Navigation Links
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

For a rescission to be rightful, an insurer must prove a patient

misrepresented a health fact that materially affected the insurer's

decision to grant coverage.

-- Even if a third party panel includes laypersons and legal experts, it is

not good policy to have a company -- whether for-profit or nonprofit --

with financial interest in retaining its contract with the state replace

a judge and jury.

-- The "facts" of a rescission review -- whether a patient lied

-- require an exhaustive review of the rescinded patient's actions,

unlike existing third-party medical reviews that consider the

particulars of a diagnosed medical condition and do not require an

interaction with the patient. The two situations cannot be compared.

-- The existing third-party independent medical review has come under

increased scrutiny and criticism for failing to observe the appropriate

statutory requirements when conducting reviews, and the Department has

been lax in its oversight.

-- Insurers may at any time bring pressure to bear on the regulators and

seek termination of a contract if a reviewer too often returns

unfavorable results. In fact, the IMR review process under a company

known as Maximus sides with health plans in 70% of the cases it reviews.

That's why the insurance companies have publicly supported the same

system for rescission.

-- The great majority of rescissions involve the actions of insurance

brokers who often counsel patients about how to fill out the complex

applications of the individual insurance -- recommendations that are

often colored by the insurance agent's financial incentives in

selling coverage. Who would review the agent's action in the

third-party review? Who would judge the weight of that evidence?

-
'/>"/>

SOURCE Consumer Watchdog
Copyright©2008 PR Newswire.
All rights reserved

Page: 1 2 3 4 5

Related medicine news :

