The Baucus bill creates a new ombudsman office that will “act as a consumer advocate.” This is a good idea. The problem is that Baucus makes the new ombudsman’s office nearly worthless by dramatically restricting individual ability to seek help with their insurance companies. According to Baucus’s mark:
Policyholders whose health insurers have rejected claims and who have exhausted internal appeals would be able to access the ombudsman office for assistance.”
This is a huge loophole just begging to be abused. You will be forbidden to get help until you have exhausted all internal appeals. This will create a strong finance incentive for insurance companies to make the appeal process a long painful bureaucratic nightmare. The more complex and time consuming the appeal process, the better for the insurance company because it would deny the patient access to professional consumer advocate assistance.
In effect this will replace the problems of “rescission” and “pre-existing condition” with the new problem of “death delay.” The hope is that the patient (who would normally be very sick or dealing with a severe medical issue) will either give up in frustration or die before the many complicated internal appeals are exhausted.
Fortunately, Senator Jeff Bingaman (D-NM) and Senator Bob Menendez (D-NJ) have offered different amendments to help improve the problem by allowing individuals to seek help from the ombudsman’s office before exhausting internal appeals.
Menendez C#7 is the better of the two amendments and is described as:
Allow policyholders to access the ombudsman for assistance in pursuing internal appeals with their health plans.
Bingaman C#5 is weaker but would be a much needed improvement. It is described as:
This amendment would authorize a policy holder to access ombudsman services: (1) if their internal appeal lasts more than three months or (2) if their appeal involves a life threatening issue.
All the consumer protections in the world are worthless unless there is a strong regulator and consumer advocate to enforce them. As it is currently written the ombudsman’s office is a massive gift to the for-profit insurance companies and would encourage bad behavior.
Of course, if Baucus’s bill gave people the option of buying a non-profit insurance plan overseen by the government (a public option), they would not need to worry about protecting themselves from a for-profit insurance industry which makes money by denying people’s claims.
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This is an appeal shield, courtesy of the Senate, to block consumers from having any recourse from medical insurance fraud and abuse.
No that’s what I call, “REform!”
Sounds like another potential revolving door for insurance vultures.
With the insurance companies of today that would be “infernal and eternal appeals.”
The appeals process is where the insurance companies have made a lot of their profit in past years. They are experts at it; they make it long enough, people die. As someone quite experienced in dealing with insurance companies’ appeals process, I can assure you that they are very well fine-tuned to the insurance companies’ advantage already. MaxTax will only permit their enhancement.
A proper ombudsman agency would REPLACE the insurance appeals process, so that denial of claims would immediately be taken out of the companies’ hands and put into a neutral agency. As soon as your claim is denied, you can go to the outside agency.
But that will surely not happen as long as Max and his industry puppetmasters are writing our health care “reform.”
Internal appeal departments should be outlawed. The insurance companies aren’t honest enough to renew their own claims denials. They must be incented to provide coverage or else see their denials reviewed immediately by a public agency.
And the composition of the public agency is very important as well. No shills.
I don’t care so if they technically have an internal appeals process, IF I can go directly to some type of consumer protection agency which would step in right away. If I’m forced by law to deal with their run around for months/years reform is useless
Good points.
One nit: in the fourth paragraph, I think the word you’re looking for is “recision,” not “recession.”
my bad
Perhaps those in the PO wouldn’t, but the PO only covers a segment of the population. Those maintaining private coverage (by far the majority, no?) would still benefit greatly from a process in which an Ombudsman has real power to reign in abuse. And three months is a huge amount of time when considering the nature of the biz…
Why is it that every time I hear about a new Congressional bill from this guy, I want to shoot myself?
Three months would be a major improvement on the current legislation. That is the scary part.
or if Baucus’s bill gave people a magic pony that poops rainbows, then they would smile so much that they wouldn’t get sick.
but no one is going to put rainbow pooping ponies in these bills, nor are they going to put in a viable, national, day-one “non-profit insurance plan overseen by the government (a public option).”
but (D) party message discipline says well-behaved progressive wonky writers who want to keep their front page posting privileges cannot mention Single Payer, and will get pats on the head for every post in which they pretend it doesn’t exist.
You are upset that I push for a public option because you think it is unlikely to pass, yet you want me to push for single payer which is even less likely of ever getting the votes in the Senate?
Newt Gingrich calls for Universal Health Care? Kinda?
If the health ”insurance” companies were truly insurance companies, they would be subject to regulation by state insurance commissioners and be subject to state insurance codes. They are not, by their own machinations. They insist that they are ”employee benefit plans,” not insurance companies, so they are subject only to the federal ERISA statutes. ERISA has no teeth.
State statutes with ”unfair claims practices” laws do have teeth. If your auto insurance company wrongly denies a claim, you can complain to your state insurance commissioner, and, if the denial falls within one of the statute’s definitions of an ”unfair claims practice,” you can sue the company for bad faith denial of your claim and seek punitive damages in a court of law from the insurance company.
If health ”insurance” companies were truly insurance companies, they would be subject to all of the same rules and regulations as other kinds of insurance companies. They prefer the protection of toothless federal laws. The Baucus ”mark” is just the same old, same old. You’ll never get the chance to sue them like you would another kind of insurance company for their bad faith practices.
