My my. Touchy touchy.

[Spheric]

206. When you have never even met me? Damn straight. /nt

[Beetwasher]

208. You're So Adorable When You're Angry

C'mon, how about a hug, handsome? :hug:

[lonestarnot]

260. kick

[firedupdem]

112. K&R

Thanks for posting this info!

[superduperfarleft]

115. You guys really are your own worst enemy. n/t

[Vinca]

118. The key word here is "appeal." How many people suffer and die during "appeals?"

I call bullshit.

[Beetwasher]

123. LOL! Well, I Guess We Need To Shoot Ins. Companies In The Face

To make them comply.

[Lydia Leftcoast]

224. That's the first sensible thing you've said all day

You should do it more often.

[unapatriciated]

126. thank you

I have pointed this out to this poster on numerous occasion in the past only to be mocked.
Spent years in california advocating for hcr and this poster makes fun of my real life experience.
The Insurance companies do not fear appeals it acts in their favor, keeping the monies on their side a little longer. They know when they have denied a claim that should have been paid and don't care.
I worked in the Industry in the late 80's and early 90's. I saw first hand how they would pay small claims that might be questionable but when it came to larger claims that I knew were covered they would deny and delay payments as long as they could.

[Phoebe Loosinhouse]

193. Which is why is it disgusting to me that we preserved the private delivery system

that made so many conscious decisions to deny treatment, bankupt people and destroy lives.

You know, I was just thinking that in the next election when we get to the public event/Town Hall phase, President Obama will be confronted with a lot of the same sad stories over healthcare as the last time. It is still unaffordable for many, nothing was done to drive down costs and he gave away the store to Pharma in exchange for very little.

I know, we're supposed to be grateful for the crumbs we got. I can't be grateful given the mandate he was given and how he and his brain trust squandered it.

[unapatriciated]

216. can't disagree

just asking op to stand up and fight for regulations that penalize the Insurance Cartel with $$$$ something they understand.
I do not think we will see such penalties and given my personal experience we will sadly see the same stories we saw in Sicko again and again for a long time to come.
That is why (if they insist on keeping them in the game) I will continue to advocate for regulations that actually penalize and hold them accountable.

Lou Reed pretty much says how I feel.
http://www.youtube.com/watch?v=ygNAnIG8g_E


btw I am by no means grateful for laws that California has had ( and not been able to enforce) for years become the new and improved Federal Regulations.

[quiet.american]

218. Why are billions for community health centers "crumbs" in your book?

Why is student loan forgiveness for those who choose to go into primary care medicine "crumbs" in your book?

Why is a path for states to convert to single-payer "crumbs" in your book?

Why is giving everyone in the country access to the same health insurance options/rates that government employees from maintenance people to Senators have, "crumbs" in your book?

They're not crumbs in mine.

HCR was supposed to reign in the worst practices of the health insurance industry and give more Americans access to care. It accomplishes that. It was never meant to be the "Abolish the Insurance Companies Act."

[Phoebe Loosinhouse]

222. We will face all the same issues in no time because they simply were not addressed.

There is no mechanism to drive prices down. That is just a fact. That was the whole role of the public option. Premium prices and the cost of care will continue to go up. They are as we speak.

Even AFTER healthcare reform, we will continue to pay the most compared to the other industrialized countries of the world who think we are quite literally insane for maintaining the wretched system we have in place.

Clinics are great, without a doubt. So is the expanded healthcare for children with PECs. But they are simply not enough. We put a bandaid on a compound fracture.

Let's talk about the high risk pools. Still too expensive and underfunded to boot - they will help only a fraction of the people who actually need the coverage. I'm not satisfied with that and neither should you be. That is actually the population that was most in need for reform - we left them high and dry.

But even with the exchanges and the subsidies, healthcare will still be too expensive for many individuals and families. I have seen the projected costs - they still amount to 17% to 20% of gross income once you add premiums, deductables and out of pockets. People say that is a false argument because not everyone will hit those heights because they won't max out on deductables and out-of pockets. OK. But what good is healthcare that is only affordable when you don't actually need it?

Age rating at 3:1 is acceptable in this reform.

The reform turned out to be Preserve the Status Quo Health Care Act. Sure there a few good things here and there, but NOT ENOUGH.

We will only get the fixes needed if the dissatisfied and still underserviced are such collossal pains in the buts that they keep the issue on the front burner. This is literally life and death we are talking here.

[quiet.american]

232. Most of the assumptions in your post are not correct.

I'll post a full rebuttal later this evening, if this thread doesn't manage to get itself locked.

[quiet.american]

263. Self-moved to proper reply point. nt

[quiet.american]

265. My full response to #222

PL: There is no mechanism to drive prices down. That is just a fact. That was the whole role of the public option. Premium prices and the cost of care will continue to go up. They are as we speak.

QA: An excellent breakdown of the cost-control mechanisms included in the ACA (Affordable Care Act) can be found here (not only is there “a” mechanism, there are several):

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jul/Health-Insurance-Exchanges-and-the-Affordable-Care-Act.aspx">The Commonwealth Fund
Overview: Health insurance exchanges are the centerpiece of the private health insurance reforms of the Patient Protection and Affordable Care Act of 2010 (ACA). If they function as planned, these exchanges will expand health insurance coverage, improve the quality of such coverage and perhaps of health care itself, and reduce costs. Previous attempts at creating health insurance exchanges, however, produced only mixed results. This report identifies the earlier attempts' problems, enumerates the key issues that are critical for overcoming those problems, analyzes in detail the ACA's provisions addressing these issues, and discusses further policy options.

Point-by-point dissection and evidence of mechanisms that are included in the Affordable Care Act at the link:
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jul/Health-Insurance-Exchanges-and-the-Affordable-Care-Act.aspx

Another analysis that includes graphs, section-by-section cost-containment in the Affordable Care Act, and assorted wonkery, including sourced material from the Congressional Budget Office:

http://www.americanprogress.org/issues/2010/06/pdf/cost_containment_hires.pdf"> Center for American Progress: Health reform’s path to lower cost, higher quality health care

And the piece de resistance - Jacob Hacker, "father of the public option" - It’s been fascinating to observe that those who claim to care most about the public option have chosen to wholly ignore what the “father of the public option” – Jacob Hacker – had to say about HCR - who, in Dec. '09 talked about the function of the public option, and how, in spite of his observation that JOSEPH LIEBERMAN, that’s right, JOSEPH LIEBERMAN (not Pres. Obama), was the main impediment to the inclusion of a public option in the Senate bill – how Hacker offered advice to Pres. Obama on how the aim of the public option could still be achieved by working to include certain provisions. Well, in the http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/affordability">President’s Proposal, that advice was taken and worked into the http://www.gpo.gov:80/fdsys/pkg/PLAW-111publ152/pdf/PLAW-111publ152.pdf">final bill, so that the ACA comes much, much closer to achieving the original aims of the public option as defined by the very person who "created" it (Jacob Hacker).

http://www.tnr.com/blog/the-treatment/why-i-still-believe-bill">Dec. 2009: Jacob Hacker - Why I Still Believe in This Bill

Excerpt: “I was devastated when it was killed at the hands of Senator Joe Lieberman, not least because of what it said about our democracy -- that a policy consistently supported by a strong majority of Americans could be brought down by a recalcitrant Senate minority.

It would therefore be tempting for me to side with Howard Dean and other progressive critics who say that health care reform should now be killed.

It would be tempting, but it would be wrong.

Excerpt: “To be sure, the bill also contains a requirement on individuals to have coverage, which has become the main target of criticism from the left. Without the public option, this mandate amounts to forcing people to buy private insurance without creating an affordable public alternative with which insurers must compete.

But the correct response to this critique is to make the requirement less necessary by providing greater assistance with the cost of premiums and by facilitating enrollment in the exchange--in other words, by making coverage more attractive and easier to obtain. http://www.gpo.gov:80/fdsys/pkg/PLAW-111publ152/pdf/PLAW-111publ152.pdf">(Done, pg 3.)

The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage. The most important way to do this is to move away from the Senate bill’s state exchanges and toward a national exchange such as that contained in the House bill. (Done - http://dpc.senate.gov/healthreformbill/healthbill65.pdf">"Ensuring Choice through a Multi-State Option. Provides a choice of coverage through a multi-State plan, available nationwide, and offered by private insurance carriers under the supervision of the Office of Personnel Management.) The federal government needs to be directly involved in implementing and enforcing strong national regulations of insurers and creating the new exchange. Otherwise, the effort for reform might fail at the hands of hostile governors.

The federal government is the only entity big enough and powerful enough to ensure a highly consolidated private insurance industry follows the law. It can and must demand transparency and obedience to the new rules. Insurers must open their books, and subject their rates, administrative costs, and profits to federal review. http://www.reuters.com/article/idUSTRE65O2QD20100625">(Done - for starters). These new rules must apply to all plans, not just those within the exchange. And states should have authority not only to enforce these rules, but to innovate beyond them as well. Done (see: Bernie Sanders inclusion of the $11 Billion, that’s “billion” for community health centers).

PL: Even AFTER healthcare reform, we will continue to pay the most compared to the other industrialized countries of the world who think we are quite literally insane for maintaining the wretched system we have in place.

QA: http://www.guardian.co.uk/commentisfree/2010/mar/23/united-states-healthcare-barack-obama">I daresay it is now ridiculous to keep insisting that HCR is not a HUGE change. There is a reason the passage of the bill is lauded as a major accomplishment that was unable to be attained by any President - before Obama - in our nation's history.)

PL: Clinics are great, without a doubt. So is the expanded healthcare for children with PECs. But they are simply not enough. We put a bandaid on a compound fracture.

QA: $11 Billion in community health centers created nationwide to which people can turn to, and pay for, their healthcare based on a sliding income scale, is a “bandaid?” Bernie Sanders, avowed Socialist, speaks for me on this:

http://sanders.senate.gov/newsroom/news/?id=1e837e36-e299-4638-a8dc-20109a960d71">“As important as health centers are for providing access to primary care for everyone, they also dramatically reduce costs by treating patients before they become so sick that they wind up in emergency rooms or hospitals,” Sanders said. “Expanding community health centers is a win, win, win,” he added. “It will provide a medical home for almost 20 million more Americans, cut down on emergency rooms visits and save taxpayers billions of dollars.”

