What Incentive Do Insurers Have to Cover Us When We Can't Sue Them If They Don't?
By Susie Madrak Thursday Oct 08, 2009 10:00amRemember Nataline Sarkisyan? She was the 17-year-old who died because CIGNA wouldn't pay for her liver transplant. Said it was "experimental." And by the time public outrage forced them to backtrack, she was dead.
Now her parents are trying to change the law that forbids them from suing CIGNA for damages - because until they do, it's cheaper for insurers to let people die:
"It was the worst thing in life," Hilda Sarkisyan said in a recent interview.
Mark Geragos, the high-profile trial lawyer who helped the family make its pleas to Cigna while Nataline was alive, filed the wrongful death suit on the family's behalf last year.
"If you don't sue, you can't make changes," Hilda Sarkisyan said. "It's not about the money. It's about the principle. They are just going to keep denying people care if we don't stop them."
Cigna said the dismissal of the wrongful-death case in April showed that the court "agreed with our position that the Sarkisyans' claims regarding Cigna's decision making were without merit."
In fact, the court did not consider the merits of the family's wrongful-death claims. Instead, it decided those claims could not be heard.
Judge Feess cited rulings by the Supreme Court and others interpreting 1974's Employee Retirement Income Security Act, or ERISA, which governs employee retirement funds and benefit plans.
Under ERISA, the courts have said, the only monetary damages that beneficiaries of workplace health plans can sue for is the cost of the treatment of service in dispute.
The cost of mounting a lawsuit often far exceeds the cost of the treatment in question, patient lawyer Scott Glovsky said. As a result, few lawyers take them on. That has in effect shut the courthouse doors on most treatment coverage disputes involving workplace health plans, which are the source of medical insurance for 132 million workers and dependents.
"ERISA is a license to kill," Glovsky said. "The companies know that they can deny treatment with the sick or dead member having virtually no recourse."
Wendell Potter, a Cigna spokesman who quit after handling the publicity surrounding the Sarkisyan case, agreed.
"HMOs and insurers are largely free to deny access to care without fear of reprisal or financial consequences," Potter said in a speech to the Civil Justice Foundation in San Francisco.
But, without these limits, an industry spokesman said suits against health insurers could be disastrous for consumers.
"It will bankrupt these plans, and employers would no longer be able to offer coverage," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans.
Then maybe you should go ahead and pay for the procedures instead. It would be good for your image and you could save a lot of money!
With Congress considering a healthcare overhaul -- including a requirement that individuals buy health insurance -- Potter, the Sarkisyans and their supporters want lawmakers to undo the high court's 1987 ERISA ruling.
Santa Monica-based Consumer Watchdog sent a letter to key congressional leaders urging them to undo the ERISA ruling, and president Jamie Court said Nataline's case shows why such a move is crucial to any healthcare reform.
"If the insurer decides they don't want to pay for the treatment because they can save a lot of money, there is not a dime available in damages if the person dies or is injured," Court said. "It's cheaper to kill you. If you die, you can't go to court."
It's not the first time this aspect of ERISA has come under fire.
In 2001, the late Sen. Edward M. Kennedy led an unsuccessful effort to take away the protection for health insurers.
"Patients should have the right to hold their HMO accountable in court when its negligence causes the injury or death of a patient," Kennedy told Senate colleagues.
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ism
day in court!
from anti-trust laws, too...This is a horrid , contemptible bailout for the Corporations at the American peoples expense...When are we going to get through to the Congressional fools that we are fed up with this morass they have created?
Call them 1.877.264.4226 or 1.800.828.0498!
Thank you. Yes, the "business of insurance" is exempt from federal anti-trust laws thanks to the McCarran Ferguson Act. What does this mean? Means the states have to police the industry. Means they can't really do a good job of it. Means there is no federal protection for you, as a consumer, if your insurance company does something harmful to you. You have no recourse.
I've ranted about it before, but still have much to learn.
http://illnessandinsurancehell.blogspot.com/2...
that health insurance companies 'have it all their way'...
absolutely NO way to hold them responsible for anything that they do. Thus they want tort reform, even though it is nearly impossible to hold them responsible for anything right now. If they do not make money for their shareholders, they have not violated their only legal obligation.
they'd also like us to fix the flat on their getaway car.
