Saturday, March 8, 2008

Talk about passing the buck.

One of the most exciting developments in the autism community that gives many parents and caregivers tremendous hope is the groundswell of autism insurance coverage. There are 10 states that provide some form of coverage with Indiana, South Carolina, and Texas being the most comprehensive. There are many other states that are currently entertaining legislation or reviewing possibilities.

The insurance industry is under tremendous pressure to stop the onslaught of state legislature initiatives to mandate coverage, from policyholders who are seeking monetary damages for denied services, and from the public demanding affordable policies.

What is common about the above is that the insurance industry could have prevented all of them by working with industry groups, employers, and being honest and up front with policyholders.

Recently, a California woman who was diagnosed with breast cancer was awarded a large monetary award from an insurance company that canceled her insurance policy. Statements were introduced into the legal record that the insurance company would cancel policies to save money.

We have all heard of many stories of families purchasing discounted insurance policies with the understanding that medical conditions and treatments would be covered. Yet, to their dismay, when their children are stricken with leukemia or other disease, the majority of costs are not covered. The family is now on the hook for several hundred thousand dollars.

Here in Oklahoma, Nick’s Law (Autism Insurance Coverage), is still alive and well as our legislature is nearing deadlines to approve legislation. It has withstood a lot of political pressure, and in its’ present form as an amendment on several other bills, children and parents are very optimistic of its passage. With autism diagnosis at epidemic proportions, parents are meeting with their legislators asking for insurance coverage for this medical condition.

Most insurance companies have been inserting exclusionary phrasing into the policies for the last several years or just flatly denying claims with such reasons as treatments are considered experimental. The financial devastation that comes from the parents providing the necessary treatments has led several states to mandate coverage.

The insurance lobby is working overtime to pressure legislators to stop or prevent health care mandates from becoming law. The statements that are being mentioned in the state halls are outrageous and insulting to the intelligence of the general public.

The most common misleading statements are:

1. Increased mandates will lead to more expensive insurance, therefore many people will not be able to afford insurance more people will become uninsured. This is the go-to comment for insurance companies. The forces that are driving up costs are not mandates, but rather inefficient use of technology, personal wellness, using of the ER instead of a primary care physician, frivolous lawsuits, and personal irresponsibility of obtaining health care insurance.

2. Mandates will cause insurance companies to leave the state. Another ridiculous statement for the simple fact of where are they going to go? Many of the states that are considering autism insurance mandates are generally some of the least mandated states. So are the companies going to leave a state and move to a more mandated state?

3. Mandates will not be covered by the insurance company but just passed on to the consumers. Once again, insurance companies are just passing the buck. They do not need a reason to raise rates, yet keeping threatening the policyholders with this action. Check your state’s record of recent health care mandates. Compare that with the increases in insurance rates. Something other than mandates is driving up the costs.

By the way, a memo to the insurance industry: By stating that a health care mandate is bad for the policyholders, how about recognizing that all you are doing is passing the buck onto the taxpayers. That is called a taxpayer mandate.

With all the debate in the presidential campaigns regarding health care, one must be reminded why so many are calling for some sort of universal health care. Polling shows that many people are unhappy with the downward trend of coverage of disabilities, medical treatments, and other conditions. Yet insurance premiums continue to rise. Once again, insurance companies are ever increasing the use of the denied button in search of lower costs.

A popular movement within the insurance industry is to develop a very low cost, very basic insurance product that can be sold to single, young customers. These policy holders will not require many services and seldom posses the health risks that older policy holders will require. Therefore the profit margins will be greater even with lower priced policies. Are they trying to skip out on their responsibility of the much higher cost/lower margin policies?

Another popular insurance initiative is to roll back existing mandates that were passed into law. Many state legislatures are considering such legislation that will either eliminate or curtail existing law. This is very dangerous since we are now allowing our government to provide preferential treatment to an industry that supersedes the public welfare and heath care of its citizens. Once again this is an effort to help lower costs by eliminating coverage benefits that are purchased in the form of a legal binding contract.

What the insurance industry should be working on is to help reduce the inefficient systems that cause as much as 30% of all dollars spent to be wasted. Now, that would be a good way of passing a buck or two!

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