Kaiser Health News has a very interesting article about satisfaction and dissatisfaction over the rules being released by HHS to implement various provisions of PPACA. Too tough, to easy on insurers, allows insurers to participate, excludes them, etc.
The anti insurer rhetoric certainly had a lasting impact. In some individuals minds these organizations (made up of people just like you and me) are out only to wrongly deny claims and encourage poor health care.
I sat on boards hearing claim appeals for both public and private organizations for many years. Appeals went both ways and many times giving the benefit of the doubt to the participant. Seventy million Americans in employer plans have been covered under ERISA claim appeal rules for the last thirty-six years and now suddenly appeal organizations are not sufficiently independent, and insurers should be excluded from many processes because they are the enemy.
We are headed for higher costs because of the expectations created by this administration and members of Congress. Not every procedure ordered is or should be covered, not every appeal should be approved, not every charge is reasonable and not everything suggested by a doctor is medically necessary. Of course, those who don’t get everything they want will never be happy.
Pushing this scale out of balance heavily in favor of consumers is a recipe for disaster, be careful what you ask for, you may get it. Regulation by horror story has long been a prescription for waste and unnecessary expense.
QUINNSCOMMENTARY 