Insurers under fire for denials of care, inadequate coverage

Nov 24 2009

When people talk about revamping the health care system, among the often-mentioned reasons for change are unfair denials of care by insurance companies and medical debt, both of which are in the news today.

Forbes reports on a "recent federal lawsuit filed in Mississippi against the local Blue Cross & Blue Shield and the Electric Power Association's benefits plan. ... The lawsuit provides a window into the chaos created by America's piecemeal insurance market. Workers face an ever-shifting array of health benefits that change each year at open enrollment time as employers shop around for better deals. What's covered in 2008 suddenly may not be in 2009."

The case involves plaintiff Paige Riley, 42, who has a painful stomach condition called gastroparesis and "alleges that Blue Cross & Blue Shield of Mississippi refused to cover an operation to replace the batteries of a stomach-pain device she had surgically implanted in 2005. As a result, Riley had to fork over the $43,364.27 cost in cash." Forbes notes that the insurer denied care, saying the device was experimental, and adds "the lawsuit has relevance to the current debate in Washington. ... 'This shows that with health reform it will be important that those who are insured still have strong appeal rights,' says [Jennifer] Jaff, [a] patient advocate." Blue Cross & Blue Shield of Mississippi had no comment on the suit (Whelan, 11/23).

Meanwhile, The Baltimore Sun has consumer advice about medical debt, which is "the single largest contributor to people declaring bankruptcy," examining what states have done to protect people and answering questions on how to avoid medical debt. "It's not just uninsured patients who rack up steep medical bills. Even if you have insurance, you might not realize that your coverage is inadequate until you're sick and overwhelmed by co-payments and other health costs." Maryland started a law in June to protect patients: "The law now requires hospitals here to provide free or reduced-price care to low-income residents and to give patients information about financial assistance. This protection may be expanded soon to make even more Marylanders eligible for free or reduced-cost care" (Ambrose, 11/24).

Related KHN archived story: Americans Ensnared By Medical Debt (Boodman, 1/13)