I guess corporate personhood is only relevant as long as it's in favor of the corporations. Why am I not surprised?
the rights of a real person, but only one legal obligation: to make money for their shareholders. I just want to make sure this fact is understood by as many real people as possible, seeing as corporations do not have any legal obligation to care if anyone lives or dies because of their behavior. Morals are discretionary for them.
Naomi Klein and others have documented this... Symon, see The Corporation and enlighten yourself.
Susie I would ask the same of vaccine makers which you have been promoting indirectly.
to burn their Health Insurance Cards and refuse to pay anymore money to the Insurance Companies.
Wouldn't that be exciting? Love to see the Med Mafia reaction when revenues suddenly plunged off the cliff.
Right on! It's about time we(the people)ask, what are we getting for our money? If it is nothing then why are we paying? We should just stop and boycott the insurance companies. If they truly believed in that free market garbage, the companies would not mind and would clean up their act.
have to put their asses on the line for something.
Clinging to imaginary comfort isn't going to solve the tough problems.
> Soon or later when all options run out people have to put their
> asses on the line for something.
Excuse me, but I thought that was what we did almost a year ago. In a sense we the people DID put our asses on the line for a man who was not proven over time as John McCain was. I voted for Obama, but I have to admit that deep down, I thought that McCain was the more capable of the two. He WAS a POW in Vietnam, for crying out loud.
Liberals are fond of saying, "Give Obama a break! He has been in office for only 9 months." Well, look at history and see what FDR accomplished in 1933 in his FIRST HUNDRED DAYS!! Obama talks good FDR, but his emulation is found wanting.
As for the fools in Congress, there is one answer: VOTE THEM OUT OF OFFICE!! They can't run in the general election if they lose the primary except by spending their own money. Voting for him because he looks like Uncle John or for her because she reminds me of Aunt Agnes simply doesn't cut it. The answer is getting behind those candidates who offer us new blood and who aren't in some corporate hip pocket. Yes, we people have to put our asses on the line, but we also have to use the brain lobes that the Supreme God above gave us.
I agree that people should be able to sue insurance companies for this type of thing, but what happens if you get denied coverage under the government plan. Who can you sue then? As someone who spent 10 years in the military and had problems with aspects of health care that my children received, you have absolutely no recourse against the government health care system if they screw up.
that covers everybody, regardless of age, gender, race, or financial circumstance. EVERYONE is covered and nobody is denied care. Like the plan I enjoy in Canada...
will not be actually providing the health care services. I hope you feel better knowing that.
I understand that. But that doesn't mean they are not going to deny your claims like a private insurance company. The AMA did a case study last year that showed Medicare denied a higher percentage of claims then any of the insurance companies did.
the same stage of this debate as most of the people here are. Or you are here to cause trouble. Medicare is far superior to anything the insurance companies give real people.
Here's the link. Not really a "study" I guess. It was a Health Insurer Report Card. I'm not here to cause trouble, I just have questions about both sides of the "debate". But if anything put out by the AMA is suspect, then why does Obama promote their support of a public option? They are suspect when they disagree with your side but fine when they do? It's like the religious nut jobs who pick and choose what they want to believe out of the bible when it suits them.
http://www.ama-assn.org/ama1/pub/upload/mm/36...
Medicare has the highest rate, with a difference of adherence to contracted payments. 98% vs. 75% for the average of the private carriers.
And the biggest reason for medicare denials seem to be when the procedure was not performed by the attending physician. Which is an issue at the doctor's end, rather than the patients.
Also, technically insurers can ignore any claim denied before the procedure as not being a "denied claim." Which is ironic, since medicare does not come in between the doctor and the patient, thus they have to review the claims later and count them as denied when pertinent.
But the main metric is the adherence to contractual terms, which in case of medicare is almost 100%. I.e. they pay what they claim to cover in almost all of the cases. Whereas private carriers seem to be all to happy to ignore their contractual obligations in 1 out of 4 contracts.
I agree with you when it comes to the evils of the insurance companies. The crap they do is without a doubt horrific. But it was government that allowed them to become like this. Now government wants to save everyone from problems that they had a hand in. You are naive if you think these politicians give a crap about whether you have quality health insurance or not. As long as they get your votes and you keep them in power, all is good. This mess is like a mechanic coming out to your car and pulling a bunch of parts off, then offering to fix it for you the next day for a "small fee"
... grossly incorrect actually.
