Comments on: Will Health Care Reform Increase Litigation Over Denied Claims? http://healthcarecostmonitor.thehastingscenter.org/jacquelinefox/will-health-care-reform-increase-litigation-over-denied-claims/ Commentary and opinion on cost control in the implementation of health reform. Thu, 02 Feb 2012 20:10:19 +0000 hourly 1 By: Will health care reform increase litigation (& costs) over denied claims? | Bioethics International http://healthcarecostmonitor.thehastingscenter.org/jacquelinefox/will-health-care-reform-increase-litigation-over-denied-claims/comment-page-1/#comment-1132 Will health care reform increase litigation (& costs) over denied claims? | Bioethics International Wed, 06 Jan 2010 16:22:35 +0000 http://healthcarecostmonitor.thehastingscenter.org/?p=361#comment-1132 [...] [Hastings Center] All of the health care reform proposals in Congress promise to substantially increase the number of people who get their insurance from sources other than an employer. This shift opens the door to an increase in civil litigation because existing federal laws, specifically the Employee Retirement Income Security Act (ERISA), protect the employer-sponsored health care system from tort damages arising from claim denials. [...] […] [Hastings Center] All of the health care reform proposals in Congress promise to substantially increase the number of people who get their insurance from sources other than an employer. This shift opens the door to an increase in civil litigation because existing federal laws, specifically the Employee Retirement Income Security Act (ERISA), protect the employer-sponsored health care system from tort damages arising from claim denials. […]

]]> By: Insurance Claims Denials and the Proposed Exchanges - Prescriptions Blog - NYTimes.com http://healthcarecostmonitor.thehastingscenter.org/jacquelinefox/will-health-care-reform-increase-litigation-over-denied-claims/comment-page-1/#comment-1130 Insurance Claims Denials and the Proposed Exchanges - Prescriptions Blog - NYTimes.com Wed, 06 Jan 2010 13:57:50 +0000 http://healthcarecostmonitor.thehastingscenter.org/?p=361#comment-1130 [...] published online by the Hastings Center, a bioethics think tank in Garrison, N.Y., suggests that an increase in suits could lead to higher costs as insurers begin to approve claims defensively to avoid [...] […] published online by the Hastings Center, a bioethics think tank in Garrison, N.Y., suggests that an increase in suits could lead to higher costs as insurers begin to approve claims defensively to avoid […]

]]> By: Insurance Claims Denials and the Proposed Exchanges - Prescriptions Blog - NYTimes.com http://healthcarecostmonitor.thehastingscenter.org/jacquelinefox/will-health-care-reform-increase-litigation-over-denied-claims/comment-page-1/#comment-1131 Insurance Claims Denials and the Proposed Exchanges - Prescriptions Blog - NYTimes.com Wed, 06 Jan 2010 13:57:50 +0000 http://healthcarecostmonitor.thehastingscenter.org/?p=361#comment-1131 [...] published online by the Hastings Center, a bioethics think tank in Garrison, N.Y., suggests that an increase in suits could lead to higher costs as insurers begin to approve claims defensively to avoid [...] […] published online by the Hastings Center, a bioethics think tank in Garrison, N.Y., suggests that an increase in suits could lead to higher costs as insurers begin to approve claims defensively to avoid […]

]]> By: Jacqueline Fox http://healthcarecostmonitor.thehastingscenter.org/jacquelinefox/will-health-care-reform-increase-litigation-over-denied-claims/comment-page-1/#comment-474 Jacqueline Fox Fri, 30 Oct 2009 19:36:25 +0000 http://healthcarecostmonitor.thehastingscenter.org/?p=361#comment-474 I should clarify here that I am not in favor of fraudulent actions on the part of insurance companies. Before I became an academic, my practice was almost entirely made up of representing patients in their appeals with third party payers. The part of my job that I hated was telling my clients that they had no recourse beyond getting the benefit that had been denied, especially when the damages were real, painful and on-going. But I think this cost implication of proposed legislation needs to be addressed head on. I worry that, otherwise, the cost increase I describe here could become a political football, used to halt or delay progress. It may also result in lessening the benefits of the proposed legislation by driving the cost of insurance higher, thus reducing access further. I should clarify here that I am not in favor of fraudulent actions on the part of insurance companies. Before I became an academic, my practice was almost entirely made up of representing patients in their appeals with third party payers. The part of my job that I hated was telling my clients that they had no recourse beyond getting the benefit that had been denied, especially when the damages were real, painful and on-going. But I think this cost implication of proposed legislation needs to be addressed head on. I worry that, otherwise, the cost increase I describe here could become a political football, used to halt or delay progress. It may also result in lessening the benefits of the proposed legislation by driving the cost of insurance higher, thus reducing access further.

]]> By: Richard Johnston http://healthcarecostmonitor.thehastingscenter.org/jacquelinefox/will-health-care-reform-increase-litigation-over-denied-claims/comment-page-1/#comment-465 Richard Johnston Fri, 30 Oct 2009 03:14:47 +0000 http://healthcarecostmonitor.thehastingscenter.org/?p=361#comment-465 Professor Fox: You may be quite correct about cost control, but then controlling costs by condoning, not to say encouraging, fraud doesn't strike me as a viable approach, and for all intents and purposes that's what ERISA preemption does. If the insurance industry is really can't offer their service at a reasonable price because they lose their immunity from liability for <i>fraud</i> then I have to ask what the hell kind of an industry is that? ERISA preemption is responsible for a lot of bad behavior by insurance companies and <i>a lot</i> of ruined lives. It's an inexcusably unjust law and cost containment does not provide an excuse for it either, IMO. Consider, for example, <a href="http://problemiserisa.blogspot.com/2009/09/rising-judicial-chorus-judge-young.html" rel="nofollow">this case</a>. Travelers certainly contained costs there, but I don't think that's how we want to go about it. Professor Fox:

You may be quite correct about cost control, but then controlling costs by condoning, not to say encouraging, fraud doesn’t strike me as a viable approach, and for all intents and purposes that’s what ERISA preemption does. If the insurance industry is really can’t offer their service at a reasonable price because they lose their immunity from liability for fraud then I have to ask what the hell kind of an industry is that?

ERISA preemption is responsible for a lot of bad behavior by insurance companies and a lot of ruined lives. It’s an inexcusably unjust law and cost containment does not provide an excuse for it either, IMO.

Consider, for example, this case. Travelers certainly contained costs there, but I don’t think that’s how we want to go about it.

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