PL: Let's talk about the high risk pools. Still too expensive and underfunded to boot - they will help only a fraction of the people who actually need the coverage. I'm not satisfied with that and neither should you be. That is actually the population that was most in need for reform - we left them high and dry.

QA: Closer to high and dry would be to say: sorry, there’s nothing we can do until this thing kicks in in 2014. Instead, there is a $5 Billion option; that’s the amount of federal funding included in the ACA. I ran the numbers for myself in my state (at Healthcare.gov) as though I were a person with pre-existing conditions with nowhere else to turn for health insurance. High risk pool premium: $400-600/month. Gasp. Expensive. Hell yes. Until I thought about all the stories I heard about leading up to the passage of HCR – a couple who could not get any health insurance at all due to a pre-existing condition in the family, who, when they finally did get insurance, discovered they had a $60,000 deductible – yes, you read that right – a $60,000 deductible. Might they be glad for the opportunity to have primary and specialty care, hospital care, and prescription drugs covered for $400-$600 a month – less than half what they were originally paying in premiums outside of the deductible. Yes. Maybe! The main thing I remember hearing from those with pre-existing conditions was that they were willing to pay for coverage, but summarily denied it from insurance companies, or charged something like a $60,000 deductible. I’d say they now have a better option.

PL: But even with the exchanges and the subsidies, healthcare will still be too expensive for many individuals and families. I have seen the projected costs - they still amount to 17% to 20% of gross income once you add premiums, deductables and out of pockets.

QA: I’d like to see the source for your assertion, because the tables I’ve seen from the final bill amount to closer to 10%-12% of income; there are mitigating factors where some co-pays and deductibles are eliminated, and the higher percentages apply mostly to individuals/family of four making over $43k/$88k a year.

PL: People say that is a false argument because not everyone will hit those heights because they won't max out on deductables and out-of pockets. OK. But what good is healthcare that is only affordable when you don't actually need it?

QA: I’m really not sure where that premise comes from. Medicaid, Medicare, employer-based coverage, Exchange-based coverage w/subsidies, TRICARE, VA, catastrophic-only coverage for those under 30; where does it come in where it’s so unaffordable that you can’t afford it when you need it? But more than that, how is it better to have defeated HCR and left things as they were so that you’re dropped from coverage when you need it; or based on the insurance industry scam of “pre-existing conditions,” you simply couldn’t get it at any price? I'd also like to add here that I read the half-hearted single-payer bill that was put up -- I would like to know how Kucinich et al. planned to rally support for laid-off insurance company executives (due to single-payer being enacted) who would have been eligible to sit on their duffs for 2 years collecting up to $100k of taxpayer money for doing absolutely nothing? Yes, that's in there.

PL: Age rating at 3:1 is acceptable in this reform.

QA: And what was it before that? - The sky’s the limit.

PL: The reform turned out to be Preserve the Status Quo Health Care Act. Sure there a few good things here and there, but NOT ENOUGH.

QA: I’m going to post here a tiny fraction of what you call “not enough.” And I’ll also state here that I paid attention when our Democrats said repeatedly, “this bill is a foundation; a beginning to build upon, not the end. This bill will be built upon.” You've no doubt heard it many times - Social Security was actually quite horrid when it was passed - no relief for women or minorities or widows and orphans - but am I glad it was passed and that it was expanded. Hell yes!

THANK YOU DEMOCRATS!:

SMALL BUSINESS TAX CREDITS—Offers tax credits of up to 35 percent of employer premium contributions for those small businesses that choose to offer coverage. Effective beginning for calendar year 2010. (Beginning in 2014, offers credits of up to 50 percent of employer premium contributions, for up to 2 years.)

BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to those Medicare beneficiaries who hit the donut hole in 2010. Beginning in January 2011, there is a 50% discount on prescription drugs in the donut hole. (Also completely closes the donut hole by 2020.)

FREE PREVENTIVE CARE UNDER MEDICARE—Eliminates co‐payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective on January 1, 2011.

HELP FOR EARLY RETIREES—Creates a temporary re‐insurance program (until the Exchanges are available) for employer health plans providing coverage for early retirees, helping to protect coverage while reducing premiums for employers and these early retirees age 55-64. Effective on June 21, 2010.

NO DISCRIMINATON AGAINST CHILDREN WITH PRE‐EXISTING CONDITIONS—Prohibits all employer plans and new plans in the individual market from denying coverage to children with pre‐existing conditions. Effective for plan years beginning on or after September 23, 2010.

NO RESCISSIONS—Bans all health plans from dropping people from coverage when they get sick. Effective for plan years beginning on or after September 23, 2010.

NO LIFETIME LIMITS ON COVERAGE—Prohibits all health plans from placing lifetime caps on coverage. Effective for plan years beginning on or after September 23, 2010.

TIGHTLY REGULATES ANNUAL LIMITS ON COVERAGE—Tightly restricts the use of annual limits by all employer plans and new plans in the individual market, to ensure access to needed care. Effective for plan years beginning on or after September 23, 2010.

