Daily News Updates - Health Insurance News

CA Rescission Legislation, Pt.5 – Circling around the justice block.

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To further exacerbate the problem, the Department of Managed Health Care announced a settlement on Friday giving health insurers an out from paying the patients’ medical bills in many illegal rescission cases. In these cases, the health insurers would be exempt from covering accumulated medical expenses a patient was wrongfully denied. Under this new settlement, the health insurer could employ closed-door procedures for the arbitration hearings. This environment created conditions where many of the victims could not afford legal representation during the hearings, even though they had been wrongfully burdened with ‘tens of thousands of dollars in medical’ expenses as a result of the illegal rescission, ‘no matter how illegal it was’. These victims are also fending for themselves to these same ‘paid judge/juries’ for other arbitrations, like “What was necessary?” without the benefit of the medical experts, including doctors.

The current De La Torre bill still allows these victims ‘who submit to the third-party review’ to sue a health insurance corporation privately. The natural barrier there, of course, is that these already-burdened victims must be able to afford it and secure a worthwhile attorney. But by doing so, they are already starting out with an automatic ‘strike’ against them. The proceedings that have already favored against them in the ‘paid’ 3rd party review will be presented as a ready-made precedent by the health insurer as admissible evidence ‘in subsequent court cases’. This situation is even more lame then what they started with. Prior to 2006, the only recourse besides civil lawsuits left to this segment of people was to file a grievance with the Department of Managed Health Care (DMHC). In 289 cases filed, the patient was denied in ‘all but 10 to 20’ of them. So, the necessitated lawsuits that followed were the cause of this legislation in the first place. It seems to have come full-circle, after all that hope.