KaiserHealthNews reports that the new regulations issued by Health and Human Services on Tuesday covers not just a wide range of issues such as annual and lifetime limits, dropping coverage when policyholders get sick--but also covers a very important issue--requiring consumers to get prior authorization from their insurer before going to the emergency room. Under the new regulations issued this week, that now is banned.
Administration officials estimated that as many as 200,000 children and adults could benefit from the protections, not counting several million who could gain easier access to emergency care, according to an analysis accompanying the proposed regulations.
How many of you have experienced denial of your claims for emergency services because you didn't clear it with your private insurer first when you were suffering a health emergency such as a heart attack, seizure, etc? How many of you know people who were denied precisely because of this reason? Thanks to this new regulation, that will happen no longer for many Americans.
Here's more on this below, including a story from an American couple about going into medical bankruptcy because their private insurer refused to cover their emergency costs since the husband allegedly didn't call in the claim first:
When Kelly Arellanes' husband, David, and daughter, Jo, rushed by car to the hospital after the accident six years ago, the neurosurgeon gave them two options. "He said, 'You need to make a decision: either we go into emergency neurosurgery now and save her life, or we don't and she'll have an hour to live,'" David recalled.
Kelly, who had a portion of her brain removed that day, has since then learned how to speak, eat and walk again. The Arellanes' finances haven't fared as well. David and Kelly had health coverage through their jobs at Southwestern Bell Telephone Co., now part of AT&T, one of many large corporations that is self-insured. In such plans, the employer sets the benefits package and pays workers' claims and benefits itself. Southwestern Bell's plan was administered by United Healthcare.
According to the plan's 2004 policy guidelines, provided by David Arellanes, emergency claims incurred at an in-network hospital were completely covered, while those at an out-of-network hospital were covered at the "non-network" rate of 80 percent, unless patients contacted their primary care provider within 24 hours.
Her husband did call it in, but it was disputed in the appeals process, but they managed to prevail and got the insurer to pick up 80% of the costs. The family still went into medical bankruptcy anyway, burning through all of their savings, to end up over $100,000 in debt.
And now this new regulation? One other good thing about it is that patients who need emergency treatment will have their costs covered at the same rate, regardless of whether the hospital is within network or out of network.
There is much that remains to be done in improving the health bill, especially with the ability to regulate premiums since they have massively increased for people who buy their own health insurance. We can't just warn insurance companies not to do massive premium rate hikes, we have to put the force of the law behind that warning as well, which is why we must continue to press on for a bill like Senator Feinstein's bill which would establish an insurance rate authority.