FREE PREVENTIVE CARE UNDER NEW PLANS—Requires new private plans to cover preventive services with no co‐payments and with preventive services being exempt from deductibles. Effective for plan years beginning on or after September 23, 2010.

NEW, INDEPENDENT APPEALS PROCESS FOR NEW PLANS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions. Effective for plan years beginning on or after September 23, 2010.

MORE FOR YOUR PREMIUM DOLLAR—Requires all health plans to put more of your premiums into your care, and less into profits, CEO pay, etc. This medical loss ratio requires plans in the individual market to spend 80 percent of premiums on medical services, and plans in the large group market to spend 85 percent. Insurers that don’t meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.

NO DISCRIMINATION BASED ON SALARY—Prohibits new employer health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective for plan years beginning on or after September 23, 2010.

FOR THOSE UNINSURED IMMEDIATE HELP FOR THE UNINSURED WITH PRE‐EXISTING CONDITIONS (INTERIM HIGH‐RISK POOL)— Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition ‐ through a temporary high‐risk pool – until the Exchanges are up and running in 2014. Effective on July 1, 2010.

EXTENDING COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE – Requires plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective for plan years beginning on or after September 23, 2010.

COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly doubling the number of patients served over the next 5 years. Effective beginning in fiscal year 2011.

MORE PRIMARY CARE PRACTITIONERS—Provides new investments to increase the number of primary care practitioners, including doctors and nurses. Effective beginning in fiscal year 2011.

HEALTH INSURANCE CONSUMER ASSISTANCE—Provides aid to states to establish offices of health insurance consumer assistance to help consumers file complaints and appeals. Effective beginning in fiscal year 2010.

CREATES NEW, VOLUNTARY, PUBLIC LONG‐TERM CARE INSURANCE PROGRAM—Creates a long‐term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. Effective on January 1, 2011.

HOLDS INSURANCE COMPANIES ACCOUNTABLE FOR UNREASONABLE RATE HIKES—Creates a grant program to support states in requiring health insurance companies to submit justification for requested premium increases. Effective beginning in fiscal year 2010.

MORE REFORMS THAT BEGIN IN 2014 (WHEN EXCHANGES HAVE FORMED)

NO DISCRIMINATION AGAINST ADULTS WITH PRE‐EXISTING CONDITIONS

BAN ON HIGHER PREMIUMS FOR WOMEN

PREMIUMS BASED ON AGE CAN ONLY VARY BY A MAXIMUM OF 3‐TO‐1 RATIO

CAP ON OUT‐OF‐POCKET EXPENSES for private health plans

PL: We will only get the fixes needed if the dissatisfied and still underserviced are such collossal pains in the butts that they keep the issue on the front burner. This is literally life and death we are talking here.

QA: I’ll just say this - if those on this board who share your views had had your way - with the constant advocacy during HCR to defeat the bill because it wasn't single-payer - many who are benefiting now/stand to benefit would absolutely be trapped in the former status quo – e.g., Kucinich considered voting "no" up to the eleventh hour – a “no” vote would have had the real world effect of allowing insurance companies to continue to be free as a bird with their abuses. How would that have been better? Yet now, it’s “oh, we have to hold their feet to the fire.” That’s really unbelievable given the TOTAL LACK OF SUPPRORT for the HARD-FOUGHT FIGHT to GET THIS LEGISLATION PASSED IN SPITE OF REPUBLICAN/BLUE DOG/CONSERVADEM/SINGLE-PAYER-OVER-ALL opposition. /end short rant

EOM

[Phoebe Loosinhouse]

272. My response

My objection to healthcare reform has always been, plain and simple - AFFORDABILITY. This is a word that the Congress and Senate simply cannot fathom. They have no idea of the world the average American, earning the average salary lives in.

Lets go to the Kaiser Family Health Subsidy calculator for healthcare so you can see what I am talking about. Remember that the median income in the US is approx 52,000. I plugged in for the calculation a family of 4, primary policy holder 45, income 52,000
area cost factor medium
http://healthreform.kff.org/SubsidyCalculator.aspx

Results
Note: Subsidies are only available for people purchasing coverage on their own in the Exchange (not through an employer). All individuals and families with incomes at or below 133% of the federal poverty level will be eligible for Medicaid. Others with higher incomes may also be eligible, depending on rules that vary by state.

Projected income in 2014
222% of poverty

52,000

Unsubsidized health insurance premium in 2014 adjusted for age
(Based on an age factor relative to a 40 year-old of: 1.17)

14,245

Maximum % of income the person/family has to pay for the premium if eligable for a subsidy
Actual person/family required premium payment
(which equals 7.07% of income and covers 26% of the overall premium)
3,676

Government tax credit
(which covers 74% of the overall premium)

10,569

Out-of-Pocket Costs
The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium) is $6,250. Whether a person or family reaches this maximum level will depend on the amount of health care services they use. Currently, about one in four people use no health care services in any given year.

The guaranteed plan for the person/family will have an actuarial value of 73%. This means that for all enrollees in a typical population, the plan will pay for 73% of expenses in total for covered benefits, with enrollees responsible for the rest. Specific provisions like deductibles and copayments may vary from plan to plan, and out-of-pocket costs for any given individual or family will depend on their health care expenses. Preventive services will be covered with no cost sharing required.