Anyone?
.
please.
Anything the AMA says is highly suspicious in my opinion.
Last I checked, unless they are peer reviewed articles they are reproducing on their publications.
carrier denies your claim?
The only incentive is money. We don't have it and they do.
These people only care about themselves.
WAKE THE FUCK UP People.
NO one cares about us. Period. ! DONE, OVER!
This whole thing was a ruse to get the ins. co.s MORE FUCKIN" MONEYYYYYYYYY!!!!!!!!!!!!
WAKE up ......
these guys are going to do the right thing at some point. The very same people and institutions which told us, in years past, that there was nothing to worry about, that the fundamentals are fine, and that there was no danger of an economic crisis.
..someone tells you not to worry!
just another confidence game to where you find out when it's to late you been had.
"Now her parents are trying to change the law that forbids them from suing CIGNA for damages - because until they do, it's cheaper for insurers to let people die:"
For the life of me, I cannot understand how this makes any logical sense whatsoever. Who the f*ck do the CEOs and people running companies like CIGNA think they are?! God???? For crissakes! This is not logical; it's outright irrational and illogical and criminal... there I said it!
to the masses, or useless eaters as they refer to them.
Nataline Sarkisyan's family should sue the individuals at CIGNA who made the decision to allow their daughter to die.
The company may be protected, but the people who do their dirty work are not.
answer your question.
Most major Companies Self Insure and CIGNA and AETNA etc. are nothing but paid Contractors of those Companies.
Sue the Company not the health insurer.
Most are self insured because they avoid taxes that would otherwise be levied on them via the ERISA law. Corporations have found they make even larger profits because the majority of Americans don't even use the insurance they have. Then, you throw into the mix this push by these same corporations for employess to start using Health Savings Accounts! You know higher copays and deductibles that only top income earners can really afford. Its all about shifting the tax burden onto the employees.
There are not two sides to this issue. There is one: the American people's side.
Anyone who sides with corporations against people is declaring their hatred of America. I don't care what the Supreme Court says: corporations can't die on the battlefield and can't serve on juries and can't run for office, so they don't get to become superpeople and own the whole damned country!
Republicans are assholes. It can't be said often enough.
Don't forget the Republicans masquerading as Democrats. There are lots of them these days.
... ain't that a bitch?
Or supposed liberals whose only contribution seems to be to make fun of them wacko lefties.
They outnumber Lulu's of the right by 80% according to people who demonstrated they know how to count such things (including WMD's).
Government is protecting Big Corporations we're just fodder now being tossed bone shards.
The surgeon assigned to my mother by her HMO had been diagnosed with Parkinson's, but was allowed to continue operating.
The HMO's contract denied my mother the right to sue. Because the hospital was not owned by the HMO, and were therefore equally liable for continuing to grant the surgeon privileges, the hospital and the HMO reached an agreement, and paid my mother a few thousand dollars for her "suffering."
when large health care organizations devote part of their stable of lawyers to digging up dirt on a plaintiff's lawyer? I believe this info, because it came directly from a hospital administration insider!
to right this wrong. As pointed out earlier, corporations have the rights of personhood without the responsibilities attached. Any challenge to the status quo would eventually end up in the supreme court and corporate entities do not lose, never have, never will in the Robert's court.
Exactly the point of tort reform! Take away your ability to sue and you take away all need to pretend to cover someone.
It is all part of the game of steal what you can when you can we call capitalism. republicanism is a mental illness!
here's one of the problem progressives face;
we let the republicans make claims that are not true or are caused by their very principles
for instance we allow the republicans to claim medicare is going bankrupt when in fact it operates far more efficiently then private care and when in fact if it's operating at a deficit that's because the republicans gave away the assets in a tax give away to the wealthy marketed as some kind of "economic stimulous"
they took our money and then use that lack of funds to claim our programs are underfunded
is that as soon as some lib decides to call them on their sh*t in real time. A troupe of other "liberals" spring out of the woodwork to make sure he understands how totally not polite he is being, while they drive the proverbial bus back and forth over the poor feller to make the point.
for their street fighting ability. Or any kind of fighting ability.
