In its infinite wisdom, Congress is eyeing a fix for people with poor health insurance whose health care is wrongly denied or delayed. No, it’s not guaranteeing everyone good health insurance. It’s not even ensuring that health insurers pay claims appropriately and in a timely manner. Rather, CNBC reports that some Democrats in Congress want to give people the right to sue their health insurance company.
If you have Medicare, you already have the right to appeal denials of care. Most people don’t realize they can or that it’s worth the time, so only about 1 percent of people appeal. But, more than 75 percent of appeals result in coverage, according to the Office of the Inspector General. And, appealing a denial of care or coverage is easy and free. You don’t need a lawyer.
To appeal, simply send a letter from your doctor justifying the need for a medical service to the address on your Explanation of Medicare Benefits form or your Medicare Advantage form and request the appeal.
That said, if you want to sue your health insurance company in federal court because it denied your claim or it’s not paying your medical bills in a timely fashion, chances are you can’t. Some Democrats want to change that.
Health insurers generally write their contracts to require arbitration of coverage disputes. They prevent class action lawsuits. Arbitration protects health insurers because decisions are neither open to public scrutiny nor easy to appeal. Arbitration keeps the health insurers from being accountable for their bad acts.
Congresswoman Katie Porter, D-Calif. proposes the Justice for Patients Act, which would prevent health insurers from requiring arbitration. It would allow individual and class action lawsuits if patients preferred to go that route.
Lawsuits might help to hold health insurers accountable. Patients rarely win money in arbitration disputes, according to the Economic Policy Institute. Fewer than one in ten arbitration disputes lead to financial rewards for patients.
So long as corporations can require consumers to engage in arbitration, they will. Porter’s bill focuses exclusively on permitting lawsuits against health insurers. But, arbitration is required in all kinds of discrimination, sexual harassment and civil rights cases. People should have the right to sue corporations. Corporations have little to fear if their behavior is not egregious. The costs are steep enough and the time involved prolonged enough that lawsuits will never become the first line of attack.
Here’s more from Just Care:
- If your health plan denies payment, fight back and appeal
- For-profit hospitals are causing rising medical debt and personal bankruptcy
- UnitedHealth Group found guilty of denying millions needed care, under court supervision
- The Medicare Advantage scam and beyond
- Could you pay more in Medicare Advantage than traditional Medicare?
