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The Race Is On: Beating the October 1 Deadline

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Missouri Gov. Jay Nixon is facing a dilemma.
By Wendell Potter

Should he sign a bill that was intended to help many state residents
get coverage for cost-effective health care that insurers often refuse
to pay for?

Or veto the bill because it is loaded with amendments that will
benefit insurers and force many Missourians to pay far more for medical
care than they do now?

Senate Bill 262, introduced by Sen. Kiki Curl, D-Kansas City, would
require insurers to pay the same for specialty care delivered via
telemedicine as for an office visit. Similar bills have been enacted in
other states, including Arizona just last month.

But in Missouri, Democrats are now regretting voting for the bill
because of amendments added at the last minute that will result in a
financial windfall for insurance companies, agents and brokers at the
expense of residents.

SB 262 would enable insurers to achieve one of their top objectives: converting HMOs into high-deductible plans. (MORE)

HMO customers enjoy relatively low copayments when they get care from
in-network doctors and hospitals. The bill would remove the current
requirement that HMO cost sharing be “reasonable” and allow HMOs to
impose high deductibles and coinsurance — up to $3,100 for an individual
and $6,250 for a family — in addition to copayments.

If Nixon signs the bill into law, Missourians in HMOs who are unlucky
enough to get sick or injured next year will have to shell out
thousands of dollars more to pay for their care.

Insurers could avoid paying for necessary care in yet another way under the bill as amended.
HMOs would be able to reduce the size of their provider networks,
meaning their enrollees would have far fewer choices of doctors and
hospitals. HMO members needing care from a specialist not in the network
would not be covered.

Insurers would win in another important way.

The bill would reduce from 60 days to 45 days the amount of time the
state’s Department of Insurance would have to review and approve a new
or modified health insurance policy. If the department doesn’t act
within 45 days, the policy would be deemed approved.

Most state insurance departments already are inadequately staffed and
resourced. Cutting the review and approval time by 15 days would mean
that insurers would gain a significant advantage by being able to sell
policies that do not meet federal and state standards.

As if all of this weren’t bad enough for consumers, the amended bill
would also make it unlawful for anyone other than a licensed agent or
broker to give advice or recommendations to any Missourian about
choosing a health plan.

This would be a major victory for agents and brokers who are
concerned that their incomes might take a hit when people start shopping
for insurance on the online health insurance marketplaces or exchanges
that states must have up and running by Oct. 1.

The amendment is an apparent violation of federal law, which states
that individuals other than brokers and agents who complete a certain
level of training can serve as “navigators” to help people choose plans
that are best suited for them.

As now worded, the bill would bar social service organizations from
helping low-income people who can’t afford to hire an insurance agent.

Nixon undoubtedly was eager to sign SB 262 before all the special
interest-backed amendments were added. It was the first bill sponsored
by Curl, a Democrat, who said she was motivated because of the role
telemedicine played in saving the life of her father.

Regrettably, the best thing for Nixon to do now is exercise his veto
and ask lawmakers to send him a clean bill during the next legislative
session. If he signs it, more people will be hurt than helped by SB 262.

88888
 

Just think on this as you begin to understand what is coming down the pike as October 1st looms closer: CIGNA claim denial rate runs upward of 21%. This is double and triple the denial rates of other HMO insurers.

This information is provided by Creating Health Institute
through our Health Matters(c) project.


Source: http://naturalhealthnews.blogspot.com/2013/06/the-race-is-on-beating-october-1.html



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