... I am just tired of the sissies who only gain their "street fighting ability" just when it comes to torpedo other "sissy liberals" exclusively.
of corporate communists!
Stop using the phrase corporate communist, it was conceived and written by a corporate mole. It is Newspeak the purpose of which is to make discourse impossible.
Look out for phony doctor and nurse looking actors on TV speaking against universal medicare reform.
Having the option to sue is only the first step. Do you have the money to sue a trillion dollar industry that can bury you in legal costs by filing all kinds of allegations in which you have to answer every claim they throw at you? Even if you have the money, do you have the time and energy to fight the battle?
American citizens the Insurance Industry has declared war on you!
Insurance Companies take away our ability to have meaningful effective health care and further lobby to take away our ability to sue, so American citizens should take away their ability to provide. Cut them out of the equation entirely. American citizens need to become the insurance providers. Medicare for all! Come on, insurance companies don't care if we die, why the hell should we care if the insurance industry dies.
They'll never change their ways until they can be held accountable. I find it unbelievable that it's ever been illegal to sue these fuckers. It'll certainly be entertaining to watch the tsunami of lawsuits if it DOES become legal. Imagine millions of people filing suits to take a chunk out of these vampires' hides.
Maybe then they'd realize just what it's like to end up penniless because some monolithic entity, in this case the law, sucks away every penny you have. *rubs hands with glee*
for some Real change we can believe in.
For instance, the NeoCon meme about Obama's "Death Panels" needs to be addressed -- in the MSM, by whatever means necessary. The "Death Panels" are not coming (through a HC PO). The "Death Panels" are already here. The conception was RM Nixon's deal with Kaiser Permanente way back in the early 1970's. Now those Death Panels are fully entrenched in the Healthcare Insurance Complex, and backed by their bought-and-paid-for henchmen in the Congress AND the Courts.
The closest that our supposed representatives in Congress AND the White House can come to a viable, equitable HC PO is a proposed legal mandate to purchase HC insurance, under penalty of fines, enforced by the IRS. Some Public "Option", which it decidedly is not. If we cannot get true HC reform, and instead are forced into economic servitude by the H.I.C., then perhaps NO Healthcare reform at this time would be better. President Obama has touted Healthcare Insurance Reform, of which this HC PO is derived.
But we don't really need any HC PO that shoves more taxpayer money to the H.I.C. Reforms that alter the Healthcare Insurance Complex modus operandi, regarding (1) caps on the rates of HC premium increases, (2) elimination on annual and lifetime HC expenditure caps, (3) elimination of preexisting condition clauses, (4) ability for patients to laterally shift policies from one insurer to another, and (5) caps on Boards of Directors salaries and bonuses, especially on those supposed "non-profits" -- all this could be done legislatively without further taxpayer-funded TARP-like "gifts" to the industry.
Personally, I don't want just Healthcare Insurance Reform -- it does not eliminate the Corporatist profit motive that drives their morally defunct Death Panels. Truly universal single-payer public option healthcare legislation, such as that represented by HR-676 is the best (and only viable) long-term HC outcome.
If such legislation as HR-676 is not within the realm of possibility, then it is perhaps time to alter the terrain through which we are traversing, by whatever means necessary. Civil disobedience, such as protest sit-ins at the Healthcare Insurance Complex offices OR at the homes of their Boards of Directors, as well as at the offices of our "honorable" bought-and-paid-for Congress-critters would be initial options. State legislature-induced recall of our intractable Congress-critters would be another option. Financial and grassroots support of Incumbent challengers, either in Party Primaries or General Election would also be a method to consider. Beyond that point, there may need to be other options that challenge the entire current Oligarchical Corporatist system of government, at the voting booth, or General Strikes, or Civil Disobedience by whatever unnamed methods.
Why do Corporations now have all the legal rights of individuals, but without the punitive legal penalties for wrongdoing? If they insist upon being treated as individuals, then couldn't such be used against them in the legal definition of self-defense against imminent bodily harm? Isn't the ultimate solution a return to the limited, state regulated corporate charters of yesteryear, in order to drive the proverbial "wooden stake" into where these blood-sucking vampires hearts should have been?
.
Thank you!
Now get the message down to 50 words, or less.
As you may have noticed from some of my prior posts, I am not much for engaging in the on-line banter that is the norm, and as such, I do have a tendency to be a bit of an opinionated gas-bag. Holy shite, do I go off on a trip, yes?
In writing down these thoughts, I was trying to formulate a generalized letter to my Congress-critters, and that guy behind the bully pulpit, President Obama -- I should be doing such strictly off-line.
Mea culpa .... 8^)
I don't twitter (not to state the Obvious), but I will try to condense my thoughts into more manageable chunks -- 50 words or less, for me, may be a bit of a stretch -- but I'll try. Thanks for the suggestion.
I was thanking you for post as it was which is fine for me.
Don't go off line with it. I didn't see anything jumping out at me that needed picking apart.
The point is that you have a well thought out position and you can be of service to the common good with it.
I only meant to suggest that if you crystallize your statement you would really have something very good that more people would read.
Keep a long and a short version.
I really do appreciate your suggestions here.
(Please don't freak out, but truth be told, I consider you to be one of my muses -- you are awesome!)
8^)
David
so don't ever apologize for being verbose, when required, because you have to express complex thoughts dealing with rather extensive issues.
Just because some people embrace their mediocrity and want to force fed it to anyone they see as a threat, it does not mean we should allow those individuals to steer the debate.
Cheers.
Health insurance company has two options:
1. Pay for the treatment, thereby guaranteeing it's out X dollars.
or
2. Deny the treatment for any reason whatsoever, however heinous, wrong, or even fraudulent, and AT WORST they're on the hook for what they would've paid with Option #1. At best, the patient goes without treatment and profits are increased.
There's absolutely no incentive not to deny coverage.
I'm just throwing this question out here to see if anyone can answer it. Where would one get the money for the fines for mandated insurance when they couldn't pay for the insurance itself? Could someone explain that to me?
... in a level playing field public option you pay based on your income. The REAL option is a single payer where everybody gets THE SAME health plan across the board and pays based on their net income... just like a lot of other countries. do it.
There is no reason why somebody in the USA dies because of money or insurance. This is not on paper (but really is in fact) a survival of the richest country... there is nothing to be proud of when it comes to taking care of our own... greed rules.
P.S. And I might add, I can't believe the stupidity in number of US citizens who vote against their own well being and healthcare being herded like sheep by a religious cult calling themselves the Republican party. Some of you rednecks are among the stupidest people I've ever seen... and I know you didn't learn to be that stupid, you where born with it.
like SS and Medicare. As there is no final bill, yet, no one can say for sure. There is also no cap on premiums that I have seen. I have seen talk about jail time for those who can afford to pay, are fined, and don't pay. Whatever happened to the "no debtor's prisons" concept which was one of the reasons for founding this country?
If one cannot truly not afford to buy the mandatory insurance, taxpayers will pay it for you.
All of this money goes to the private health insurance industry, and to the politicians who take money from them.
... somebody high up in CIGNA would also be "resting in peace"!
Denying Coverage For The Transplant,
Be Haunted Every Minute Of The Rest
of Their Lives For The Death Of That
Young Woman.
...like CIGNA are asking for it. Sooner or later, someone will show up at a board meeting to seek justice with an AK-47. "You bastards killed my little girl!" BLAM! BLAM! BANG! RAT-A-TAT!
Keep it up, you callous capitalist pigs. People like Beck, Hannity, Malkin, O'Reilly and Coulter are stirring up the violence-prone crazies, and the actions of insurance companies and their employees are guaranteed to make targets out of their boards of directors.
Don't think you're safe because you've aligned yourselves with the Republicans and their right-wing nut jobs. Remember this historical fact: Lee Harvey Oswald fired a shot at and narrowly missed right-wing Republican General Edwin Walker just a few days before he shot President Kennedy. You insurance companies and your boards of directors make tempting targets for some people. It's only a matter of time.
goes beyond just gutting what can be recovered. It also makes it nigh on impossible to recover the stingy remedies it does allow. ERISA needs to be amended to counter this if anything approaching real reform is to be achieved. Those interested may want to take a look at my ERISA-reform blog for further information.
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