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Consumer Watchdog to Congress: Put Patients' Bill of Rights Back on the Table
Date:6/4/2009

b the most common abuses, particularly delay and denial of care.

"Have we forgotten what the HMO and health insurance industry is capable of? Congress' plan to require Americans to buy health insurance policies or face tax fines would further cede control of our health care system to an industry that has demonstrated that it will stop at nothing -- including killing its customers -- to make a profit."

The top 10 problems plaguing health care consumers that are not adequately addressed by the House and Senate plans are:

  1. Killing patients with fine print. Health insurers have bankrupted and killed patients with the fine print of health insurance contracts. A consistent theme of the industry's anti-consumer arsenal has been the use of incomprehensibly technical language buried in insurance contracts to refuse needed care when care is needed most. Case in point: insurance companies now commonly refuse to cover certain proven treatments for autistic children by redefining them as "education." Delays of such care during crucial periods of early development mean autistic children may never improve to their full potential. They also seize on "pre-authorization" and proper "coding" requirements to block care. The lack of legal accountability and financial consequence for insurers that refuse to honor promises to pay for health care encourages this practice. (See point 8 below).
  2. No definition of "medical necessity" and "experimental treatment." HMOs make false claims that doctor-recommended care is not "medically necessary" or is "experimental" in order to deny care that is too expensive. Though state laws provide factors for determining whether care is truly medically necessary or experimental, there are no effective financial consequences for such denials by false classification. As a result, insurance companies commonly use this tactic to dodge necessary and legally re
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SOURCE Consumer Watchdog
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