Points to ponder

family of 4, average income of 52, buying insurance on the exchange because they don't have employer provided. Let's assume they have a sick family member and actually have to use (gasp!) the insurance
Simple arithmetic

3,676 for premium + 6,250 max out of pocket = 9926= 19% of gross income

We are not even addressing the 27% of the medical costs they are still responsible for with a coverage actuarial of 73%. Remember that in SICKO, everyone going bankrupt HAD insurance.

This family would have gone bankrupt before healthcare reform and they will go bankrupt after healthcare reform. I don't care how many CBO graphs or Commonwealth articles you show me.

Here is some further reading from the California Nurses Association:

http://www.guaranteedhealthcare.org/blog/john-geyman-md-pnhp/2010/07/08/hijacked%E2%80%94stolen-health-care-reform-why-health-care-costs-will-no

HIJACKED—STOLEN HEALTH CARE REFORM: WHY HEALTH CARE COSTS WILL NOT BE CONTAINED
Posted by John Geyman MD PNHP on July 8, 2010 - 12:51pm

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CONTINUED UNRESTRAINED DRIVERS OF HEALTH CARE COSTS
These are some of the many reasons that we can already conclude that health care costs will continue to run out of control at rates far exceeding the costs of living and median household incomes.

• No price controls. Wall Street has already factored in rapid expansion of
markets for drugs, medical devices and other services in a system of expanded
access. There is also a long line forming of providers of information technology
and administrative services that will exploit the complex implementation of this
law.


• No bulk purchasing. The PPACA has prohibited the government from
negotiating the prices of prescription drugs and retains a ban on importation of
drugs from Canada and other countries.


• Lack of control over perverse incentives that drive increased volume of
services. These in turn are driven by retention of fee-for-service (FFS)
reimbursement that encourages physicians and other providers to offer more
services than are medically appropriate or necessary.


• No effective mechanism to rein in marginal or ineffective technologies. Coverage policies for new drugs and medical devices are still lax and not subject to rigorous evidence-based criteria for either efficacy or cost-effectiveness.
Although the PPACA does call for a Patient-Centered Outcomes Research Institute, its role is already neutered by not having the power to mandate or even endorse coverage or reimbursement rules for any particular treatment. (2) (Kaiser Health News staff. True or false: Seven concerns about the new health law, March 31, 2010)

• The dominant business model of health care prevails, with many facilities and
services remaining for-profit and investor-owned and with an ongoing trend for
increasing consolidation within industries.


• The PPACA has grandfathered-in specialty hospitals, typically physician-
owned facilities that focus on well-reimbursed procedures in such areas as
cardiology and orthopedics, whereby physicians can “triple dip”, earning high
incomes as providers, owners and investors.

• More preventive services will further fuel health care inflation. While the
PPACA does provide new coverage for many preventive services, this will lead to
increased costs due to additional diagnostic and treatment services engendered.
(3) (Russell, L. Preventing chronic disease: An important investment, but don’t
count on cost savings. Health Affairs 28 (1): 42-5, 2009)


• Private insurers can’t contain health care costs, even where they have
dominant market power. A 2009 report by the Congressional Research Service,
The Market Structure of the Health Insurance Industry, concludes that “The
exercise of market power by firms in concentrated markets generally leads to
higher prices and reduced output—high premiums and limited access to health
insurance—combined with high profits.” (4) (Austin, DA, Hungerford, TL. The
Market Structure of the Health Insurance Industry. Washington, D.C.
Congressional Research Service, November 17, 2009)


• There are no controls over premium rate increases by insurers. Despite the
outcry by government officials, annual premium rates are escalating at rates up to
56 percent (5) (Johnson, A. Fight over health-care premiums heats up. Wall Street
Journal, February 19, 2010: A6), and there is no end in sight for continued
exorbitant rate increases. Insurers will continue to game the system by extracting
maximal profits and offering reduced coverage with actuarial values (the amounts
insurers actually pay in coverage) as low as 60 or 70 percent.

• National health care spending will grow unabated despite the passage of
PPACA. The Centers for Medicare and Medicaid Services (CMS) projects that
overall national health expenditures (NHE) will increase from its present 17
percent of GDP to 21 percent in 2019, a total of $4.470 trillion. (6) (Foster, RS.
Office of the Actuary. Estimated financial effects of the “Patient Protection and
Affordable Care Act,” as Amended. Centers for Medicare and Medicaid Services,
April 22, 2010)

These well-documented trends leave no room to think that health care “reform” will have any chance to contain health care costs. Instead, health care inflation will be exacerbated by all the new incentives and inefficiencies in the new “system”.

When I talked about what the rest of the world has for healthcare and their perception of us, you posted a link to an editorial from the Guardian which congratulated President Obama on his POLITICAL VICTORY, the substance had nothing to do with the quality of the bill passed.

Here is just a little reminder of the kind of healthcare available in the parts of the world where they are not so driven to preserve the private delivery system.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=5736222

Charts, graphs, grey boxes, self-congratulatory pats on the back for a political victory all leave me cold. What I wanted AND STILL WANT is AFFORDABLE HEALTHCARE FOR EVERY SINGLE AMERICAN whether they are young, old, sick, or well.

