Exposing a Provision That Extends Immunity for Insurance Companies



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she's right.

gigi36b Thursday, November 5th at 10:00AM EST (link)

I don’t think that anyone wants to shield insurance companies from being responsible for their dereliction of duties. America does need healthcare reform, but universalizing it is only going to bring people to podiums weeping about losses and pointing their finger at the government instead of insurance companies.

In Canada, everyone knows someone who feels that the care they received (or didn’t receive at all) during illness or disease was substandard. Hard to sue the government though, when protocol is set out in a book and if the doctors adhere to the bare bones process of care, then it’s a no-fault situation.

And you are right

izoneguy (Diary) Thursday, November 5th at 10:07AM EST (link)

What happens if the government takes over?
On one hand they say they want to protect you and on the other hand they are screwing you and will be saying “you cannot sue the federal government” if your doctor working under ObamaCare screws up.

The point cannot be made often enough: Modern liberalism, as embodied in the Obama presidency, is the defender of the status quo. And the status quo is a road to economic ruin. Political forces cannot redistribute the wealth that the economic system does not produce.

What happens when the government takes over?

Steve Maley (Diary) Thursday, November 5th at 10:29AM EST (link)

All this will be in the purview of some Assistant Deputy Undersecretary of HHS, who six weeks ago was an SEIU member, public school custodian in Chicago.

Democrats get into power by claiming to be for “the little people”, but when it comes to the plight of these folks, they could give two s**ts less.

It’s all about power and control. Health care is just one more thing to be plundered.

The blogger formerly known as ‘Vladimir’.

 
 
 

If the government takes over there will DEFINITELY be no...

JadedByPolitics (Diary) Thursday, November 5th at 10:14AM EST (link)

remedy for consumers when Insurance companies deny coverage. This “plan” does NOTHING to fix those who are uninsured due to high risk health however there MUST be that fix in a ANY bill!

I must say I do NOT like Republicans attempting to play the blame game though! There is a problem and it should be fixed but for every ONE like that woman there are MILLIONS who have NEVER had a problem nor been DENIED coverage! I do NOT want to ASSAULT the FREE Market Insurance companies to WIN a debate….insulting really!

 

Thanks, Rep. Shadegg

illinoisconservative (Diary) Thursday, November 5th at 10:51AM EST (link)

Thank you for bringing this to our attention. It’s really important that we allow grievances to come to court. That is where disputes should be decided and we shouldn’t be protecting any industry from being responsible for their actions.

What regulations would you put in place to keep this from happening in the first place? I can only speak for myself, but I think it is safe to say many conservatives, while vehemently opposing the government take-over of health care Congress is attempting, feel something needs to be done to regulate the insurance industry and prevent horrendous acts such as this from ever happening. I hope you will be back to respond to this.

Thanks again.

Government regulation is the answer?

skorrent1 (Diary) Thursday, November 5th at 11:52AM EST (link)

Let’s not jump too quickly on that bandwagon.

The lady’s story was a tragedy, but she was not denied “healthcare”. It’s only that the insurance policy she had refused to pay for it. Chances are that, because the policy was agreed to by her husband’s union, she and her husband were not even offered an opportunity to read its provisions. In any event, it was obvious they had not done so. I’m guilty myself. I didn’t catch the difference between “doctors’ fees” and “doctor’s fees” in my policy, and it cost me several thousand dollars. I was free to change insurance companies. They were stuck. To go through the very same situation the next year and expect a different result— well, what do they say about insanity?

The problem is lack of individual choice. You can bet that if the husband weren’t bound by the union contract, he and all his friends would have ditched that insurance company in favor of one with better provisions before his wife got pregnant the second time.

ERISA is the government regulators’ attempt to control tort expenses. Do you really think that ERISA2 would be that much better?

Bull. She was denied care.

illinoisconservative (Diary) Thursday, November 5th at 12:31PM EST (link)

We cannot play semantic games when people’s lives are at stake.

Pre-denial of payment denies care as effectively as a doctor kicking her out on the street.

It is the height of hypocrisy to declare one minute that we will not allow our government to control or ration care and then defend in the next breath practices like this by insurers who override doctors orders.

Yes, we need regulation. Not all regulation is bad.

Generally, ERISA has been good for setting standards for retirement plans. There are protections you and I never see that are in effect and helping to safeguard our retirement funds.

But regulation can be overreaching and overly complex as well.

The regulations that should be put in place regarding the health care industry should simplify health care insurance plans by not allowing the contractual loopholes they build into them. And regulations should guarantee that doctors are the ones who determine a course of treatment, not the insurers (or the government!).

 

The insurance policy did not refuse to pay for it...

richardjohnston Thursday, November 5th at 2:50PM EST (link)

The insurance company did, despite the fact the policy covered it. It was fraud, not just a policy that didn’t cover a treatment. It goes on all the time. Take a look at this for example:

http://problemiserisa.blogspot.com/2009/09/rising-judicial-chorus-judge-young.html

There are many many more examples of this. If the insurance industry cannot offer their services unless they have immunity from liability for fraud, it is time for them to go. And then we’ll find some entity to deliver health care services that does not need to be able to commit fraud with impunity in order to stay in business.

