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CA Legislature's 'Reform' of Health Insurance Cancellations Resembles Insurance Industry's Own Plan; Insurers, Satisfied With Getting a Legal Edge Against Patients, Drop Opposition to the Bill
Date:6/23/2008

out jail free' card that allows their financially captive third-party agents to play judge and jury over rescission reviews," said Jerry Flanagan of Consumer Watchdog. "California patients who've lost their health, their credit ratings, even their homes after illegal cancellations of their insurance need tough new rules and criminal prosecutions of insurance executives whose companies boost profits by cutting loose anyone who dares to get sick. Instead, insurers are getting industry-friendly legislation and capitulation by regulators. The industry-backed 'reforms' and settlements give lip service to allowing patients to recover unpaid medical bills and other damages caused by illegal policy cancellations, but actually foist big legal burdens on patients."

A settlement announced Friday by the Department of Managed Health Care (DMHC) would allow insurers in many cases to evade any payment of unpaid medical bills resulting from policy cancellations. Under the settlement, insurers could use closed-door arbitration proceedings where patients would likely not be able to afford legal representation to evade paying up tens of thousands of dollars in medical bills racked up by patients both before and after the policy rescission, no matter how illegal it was. Patients would also be fighting the insurer about the necessity of their medical care in front of arbitration judges with financial ties to the health insurers, not before doctors or medical experts.

Though under the current De La Torre bill, patients who submit to the third-party review could still sue their insurer to recover past medical bills, insurers could use favorable results made by captive third-party reviewers as evidence against patients in subsequent court cases. It was only civil lawsuits that forced regulators to act in the first place. Prior to a wave of lawsuits in 2006, 289 policyholders complained to the DMHC that their insurance was improperly canceled. The agency ruled against policyh
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SOURCE Consumer Watchdog
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