[quiet.american]

295. It's truly interesting how differently we see the kff.org calculator results.

You see something worthy of contempt and scorn, and something that is useless to anyone, anywhere.

I see a family of four that would have had to pay $14,245 a year for their health insurance on their own.

Instead, the government subsidy will now cover 74% of the premium for them, so that annually, this family of four has gone from looking at a monthly payment of $1,187.08 (14,245/12) to a monthly payment of $306.33 (3676/12). For a family of four. Even as a single person, I couldn't even get anything near $300/month before HCR.

Let's say that there is a very ill family member - without healthcare reform, this family would be looking at possible bankruptcy, possibly having to sell their home, perhaps both parents having to work multiple jobs just to try to keep up - and they probably still would not be able to afford the medical costs. With healthcare reform, yes, there may be a struggle to come up with $6,000 - but that is a lifeline, whereas before, there was absolutely none. Plus, that sick family member cannot be dropped from coverage, as well as other protections that will kick in.

That release from the California Nurses Association is filled with misstatements - and quite frankly, the hyperbolic, vitriolic tone of it makes me hope I'm never in need of their services if I ever get to LA again.

The most pointed difference between the way you look at this, and the way I look at this is, I don't think that Democrats who fought to reduce insurance costs for most in this country deserve scorn because they didn't deliver a bill on the first attempt that turns us into Canada. We're not Canada. Our politics is not Canadian politics. The votes for single-payer were not there in the House and Senate. That's the the simple truth. And quite frankly, the single-payer bill that was submitted comes across as a half-hearted attempt that was created just for the sake of saying, "well, we did put forth a single-payer bill."

I say "thank you" to the Democratic leadership for this bill. Because what I see is the real world effect of a family of four paying less than one-third of an annual premium cost, with the government paying the rest. Yes, that's a good thing in my book. I wish someone would show up at my door and offer to pay 74% of my rent! I'd take it! But since that's not going to happen, I'll gladly take the government subsidy to help with health insurance (if I still need the subsidy by 2013).

And actually, the Guardian article does talk about what a major change for this country the bill is, aside from Pres. Obama's "POLITICAL VICTORY."

I'll leave it at this - single-payer advocates in the House and Senate failed, yes, failed to gather the support needed for single-payer legislation to successfully pass - although extreme kudos to Sanders for mapping out a way for single-payer to eventually begin state-by-state.

I'm proud that Democrats, including those who championed single-payer, didn't throw up their hands and say, well, that's that. They kept fighting. I'm not going to view that as something worthy of scorn. I'm just not.

I view HCR as providing much needed help. And I also feel the very results you posted from the Kaiser calculator bear me out on that.

[treestar]

286. So there should be no rule of law?

All such processes take time. It should not hold up the treatment, just the issue of who pays.

[dflprincess]

119. And how long will the appeal take and who pays your provider

while you're waiting for the appeal to be settled? For that matter - who pays for the 3rd party appeal? The article says that three federal agencies issued regulations, but there is nothing about who you take your appeal to. For all we know, you may need to hire someone to help you with it. (Though I wee that $30 million is being spent to help fund state offices that will help you pick which gang of thieves you want to send your premium payments to.)

from the OP:

According to Robert Zirkelbach, press secretary for America's Health Insurance Plans, "Health plans have a long track record of supporting third-party review to give patients greater peace of mind about their health care coverage."

We support the National Association of Insurance Commissioners external review model," Zirkelbach said, "and we are currently reviewing the new regulations to see how they compare to existing state programs.”

You don't really believe this guy, do you? His job is to lie for the insurance companies and they are the ones who will be controlling this show - just like they do now.

[Beetwasher]

124. Umm, That's Their Response To New Federal Regs

I don't have to believe him, he doesn't speak for the Feds. He is NOW subject to FEDERAL regulations.

[dflprincess]

127. The insurance companies have long been the subjects of all sorts of state and federal regulations

a few more won't phase them. Especially if they're enforced as well as work safety laws. They will do what they've always done, make the appeals process so unpleasant most people will give up - if they even bother to try at all.

You can keep trying to spin this scam as a positive but as long as the same old crooks are in charge of our access to care and are allowed to overrule the treating provider, nothing is going to change.

[Beetwasher]

128. Really???? They've Been Subject To Federal Regulation Regarding Coverage Denials????

Please provide evidence of this. Thanks.

So, might as well get rid of laws against murder since some people get away with it despite the law. That's your logic at work.

[dflprincess]

133. Nothing in the links you posted have anything to do with

the crooks facing any penalties for not covering claims.

All the article talks about is people being able to appeal to a third party. What this all does seem to prove is that it is possible to fool some of the people all of the time.

[Beetwasher]

145. For Starters They Will Not Be Qualified For The Exchanges

And the regs are still being written.

[dflprincess]

176. Nothing says they will not be eligible for the exchanges if they fail to pay claims.

All they have to do to be eligible is OFFER "coverage" of certain services but nothing says they can't find a way to weasel out of paying for those services - just like they do now - including those services that are currently supposed to be covered because of state or federal mandates.

