When is health insurance coverage not health insurance coverage?
The answer is, when it's based on health insurance obtained through an employer.
The Los Angeles Times noted in a story last week that a key part of the "a public option is unnecessary for reform" argument is the elimination of pre-existing condition exclusions. And that is unquestionably a good thing. However, as the Times reported, it also creates an incentive for insurance companies to simply refuse to pay for treatment, even if it is supposedly covered.
"There are going to be a lot of denials," said insurance industry analyst Robert Laszewski, a former health insurance executive. ... "How else are they going to bend the cost curve?"I think that would more accurately be expressed as "How else are they going to maintain their profits and their CEO mansions," but leave that aside because this is the real kicker:
If you get your insurance through an employer you have no right to challenge in court a refusal to cover treatment.
The Supreme Court ruled in 1987 that the Employee Retirement Income Security Act (ERISA) bars suits for damages over health benefit decisions. That affects some 132 million people.
No matter how arbitrary, foolish, cruel, cold-hearted, or downright outright stupid the decision, if the insurance carrier says "we won't pay," you're screwed. There is nothing you can do beyond appealing to the same company that refused you in the first place.
None of the health care bills pending in Congress would remove that ban and there are not enough votes to overturn it in the face of the obvious and expected industry support for the ERISA decision.
Without at least a government plan that would directly compete for business with private insurers, which is not what is being proposed now, we do not have real reform.
We are so screwed.
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