 
 
 

Open html tag?

civil truth (Diary) Thursday, November 5th at 10:54AM EST (link)

Strange fonts everwhere.

As for the diary – just follow the money; that the story behind ObamaCare.

The greatest evil…is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed, and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voice. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the offices of a thoroughly nasty business concern. -C.S. Lewis

http://www.gmsplace.com/

 

Now please remember this travesty, Rep Shadegg

reason60 (Diary) Thursday, November 5th at 11:49AM EST (link)

The debate over health care reform is hurt when people try to make it about capitalism or socialism;
What we have here is a situation where powerful private interests have exerted their influence to destroy the natural regulating effects of the marketplace, to their own advantage.

The problem is having a Congress that is beholden to private interests, who don’t care a whit about abstract principles of freedom of the marketplace; they only want to benefit themselves.

Laws are written by lobbyists for the benefit of the companies that hire them; the public good is disregarded. In this, the Democrats and Republicans are equally guilty.

This is why the debate is so endless- the Dems posture as champions of the people, when they are beholden to corporations; the Republicans posture as champions of the free market, when they are beholden to corporations who want to avoid competition and accountability.

A public insurance option would avoid the temptation to cut corners like what happend to this poor woman; but unless it were accountable to the people it serves, it would be no better.

Chanting slogans about Karl Marx or Adam Smith is a silly distraction; we first need to break the stranglehold private interests- insurers, hospitals, PhRMA, and the like have over our – OUR- representatives.

So Rep. Shadegg, please remember this horrific criminal act when you go about your duties- please remember who you swore to represent- not the private interests, but the people.

 

Not Sure this helps you

FreelanceMinion Thursday, November 5th at 1:24PM EST (link)

Yes, this woman is complaining about Nancy Pelosi, but isn’t she complaining because Pelosi is accepting a too CONSERVATIVE provision? You really want to agree with people who say Pelosi is not LIBERAL enough? Isn’t that more a Huffington Post stance?

She seems to be complaining that Pelosi is keeping the anti-lawsuit provisions of ERISA, and I thought the Republican and conservative health reform idea was basically eliminating all other lawsuits against doctors and care providers.

If this gal is your hero, you would seem to be not just laughing at Nancy pelosi but calling for MORE lawsuits against insurance companies. Is that really the position of RED STATE?

 

It's really not that simple...

hgstern Thursday, November 5th at 10:11PM EST (link)

From the video, it appears that the poor woman was covered by an ERISA (commonly known as a self-funded) plan, which is exempt from state regulation. This is important because the carrier is only allowed to pay for benefits explicitly agreed to by the policyowner (which in this case *appears* to be the union). *If* that’s the case, then it’s really the union which cut off the funds.

For the sake of argument, though, let’s presume that that’s not the case. The next question to ask is why the carrier denied the claim (and/or refused further treatment). We don’t know, and it could be that they were wrong to have done so. But the *court* knew the *facts,* and *it* found that the carrier hadn’t wrongfully denied the claim. So what is it that the couple isn’t telling us?

Finally, why is it the insurance company’s fault that *care* was denied? Contrary to popular belief, carriers have NO POWER to deny *care* – they can only deny payment for it. And no, I’m not splitting hairs, the distinction is real, and important. Why is no one asking the providers why *they* denied care to this woman? Why is no one complaining about *their* greed?

That's not how ERISA works...

richardjohnston Friday, November 6th at 10:47AM EST (link)

First of all a plan does not have to be “self-funded” to be an ERISA plan, it just has to be employment-based. So if you have an insurance policy which you have because of your job (whether it it provided by the employer or a union) that’s covered by ERISA.

You also say “But the *court* knew the *facts,* and *it* found that the carrier hadn’t wrongfully denied the claim..”

That’s where ERISA is really a very very big problem. The court did NOT find the claim denial was legit — thanks to ERISA the court didn’t even think about that; it didn’t make any difference because the carrier won either way. In other words the Corcorans’ claims were never even considered by the court because ERISA precluded them from having a case in the first place. For examples of how it works see the following:

http://problemiserisa.blogspot.com/2009/09/rising-judicial-chorus-judge-young.html

http://problemiserisa.blogspot.com/2009/10/erisa-to-insurance-companies-its-ok-to.html

http://problemiserisa.blogspot.com/2009/08/rising-judicial-chorus-judge-becker.html

http://problemiserisa.blogspot.com/2009/08/theres-no-remedy-if-your-insurance.html

Finally, the practical fact of the matter is that denying coverage equals denying care. And remember the insurance company freely entered into a contract to cover this care — their own retained specialist said the care was medically necessary, and there was no other basis in the policy for a denial. In this case the insurer really did just breach its contract, and someone died as a result, and there were utterly no consequences. If you would like to read the Corcoran case you can find it here:

http://www.harp.org/corcor.htm