1. Assembly on the Move for Rx Reform
2. Bayer Announces Availability of Reformulated Liquid Leukine(R)
3. ACP says major system reforms needed to improve the state of primary care medicine in the US
4. AARP Statement on Governors Bill for Prescription Drug Marketing Reform and Transparency
5. Presidential Candidates Health Care Plans Lack Key Reform Elements, Aspen Institute Finds
6. CEOs From Multiple Health Industries Announce Consensus Plan to Reform U.S. Health Care
7. Aspen Institute to Release Presidential Candidates Responses to Health Care Reform Questionnaire; New Zogby Poll Findings Also to be Released
8. SEIU Retaliates Against California Caregivers & Democratic Reform Movement
9. Photos: New Kind of Health Care Reform Brings Five-Star Hospitality to Hospital Care
10. Voters Believe They Hold Power in Health Care Reform Debate
11. Kidney Care Community Applauds National Taxpayers Unions Endorsement of Medicare Reforms to Extend Patient Private Health Insurance Coverage; Calls Proposal Common Sense Coverage Reform
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:9/16/2014)... 15, 2014 For patients with locally advanced pancreatic ... radiation (SABR) may be a promising treatment option, ... not otherwise be an option, according to research ... Oncology,s (ASTRO,s) 56th Annual Meeting. , Surgery is ... pancreatic ductal adenocarcinoma (PDA), the most common type ...
(Date:9/16/2014)... Texas (PRWEB) September 16, 2014 Beginning October ... adding a new service offering for its clients who book ... to the volume of business they buy. Most recurring ... during the work week, but others include clients whose ... pet sitter on a daily basis. The ...
(Date:9/16/2014)... Brightree® , the leading ... software solutions for the post-acute care industry, today ... of Brightree HME , serving home medical ... well as home infusion pharmacies. The release includes ... purchasing, document management and electronic eligibility checking all ...
(Date:9/16/2014)... (PRWEB) September 16, 2014 Synergy Research ... comprehensive report gives the best detail and analysis of ... pulled from a variety of sources, including Ministry of ... Orange Paper will give readers actionable intelligence on clinical ... Paper is relied on by the local and international ...
(Date:9/16/2014)... Valley Cellars and company owner Jay Rosen are featured ... This feature is part of the private cellars section ... company as a whole. , Washington Valley Cellars has ... wine storage solutions for their clients for over 15 ... across the country, especially in New York, New Jersey, ...
Breaking Medicine News(10 mins):Health News:Chemotherapy and SABR consecutively may be promising treatment option for advanced pancreatic cancer 2Health News:Chemotherapy and SABR consecutively may be promising treatment option for advanced pancreatic cancer 3Health News:Chemotherapy and SABR consecutively may be promising treatment option for advanced pancreatic cancer 4Health News:Dallas-based Park Cities Pet Sitter Introduces New 15-Minute Visit for Clients on Recurring Visit Schedules. 2Health News:Dallas-based Park Cities Pet Sitter Introduces New 15-Minute Visit for Clients on Recurring Visit Schedules. 3Health News:Brightree Announces Availability of Latest Release 2Health News:Brightree Announces Availability of Latest Release 3Health News:Brightree Announces Availability of Latest Release 4Health News:Synergy Research Group Debuts Ukraine Orange Paper 2Health News:Washington Valley Cellars Featured in September Issue of Wine Spectator 2
... , ... Disease Foundation (VDF) is seeking nominations for the 2010 President’s Awards, which recognize those ... disease or have assisted the Foundation in accomplishing its mission in various categories. The ... ...
... ... this health observance day, VIP Smiles, owned by celebrity dentist Dr. Catrise Austin ... Street location by appointment from June 21st - June 28th, 2010. VIP Smiles ... offer the OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test, which can be administered orally ...
... By combining two relatively inexpensive technologies based on sound and ... women undergo breast biopsies for suspicious lesions. Results of the ... edition and the August print issue of Radiology . ... the potential of diffuse optical tomography in the near infrared ...
... realize international health goals aiming to improve maternal health, ... is crucial. In an editorial published this week entitled ... editors argue that action on maternal health must ... much as it does access to basic medical care. ...
... appendages such as hair, nails, sweat glands and mammary ... the United States, according to a report in the ... of the JAMA/Archives journals. "Cutaneous appendageal carcinomas are ... diverse differentiation that frequently present a diagnostic challenge," the ...
... A new study in the journal Respirology ... acute exacerbations of chronic obstructive pulmonary disease (COPD) experience ... an increased risk of death, compared to those without ... due to impairment of immune responses. Researchers led by ...
Cached Medicine News:Health News:Nominations Wanted for Vascular Disease Foundation President's Awards 2Health News:June 27th Is National HIV Testing Day-New York Celebrity Dentist Offers Free Oral Rapid HIV Testing In the Dental Office 2Health News:June 27th Is National HIV Testing Day-New York Celebrity Dentist Offers Free Oral Rapid HIV Testing In the Dental Office 3Health News:Noninvasive combination technique may reduce number of breast biopsies 2Health News:Cancers of sweat glands, other skin-related structures may be increasing in United States 2
(Date:9/16/2014)... , Sept. 16, 2014 CorMedix ... focused on developing and commercializing therapeutic products for ... infectious diseases, announces the amendment and restatement of ... preferred stock and related warrants, as well as ... stock and warrant financing, to remove anti-dilution, price ...
(Date:9/16/2014)... 16, 2014  DNAtrix, Inc., experts in oncolytic ... was treated with the company,s lead product, DNX-2401, ... a randomized, multicenter, open-label Phase Ib study for ... collaboration with leading neurosurgeons and neuro-oncologists in the ... our randomized Phase Ib study of DNX-2401 at ...
(Date:9/16/2014)... Sept. 16, 2014 Henry Schein, Inc. ... provider of health care products and services to ... today that Stanley M. Bergman, Henry Schein,s Chairman of the ... a healthcare services panel at the Leerink Partners ... will be Dr. Stohler, Dean of Columbia University,s ...
Breaking Medicine Technology:CorMedix Amends and Restates Outstanding Securities to Remove Provisions Causing Derivative Liability Classification 2CorMedix Amends and Restates Outstanding Securities to Remove Provisions Causing Derivative Liability Classification 3DNAtrix Announces Treatment Of First Patient With DNX-2401 In Recurrent Glioblastoma Trial 2Henry Schein To Present At The Leerink Partners Services Roundtable 2
... March 28, 2012   Novus Scientific, manufacturer ... the world,s first long-term resorbable (100% absorbable) synthetic mesh, ... data gathered by the Division of Plastic Reconstructive and ... pedicled transverse rectus abdominis myocutaneous (TRAM) flap is a ...
... March 28, 2012  Hawthorn Pharmaceuticals Inc. and its parent ... and certain states a total of $2.8 million to ... LLP that alleged Hawthorn falsely marketed unapproved prescription drugs ... government health care programs. An even bigger ...
Cached Medicine Technology:12 Month TRAM Data Collated Using TIGR® Matrix Surgical Mesh in a Randomized Controlled Study Presented at MAPACS 2012 212 Month TRAM Data Collated Using TIGR® Matrix Surgical Mesh in a Randomized Controlled Study Presented at MAPACS 2012 3Whistleblower Comments on Hawthorn Pharmaceuticals' $2.8 Million Settlement of His Medicaid Fraud Qui Tam Case 2Whistleblower Comments on Hawthorn Pharmaceuticals' $2.8 Million Settlement of His Medicaid Fraud Qui Tam Case 3
Nidek offers 3-Dx/F Digital stereo camera to provide a complete and comprehensive digital imaging platform....
Eye Q PRO is the optimum choice for ophthalmologists and clinicians specializing in advanced pathology and research....
Nidek LM-990A accomplishes precise measurement, quick response and easy operation....
... is a diversified wide-angle fundus ... ICG (optional) with various magnifications, ... the market), 40 degrees for ... picture and 30 degrees for ...
Medicine Products: