Health Care Law Allows Insurance Companies to Choose Who Examines Their Disputed Decisions

[The Straight Story]

Fine Print in Health Care Law Allows Insurance Companies to Choose Who Examines Their Disputed Decisions

Consumer advocates are complaining about a provision in the federal healthcare reform law that was supposed to give patients more power in disputes with insurance companies.

With insurers often refusing to pay for certain medical services, the legislation was drafted to include external reviews so patients had a way to appeal denials in coverage. But in implementing the mammoth new law, the Department of Health and Human Services has created regulations that allow insurance companies to choose the external reviewer—which makes the provision decidedly more business friendly, consumer watchdogs say.

“Advocates who have dealt with the external review process believe that it’s pretty clear that if is being chosen by an employer (or insurer) it’s not independent,” Timothy Jost, a professor at Washington and Lee University School of Law, told Kaiser Health News.

Siding with insurers rather than patients, the Obama administration also changed the rules to prevent patients from appealing contractual disputes, such as a particular service or medication is covered in a policy.

http://www.allgov.com/Controversies/ViewNews/Fine_Print_in_Health_Care_Law_Allows_Insurance_Companies_to_Choose_Who_Examines_Their_Disputed_Decisions_110912

[msongs]

1. changed the rules to side with corporations? no surprise here lol nt

[Autumn]

2. Insurance Finance Reform is what we got

And that protects the insurances companies finances.

[Supersedeas]

6. the bean counters do not want anyone humanizing the human beans

[bvar22]

3. Wierd double post.

?

[bvar22]

4. Of Course it does.

That 2,200 page Comprehensive Monstrosity was written by the Lawyers & Lobbyists of the Health Insurance Industry.
You can be sure that it is Chock Full of
*Trap Doors,

*Escape Hatches,

*Loopholes,

*Weasel Leagalese,

*and Hidey Holes.

After all, it is "A Uniquely American Solution" that forces Americans to settle for Far LESS
than every other Civilized Nation takes for granted.
The will be NO "Fixing it Later."
There is nothing to FIX.
This "reform" establishes For Profit Health Insurance Corporations as the sole Gateway to Health Care,
and even MANDATES Profits for the corporations who:
*Manufacture NOTHING
*Provide NO Service
*Produce NO wealth (Value Added).

This "reform" will have to be undone before we can have something better.
America will be forced to LIVE with this "historic reform" for a long time.

In 2014, when the MANDATE kicks in, there WILL be a Perfect Storm of outrage
as MILLIONS (40 - 70?) of already struggling Americans in the Working Class will be FORCED to BUY
Junk Insurance that they can't afford to used due to High Co-Pays/Deductibles.
Even with subsides, many of these American will be forced to write a FAT check every year for a worthless "product".
Adding the ultimate insult to the injury, the IRS will be the de-facto Enforcer/Collection Agency for the Insurance Corporations!

They WILL blame the Democrats, and rightly so.
The "Democrats" passed a Republican Insurance SCAM
without forcing the Republicans to take ANY responsibility.
All the Republicans have to do now is sit back and say, "YEP. We voted against it."
Democrats will be unelectable for a generation.

Good Luck trying to tell American how BAD it would have been without the "Historic Reform".
THAT won't sell in Peoria, or anywhere else.


You will know them by their WORKS,
not by their excuses.

Solidarity!
--------------------------------------------------------------------------------------------------------------------------------

[area51]

11. +1 n/t

[Agony]

14. K & R nt

[Safetykitten]

5. And?

[Fumesucker]

7. It's a good thing to reduce oversight of insurance companies..

It will lead to more efficiency in the marketplace and increasing stockholder value if insurance companies can pick the entity that arbitrates cases brought against them.

What's not to love?

[Safetykitten]

8. I love everything about our HCR! It's fabulous. It's a spectacular achievement.

I for one cannot say anything bad about our soon to come 2014 HCR new world. It's a paradise waiting!

[dflprincess]

9. Truly, it will make us the envy of all those unlucky enough to live in countries

that provide citizens with actual access to health care.

[eridani]

10. In other countries with universal health care and private insurance--

--claims denial is flat out ILLEGAL.

[stillwaiting]

15. Those countries clearly do not value FREEDOM the way we do!

*Freedom for the investor class to profit on the needless deaths of its citizens that is.

[Scuba]

12. A monstrosity designed to prove that government can't do healthcare. n/t

[Selatius]

13. Are any of you actually surprised this aspect happened? The bill was written by lobbyists.

The biggest tell that it was written by lobbyists is that the version that passed excluded a robust Public Option. Too many senators on the corporate dole, and the result is a half-hearted attempt at reform.

Sure, you can't exclude people based on pre-existing conditions anymore, and you are not allowed to discriminate against this class of people, but you are still free to discriminate on the premium rates with respect to age, so people are still going to be squeezed, and you're going to have people who make too much money for government help but not enough money that they actually can afford to use their own fucking policies.

[Yo_Mama]

16. And you will also be free to deny coverage

Frankly, it is an insurance co's wet dream. Pass a law requiring the public to buy your product, and also get regs THAT ACTUALLY WEAKEN MANY STATE PROTECTIONS and which will allow you to arbitrarily deny their coverage requests.

Who could ask for more? As this has unfolded, it has more and more turned into the Times Square of the insurance industry. Unfortunately, it is the old and sick who are going to have their asses pimped out.

[midnight]

17. Why would Obama change the rules to favor the corporations?

What ever happened to Consumer protectionism?

[woo me with science]

18. "Siding with insurers rather than patients, the Obama administration changed the rules..."

Of course they did.

[ThomCat]

19. We were all told to support that imperfect mess because it was

a "first step," and the Obama administration was going to keep following up with improvements as time went on. But all we have seen since then is that Obama's administration has allowed that mess to get worse as time goes on.

Insurance companies have been allowed to raise their rates astronomically in preparation for any regulations that limit how quickly they can increase their rates in the future.

Insurance companies have been allowed to stop covering entire classes of people in entire states because they don't feel they'll make enough profit.

Insurance companies have been allowed to change all the policies they offer so that they provide less coverage, and include higher co-pays, and higher co-insurance fees, for higher premium costs. The result is the lowest cost insurance plans don't pay for anything more than an annual physical, and you're paying hundreds of dollars a month to get that one annual physical. Even the very expensive plans can easily drive you into bankruptcy if you ever actually need to use them because you need surgery or become disabled and need regular care.

And now rules for the escalation of disputes takes those escalations out of impartial hands and puts them into the hands of whomever the insurance company chooses. This means that the insurance companies can always choose someone that they know will rule in their favor, shutting out any chance that patients will ever get fair decisions.

THIS is the supposed Grand Victory that Obama won for all of us that proves his progressive credentials. x(

[Wind Dancer]

20. Why am I not surprised?

This is a never ending nightmare. :grr:

[Hoyt]

21. I'm for concern, but external review is better than what most have now. Even Medicare limits drugs

and services.

Now, if an external reviewer profits from their decision, that's different.