Obama use to tell us needed a public option to "keep them honest" so once upon a even he admited they were crooked. But there is no public option, so there is nothing to keep them honest - unless you're naive enough to think these regulations will work better than the ones that are suppose to keep mines safe.

[Beetwasher]

179. They Have To Meet The Requirements To Be Eligible

If they don't meet the requirements which are being written by Kathleen Sebelius' DHHS, they cannot be on the exchanges. It's not hard to understand except for people who don't want to understand it.

[dflprincess]

195. Show me where there is a requirement that they pay claims any more honestly than they do now

You can't - it's not there. They will play the same games with this scam that they play now and they will get by with it, just like they do now.

There is nothing in the Insurance Company Profit & Campaign Donation Protection Act to "keep them honest" like we were told there had to be and there is nothing in the bill that says we will actually be able to access care when we need to.

[Beetwasher]

198. It's Called Oversight

Now Federal for the first time.

[Mimosa]

294. Exactly right. Sick people aren't great at fighting the insurance bullies.

Who'll pay to help them appeal? What if a person is too ill to FIGHT?

Dammit, why must we have to fight and still not get what Europeans take for granted: some peace of mind about basic health care and assurance that an illness will not destroy their security.

[bvar22]

130. OK. So the enforcement of the "regulations"...

...STILL falls on the shoulders of the sick and injured individual "consumer" who must initiate a complaint against a huge corporation with thousands of lawyers on the payroll who specialize in stringing out these actions for years.

This sounds like it will be difficult to do from a hospital bed, especially when the hospital is demanding immediate payment.

You are right.
BFD.

[Beetwasher]

132. No, It Falls On The FEDERAL Gov't And DHHS and Treasury And Labor

As the article states.

[bvar22]

138. From YOUR OP.

"the right to appeal decisions made by a health plan to an outside, independent decision-maker,"

The right to appeal decisions.
This changes little.
The responsibility for initiating enforcement rests squarely on the shoulders of the individual consumer who must have the resources and the opportunity to initiate the appeal.

There ARE better ways to "regulate".
The most effective is well funded WatchDog Agency armed with sharp teeth.
That takes the responsibility OFF the back of the sick human being lying in a hospital bed.

[Beetwasher]

147. Umm, How Else Would They Know Claims Are Being Denied Unless They Are Told???

You want to enforce by mind reading? :rofl:

How would this "watch dog agency" going to know about denials unless, umm, people tell them. :eyes:

There is a "watchdog" they are called DHHS, Labor and Treasury which are now responsible for oversight. Duh.

[dflprincess]

180. There is nothing in the article that say DHHS or any other agency will be mediating appeals.

You're letting your imagination run away with you.

[Beetwasher]

185. They Are Responsible For OVERSIGHT

And are setting up the independant agency for the appeals process.

They write the regs and conduct oversight, part of which is the setting up the independent appeals process.

[phleshdef]

189. Actually it says that DHHS will be helping states establish Consumer Assistance offices.

And they will be using funding from the consumer assistance program to make that all happen. That pretty much puts DHHS square in the middle of the big picture aspects of it.

[dflprincess]

192. It says the consumer assistance program will be there to help

people decide which of the same old, shoddy products being offered in an exchange is best for that individual. It says nothing about helping people get their claims paid.

[phleshdef]

200. No it clearly states that the CAP will help "appeal decisions by plans to deny cov."

"In addition to the new regulations issued Thursday, the administration announced $30 million in grants from the Consumer Assistance Program to help states and territories establish consumer assistance offices or strengthen existing ones.


According to HHS Secretary Kathleen Sebelius, the new funds will be used to provide consumers with the information they need to pick from a range of coverage options that best meets their needs, appeal decisions by plans to deny coverage of needed services, and select an available primary care provider of their choosing."

You can try to downplay it all you want. Thats not going to stop people from getting help.

[dflprincess]

203. You are correct, I did misread that line

but I still don't expect that any of this will be enforced any better than any safety or other regulations designed to protect the serfs. How well they are enforced will depend on how much money the government puts into enforcement, what state a person lives in and how much importance they'll put on you getting your claim paid. (Hint: not much)

How long do you think it will take to get anything resolved?

And the question still remains, who pays the doctor while you're fighting your way through the bueraucracy? And should a person who is dealing with a serious illness have to deal with worrying about paying the bill (as well as the premium and out of pockets). Once upon a time Obama didn't think that was right because he rememberd how his ailing mother had to fight with the insurance companies.

Nothing here is going to change scenarios like that and fighting with the outfit that supposed to working on your appeal is not going to be any easier than fighting with the insurance company.

We remain the only industrialized country that allows a for profit middle man to control our access to care. The bill was a gift to the insurance industry (and credit card companies as we continue to pay for health care with credit) and the administration can put out these happy little announcements, but it has a record of actions that fall short of its words.

[phleshdef]

205. If I felt like you did, I wouldn't think we should to bother to do anything, ever.

[dflprincess]

209. I supported reform

not digging the same old crooks in deeper.

