Insurance Parity Issues
Jim DeWees
Description
Collection
Title:
Insurance Parity Issues
Creator:
Jim DeWees
Date:
12/20/2011
Text:
Thanks to those that responded to my post about the Parity issues and current policies.
Just to add a little more, someone from the Indiana Dept of Insurance did return my phone call, and we spoke this morning. He basically said that I need to file an official complaint with their Consumer's Services division, which I can do online, with the information. Then within 24 hours someone there will review my complaint and see if there is indeed some violation, and then notify the insurance company of this complaint and give them a time frame to respond back and give the Insurance Dept some reply about this complaint.
IF they find that there is indeed a violation, there is not a lot that the state can do to an insurance company, other than to notify them that they are in violation. They might be able to fine the company, or make some kind of negative mark on them somehow. BUT from what I learned today is that there is little or nothing that they can do to MAKE an insurance company play fairly or follow the laws.
I spoke with someone in the Consumer's Service division, and she told me to file the complaint online, and then that opens a case where they can investigate. There are only 4 people working in this department, and she told me that she cannot recall any cases regarding this Parity issue. I found that interesting, because the ACA was here in Indiana, and they found several amputees that were willing and eager to express their stories about how they had been treated unfairly by their insurance companies....etc. But, since July 1, 2008 (when this law was put into place), in over 3 years now, there has been NO complaints or issues with prosthetics filed with the State.
I filed the complaint online, and have no idea of when (or IF) I will ever hear back. In the meantime, the patient has also filed a formal complaint over this, and they have read the Parity Law for Indiana, and know exactly what the violation is.
Here is a small part of the bill:
Code § 27-13-7-19 : Indiana Code - Section 27-13-7-19: Coverage for prosthetic devices
....the coverage
required under subsection (c):
(1) may be subject to; and
(2) may not be more restrictive than;
the provisions that apply to other benefits under the individual contract or group contract....
So having a $4000 annual cap is restrictive compared to other benefits on their policy.
So, this battle is just now beginning with this insurance company, and it will be quite interesting to see IF the state CAN do anything, or IF the state WILL do anything.
From my perspective, I have not seen ONE case where this parity bill has helped any amputees here in Indiana. I have seen several cases where this law has really hurt the amputees. Here is just a couple examples of the negative impact:
Personally, I tried to change insurance companies for myself, which is an individual policy for my family. I have had the same company and policy now for about 5 years, but the network is not that great, and the coverage and customer service with this company is horrible. I went to one insurance broker, he thought it would be simple to get me a new policy with a better company, BUT when we looked at a few companies, I wasn't even allowed to apply because now it asks if I am an amputee or if I have a prosthetic limb....and answering this question with a YES makes it so that they won't even take my application. Two other bigger companies didn't come right out and ask that question, but during the medical review and the underwriting process, they denied coverage. I am not overweight, I do not smoke, I take no medications, blood sugar levels are perfect, blood pressure is perfect, etc...and they still won't take me...OR my 10 year old son who is missing his right hand (birth defect, adopted from China).
This past year, the Obamacare deal went into effect where children are supposed to be able to get coverage regardless of the pre-existing conditions....BUT the catch to that was that the insurance company must have the entire family covered, and then if they exclude a parent due to pre-existing conditions, then they do not have to cover the child. So, my son could not get any new coverage under this new wonderful law, which sounded so great on the mainstream media.
Another issue that I have seen 3 times now are patients that have had personal, individual policies for a few years, and when this law was passed, they received a letter forcing them to sign a 10 year voluntary waiver of benefits for anything related to the amputated limb. If they did not sign that waiver, their policies would be cancelled and their coverage terminated.
I wrote about this a few months ago, and it ended up in a magazine for this field, and there was a reply to my article stating that ALL my claims here are false and innacurate. There is no reason for me to make any of this up, and if this was all false, then I would have a new insurance policy that would work much better for my family and me. But, I cannot get new insurance. So far, my current insurance has not asked for any waiver of benefits, BUT I have never submitted any claims for any prosthetic services since I make my own, as well as my son's prosthetic devices. But, my insurance is based out of Ohio (not based in Indiana) and so I guess this might not be an issue yet in Ohio.
IF I had to take an insurance policy that did require this voluntary waiver of benefits, that could be financially devastating. What happens if I needed some revision surgery for bone growth or something....that would ALL be out of my pocket, and not covered. That would be several thousand dollars. Most of my patients could not afford to choke out that kind of money.
Again, this is just my view of what this parity law has caused in my state. I can't see anything positive about it at all from a personal point of view, or from my professional point of view.
Thanks again everyone,
Jim DeWees, CP
Just to add a little more, someone from the Indiana Dept of Insurance did return my phone call, and we spoke this morning. He basically said that I need to file an official complaint with their Consumer's Services division, which I can do online, with the information. Then within 24 hours someone there will review my complaint and see if there is indeed some violation, and then notify the insurance company of this complaint and give them a time frame to respond back and give the Insurance Dept some reply about this complaint.
IF they find that there is indeed a violation, there is not a lot that the state can do to an insurance company, other than to notify them that they are in violation. They might be able to fine the company, or make some kind of negative mark on them somehow. BUT from what I learned today is that there is little or nothing that they can do to MAKE an insurance company play fairly or follow the laws.
I spoke with someone in the Consumer's Service division, and she told me to file the complaint online, and then that opens a case where they can investigate. There are only 4 people working in this department, and she told me that she cannot recall any cases regarding this Parity issue. I found that interesting, because the ACA was here in Indiana, and they found several amputees that were willing and eager to express their stories about how they had been treated unfairly by their insurance companies....etc. But, since July 1, 2008 (when this law was put into place), in over 3 years now, there has been NO complaints or issues with prosthetics filed with the State.
I filed the complaint online, and have no idea of when (or IF) I will ever hear back. In the meantime, the patient has also filed a formal complaint over this, and they have read the Parity Law for Indiana, and know exactly what the violation is.
Here is a small part of the bill:
Code § 27-13-7-19 : Indiana Code - Section 27-13-7-19: Coverage for prosthetic devices
....the coverage
required under subsection (c):
(1) may be subject to; and
(2) may not be more restrictive than;
the provisions that apply to other benefits under the individual contract or group contract....
So having a $4000 annual cap is restrictive compared to other benefits on their policy.
So, this battle is just now beginning with this insurance company, and it will be quite interesting to see IF the state CAN do anything, or IF the state WILL do anything.
From my perspective, I have not seen ONE case where this parity bill has helped any amputees here in Indiana. I have seen several cases where this law has really hurt the amputees. Here is just a couple examples of the negative impact:
Personally, I tried to change insurance companies for myself, which is an individual policy for my family. I have had the same company and policy now for about 5 years, but the network is not that great, and the coverage and customer service with this company is horrible. I went to one insurance broker, he thought it would be simple to get me a new policy with a better company, BUT when we looked at a few companies, I wasn't even allowed to apply because now it asks if I am an amputee or if I have a prosthetic limb....and answering this question with a YES makes it so that they won't even take my application. Two other bigger companies didn't come right out and ask that question, but during the medical review and the underwriting process, they denied coverage. I am not overweight, I do not smoke, I take no medications, blood sugar levels are perfect, blood pressure is perfect, etc...and they still won't take me...OR my 10 year old son who is missing his right hand (birth defect, adopted from China).
This past year, the Obamacare deal went into effect where children are supposed to be able to get coverage regardless of the pre-existing conditions....BUT the catch to that was that the insurance company must have the entire family covered, and then if they exclude a parent due to pre-existing conditions, then they do not have to cover the child. So, my son could not get any new coverage under this new wonderful law, which sounded so great on the mainstream media.
Another issue that I have seen 3 times now are patients that have had personal, individual policies for a few years, and when this law was passed, they received a letter forcing them to sign a 10 year voluntary waiver of benefits for anything related to the amputated limb. If they did not sign that waiver, their policies would be cancelled and their coverage terminated.
I wrote about this a few months ago, and it ended up in a magazine for this field, and there was a reply to my article stating that ALL my claims here are false and innacurate. There is no reason for me to make any of this up, and if this was all false, then I would have a new insurance policy that would work much better for my family and me. But, I cannot get new insurance. So far, my current insurance has not asked for any waiver of benefits, BUT I have never submitted any claims for any prosthetic services since I make my own, as well as my son's prosthetic devices. But, my insurance is based out of Ohio (not based in Indiana) and so I guess this might not be an issue yet in Ohio.
IF I had to take an insurance policy that did require this voluntary waiver of benefits, that could be financially devastating. What happens if I needed some revision surgery for bone growth or something....that would ALL be out of my pocket, and not covered. That would be several thousand dollars. Most of my patients could not afford to choke out that kind of money.
Again, this is just my view of what this parity law has caused in my state. I can't see anything positive about it at all from a personal point of view, or from my professional point of view.
Thanks again everyone,
Jim DeWees, CP
Citation
Jim DeWees, “Insurance Parity Issues,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/233106.
