Consumers Versus Health Insurance Companies

On September 23, 2010, several very important provisions of the Affordable Health Care Act, signed by President Barack Obama on March 23, 2010, became effective. This Act is part of the healthcare reform agenda of the currently in-office Democrats. These provisions provide greater protection to the consumer by reigning in long practiced atrocities committed by greedy health insurance companies. The following is a list of what insurance companies can no longer do, followed by what consumers can now do.

Insurers cannot:

  • Deny coverage to children with pre-existing conditions, such as asthma, diabetes or heart disease.

  • Place lifetime limits or caps on benefits.

  • Cancel a health insurance policy without proving fraud.

  • Deny medical claims without providing the consumer with a chance to appeal the decision.

Consumers can now:

  • Receive free preventative services such as immunization shots and office visit check-ups.

  • Keep their children on their parents’ medical plan up to the age of 26 years old.

  • Select their own primary care, OB/Gyn and pediatrician without interference from the insurance company.

  • Use the nearest emergency room without being penalized by the insurer.

Furthermore, individual states can offer a Pre-Existing Condition Insurance Plan. These plans focus on people with pre-existing health conditions and who have not been able to be approved by any other insurer for any other reason but for their health condition; the person must be a U.S. citizen or national, and must not have been able to be approved for insurance for at least the prior 6 months. This plan covers a wide range of pre-existing health conditions, provides primary and specialty care, hospital benefits, and prescription drugs.

Unfortunately, the prohibitive part of the Pre-Existing Condition Insurance Plan is its cost. For a family of four, the premium can be close to $1,000 per month, which is still beyond the means of most consumers.

Consumer Suffering

Many citizens have suffered at the hands of the health insurance companies. Insurers have cancelled or completely revoked policies from the policy date of inception for inconsequential reasons.

For example, in the case of Denise and Stephen Wheeler versus Nationwide Insurance Company, Mr. and Mrs. Wheeler were approved for health insurance in December. In May 2006 Mrs. Wheeler was taken via ambulance to the hospital due to a perforated ulcer, which she was unaware existed. She endured five hours of surgery where the perforation was repaired. A short time after the surgery, her health insurance carrier requested additional health insurance information from her. According to court documents, Mrs. Wheeler had not disclosed an emergency room and Ob/Gyn visit that happened two months prior, but was caused by heavy menstrual bleeding. The insurer contended that they would not have approved the insurance had they had known of the condition with her menstrual cycle. The Wheelers were left with a $30,000 hospital and medical bill.

Another example is the case of Susan and Tony Seals versus HealthNet. In March of 2003, Mr. and Mrs. Seals applied for and were approved for health insurance through HealthNet effective April 1, 2003. Shortly thereafter, Mrs. Seals was informed that she was pregnant and gave birth to a daughter in October 2003. Mother and daughter had difficulties during the labor and delivery process where the baby had to be resuscitated immediately after birth and sustained brain damage. The Seals medical expenses came to $140,000. At this point, HealthNet decided to review their original application and determined that Mrs. Seals was two weeks off when she answered the question requesting the date of her last menstrual cycle.

The Seals brought suit against HealthNet, and won. They received $95,000 toward medical bills and $1,000,000 in a trust fund toward care of their daughter who will need constant care for the entirety of her life.

These are just two of the hundreds of policy cancellations, revocations, and lawsuits brought against the health insurance industry. They have had a choke hold on the American public long enough. Even after being fined millions of dollars in the recent past because of their underhanded practices, their practice continued.

Now, with the new portion of the Affordable Health Insurance Act finally in place, consumers can begin to feel more secure that their protection is first and foremost. By the year 2014, all of the portions of this Act will be in place, which will further protect the public from the greedy health insurers.

 

After speaking with various individuals within the medical professions, many oppose this Act. They claim that this will inhibit their treatments and care toward patients. But if you carefully read all portions of this Act, you will find that it protects the general public from underhandedness of health insurers and limits medical costs that can be charged by doctors. We, the consumers, can now be assured that we are no longer at the mercy of the giant health insurers.

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