Sunday, April 29, 2012

Strong Industry Oversight Key to Healthcare Overhaul's Success


CareShare Network cannot say whether the new healthcare law is the antidote for the US’ healthcare woes. However, we hope the system will provide recourse for individuals with ongoing medical conditions when they are in conflict with their insurers over their care. 

In 2007, the CareShare Network blog featured the story of a woman who had appeared on Good Morning America.  She was living with a rare condition. In spite of her personal entreaties and letters of support from her doctors, her insurance provider would not cover the only medication capable of helping her.

Even with Good Morning America’s national spotlight on its policies, the insurer stood firm unwilling to reverse its decision. The woman was frustrated and baffled that one entity could hold such power over her life and health.  

In cases where doctors recommend one treatment and the insurer denies coverage, under the new law, will a strong third party oversee the appeals process?

Currently, a version of this arbitration process exists.  When private insurers make a decision patients believe is wrong, patients have the right to appeal.  Unfortunately, an appeal often ends in insurers affirming their own decisions:  The insurer claims their internal, impartial medical teams further reviewed its decision -- and approves of it.

These reviews can go as far as a state appeal board.  Some patients follow the process through its end at the state level. Others give up, exhausted and depleted at the thought of facing yet another battle with an uncertain outcome.

Our reason for recounting this story of old is to stress the need for an official, independent and strong appeal system implemented to protect patient consumers under the healthcare law. Otherwise, the national insurance mandate becomes a boon for private insurers, leaving consumers trapped between accepting inadequate private plans and no viable alternative when they fail them.

3 comments:

Anonymous said...

The government is the government. What or who should head the third party overseer?

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