There was no point in passing a bill that's main point was to protect the status quo. Rahm has been bragging about how they "protected the private delivery system" and that tells us all we need to know about who will benefit from this. I hope whatever they got for selling us out was worth it.

[Beetwasher]

210. And Federal Oversight And Regulation For The FIRST TIME IN HISTORY Is Somehow The Very Definition Of

"Status Quo". In bizzaro world.

[jpak]

158. BFD indeed - another epic Obama FAIL

*NOT*

:hi:

[Bluebear]

163. THANK GOD IT PASSED!!1

[Warren DeMontague]

194. BWAAAAAK!

[Foo Fighter]

289. Aw, shit.

Ya had to do it.

:rofl:

Good on you!

[MadHound]

188. Yet nothing in that suggests that there is any sort of price control,

And for good reason, there isn't any. Under HCR, with a mandated monopoly, the insurance industry can continue to jack up the rates and drain folks in the middle and working classes dry.

[Beetwasher]

190. Well, Since This Is Regulation About Claim Denials, Not Price Control

It's no wonder there's nothing in these regs about price control. :eyes:

[laughingliberal]

211. Four things which could beef this up into some real help:

1) Impose a deadline on the insurance company for their 'review.'

Often the insurance company expects they will, eventually, have to pay the claim but delaying the day they have to let go of the money is a goal. One, they get to maintain the use of the money for longer. Two, it increases the chance of the patient dying while they drag it out and gets them off the hook for good.

2) Automatic appeal for all claims denied.

Another of their tricks is to wear people down hoping they'll give up. Require the insurance company to submit every denial to the feds for appeal.

3)Denials found to be without merit carry a significant fine.

I'd say a fine equal to the amount of the claim would be in order.

4) Insurance companies found to be engaged in a pattern of abuse are fined at a higher rate.

Once a certain percentage of claims denials are found to be unwarranted, their fine goes up for the rest of the year.

That oughta do it.

[Beetwasher]

213. Those Are Good

And I wouldn't be surprised to see these ideas (or similar) in further regulations when they become available.

Remember, we're getting these regs peicemeal as they become available and are completed. There's a lot more coming.

[Cha]

233. Exactly..this isn't the ending point..it's only the

beginning.. the Dems & President Obama knew this..why even Dennis helped out.

[Beetwasher]

240. These Types Of Regulations Are CONSTANTLY Being Revised And Updated

Updated, clarified etc. That's what CFR's and OMB Circulars are for (fun fun fun!)!

[bvar22]

244. The MMS is an OVERSIGHT regulatory agency....

...and we all know how THAT worked out with BP.
The agency contained in the HIR is not even an oversight agency, but merely a 3rd party appeals vehicle.

"Without a Public Option, there is no reform."

[Beetwasher]

255. Well Then! Let's Scrap Them All And Not Even Try, Right?

FEMA, FDA, EPA etc. Just scrap 'em because next time a Repub is in office he'll fuck 'em up, so why bother?

[Cha]

225. Here's another fraud perpetrated by insurance co that the FEDS

can help with some of that regulating.

"Fallen Soldiers' Families Denied Cash as Insurers Profit"

http://www.bloomberg.com/news/2010-07-28/fallen-soldiers-families-denied-cash-payout-as-life-insurers-boost-profit.html

[unapatriciated]

229. and you want to trust these guys with our health care?

been there done that didn't work out very well. You can not regulate if there is no clear cut $$$ penalties for bad acts.
So join me in writing, calling, e-mailing and faxing your reps asking that they include monetary penalties that will insure that they comply with the new Federal Regulations.
California has the same regulations and it still took years in the court system to bring them into compliance.

[midnight]

235. I wonder how long a critically ill patient has to wind through

that process. Each length of the pathway is filled with triggered questions designed by both health care professionals and attorneys to keep one in the appeals process. The devil is in the details.

[Number23]

237. Wow. This is great news. I like the idea of an independent third party decision-maker

Happy to rec!

[unapatriciated]

238. it's not that much fun when your child is critically ill....

and you have to go through this two or three times a year, while your scrambling to find the money to pay for treatment and meds during the process.
I would be jumping for joy if they had included monetary penalties in regards to the companies who continue to deny claims in bad faith. Too bad our Federal Regulations are not stronger than what California enacted in the early 90's.
Without monetary penalties there is no real incentive to comply with regulations. California learned this the hard way. At least the six states who didn't have these regulations now do.

[lonestarnot]

256. Woooodamnfuckingwhoooo! Big Deal! Thanks! K & R!

[SunsetDreams]

264. K&R!

[eridani]

267. And if you die while the appeals process is going on, then what?

The insurance companies are hoping that you do, which is why they'll stall the appeals process as long as they can.

[Beetwasher]

271. You're Right, Let's Do Nothing

And just leave things as they r. That's working so well.

[unapatriciated]

273. so start calling your Reps. demand real penalties that hurt their pocket book

or maybe another late night chat with Kathleen

[Beetwasher]

277. Bossy Bossy!

Can I finish my breakfast first?

[eridani]

288. Let's have single payer. Or alternatively--

--private insurance regulated the way it is in the Netherlands and France, where the government flat out dictates that this kind of bullshit doesn't happen.