What timid gestures from our liberals! Why not require private insurance companies to pay all MD-certified claims that aren’t fraudulent on their face and fight to get their money back if they can prove a basis after the fact? In other words, shift the risk of a payment error onto their backs and put the process at the back end, after the patient has been treated. It would save an administrative bundle because it would cut out the incentive to bullshit.
Why the timidity? Are you kidding? If someone proposed such a thing, Baucus would turn raucous. He’d laugh it off the floor. We’d then hear about a new kind of welfare queen who stations herself in a hospital bed and orders in fast food between acts of trying to have babies, then makes your friendly insurance company foot the bill.
The private reform show is just kabuki theater, a dead end. Switzerland uses private insurance companies, but there, if a certified claim isn’t paid in a matter of days, the next month’s premium is excused. Could the US go even this far? Again, are you kidding?
US private insurance won’t reform itself without generally available public insurance to set the standard and bring it to heel or, more likely, put a stake through its heart.
Clinton’s the guest on TDS.
watertiger is upstairs!
Late Night: On Bailouts, Bogeymen and False Equivalencies
you can push for a public option, that is fine, and of course puts you in the mainstream of the FDL, but you keep referring to something that doesn’t exist in any of the bills under consideration in Congress, a real, robust PO along the lines of Jacob Hacker’s original public option proposals.
But, have you considered that you are simply being used, and the ‘PO’ was always just a feint, to divide and conquer the Left and avert serious consideration of Single Payer?
http://crooksandliars.com/susi…..ngle-payer
therefore, not only does this magical rainbow-pooping robust PO not exist, it was conjured on purpose to distract from real reform while a vast bailout is arranged for the greedy insurance cartel. And it is they whose water you are carrying, whether you are aware of it or not.
My spouse has medicare with a supplemental policy. Every bill, every claim is flawless. It is paid. I get the supporting documentation showing it is paid. No problems. On the other hand, I have private insurance. (Can’t wait to turn 65) When I have met my huge deductable (despite huge premium), it is a paperwork nightmare. Paperwork from everywhere, difficult to match up with services, errors, no itemized bills unless requested after the fact, and always a bill from some unknown provider that you have to figure out what their service was related to. I can’t imagine a really sick person, an older person, a non-computer literate person or a person that is not a persistent bull-dog dealing with the deliberate pile that is health care. As I write this I am waiting for an itemized bill for ONE test which has been requested in writing two times and requested verbally two times. I have been sent the wrong bill for the wrong date for the wrong service three time already. Anyone that has actually used their healthcare and has any experience with medicare knows that a government program is the absolute best way to go for healthcare.
Amendments aside , according to Ron Wyden the way it stands now the public option would apply to MAYBE 15% of the population ( the working poor )and that’s if it’s even in the the final Bill !
Obama has already shown his thinking in relation to the uninsured,” were not going to carry your weight anymore “. He is no more or less than the face of corporate power .Big surprise .
Without the threat from the progressive caucus in the house the public option would be history already .That single fact is more important than even the so called reform being offered !
Obama campaigned saying he was a proponent of single payer , so give him what he asked for !!!
Play some hardball or you are allowing the corporations to write their own ticket and handing them 45 million new customers and we will have missed the first opportunity in a generation to advance our democracy !
How come there is enough money to bailout wall street and fund two wars simultaneously while spending nearly as much money on defence as the entire world combined for decades ?
How did alexander unravel the gordian knot ?
You’re exactly right. One bite – Approve or deny (on a short deadline – with claim procedures simple and clear)and have monster penalties for wrongful denial. No cap on damages – lives are at stake.
If they want to pay under protest (on some reasonable percentage of claims) that could be worth discussing. Just fine the hell out of them if they are wrong. Every single time.
All appeals should be totally outside the industry’s sphere of influence.
Baucus is wicked and shameless.
LOL! they’re supposed to make recommendations to the insurance companies. replete with all the ‘pretty pleases’ decorum dictates.
sorry obama/max, still so transparent
Play hardball? Why not just vote no to a putrid giveaway to the private health insurance companies and let Obama go get himself some Republican votes to make it law. What liberal/progressive would want to run for re-election defending this pile of steaming shit that Obama calls health care reform?
Surely, some smart Republican could ass a provision giving insurance companies legal immunity for denying treatment to a policy holder. He’d have his 51 votes in a heart beat.
Obama doesn’t do hardball. I voted for him, because he espoused public option and an end to Iraq. He wants everyone to come to a consensus, but that is just another word for the least objectionable compromise. Last night’s appearance on Letterman was part of Rahm Emanuel’s (who does do hardball) PR blitz to push the health care reform bill, no matter what the final act actually entails. It is part of re-election campaign of the President. If the Republicans can roll him on this, they will copy the playbook over and over on his succeeding initiatives, including cap and trade, the environment, financial oversight of Wall St., et al.
“In effect this will replace the problems of “rescission” and “pre-existing condition” with the new problem of “death delay.” “
“Death delay” is hardly new. Anyone who has dealt with an insurance company in a cancer case knows about the routine denials of obviously covered care, the call-center round robin tactics, the dropped calls, and the endless so-called mistakes and misunderstandings that end only when you make it very clear that you have both more than usual knowledge of the system and a readiness to seek legal redress. These tactics are intended to discourage at least a few until they die.