The insurance companies will be a problem.

The reason the Patient Protection and Affordable Care Act was passed in the first place was due to the 'gaming' the insurance companies engaged to 'beat their responsibilities' under contracts. There is no reason to believe that will not continue. There was no 'pledge of honesty or good practice' required by the PPACA. If such a pledge was required there would not be a health care insurance company issuing policies.

The shenanigans will be the same and the rejection of claims will not change. There will be well funded insurance claim agents still serving up deaths of citizens. The difference this time is the patients being served as victims to increase profits have power on their side. It will still continue to require filing for appeals regarding claims and filing complaints with any state's insurance commission. 

None of that frustration will change, as a matter of fact the insurance companies will be more tenacious as ever because the Republicans have painted 'the big mistake' picture of the PPACA. The insurance companies will use that 'tone' in the country to reinforce that understanding to avoid paying claims.

In the state of California, there needs to be real consequences for complaints filed by consumers. If an insurance company is racking up the complaints with the state insurance commission fines need to be levied. The reason? The insurance companies will attempt to overwhelm a state agency and slow down the process to claims. A state agency could become so slow that it will never serve the best interest of the consumer and people will stop filing complaints. The fine facing insurance companies for repetitive and volumes of complaints should be significant. Once a trend is realized by the state the fines should immediately match the monies denied the consumer.

In other words, if a complaint is for $8,000 then the fine should be $8,000. If the insurance company finds it is still less of a liability to pay the fines, then up it to a quarter million per complaint. If that doesn't work and after 25 to 50 complaints a year file charges of fraud against the CEO.

No one said this was going to be easy, but, it certainly may well be a real addition to any state's treasury.

June 28, 2014

By Chad Terhune

Fustration and legal challenges (click here) over the network of doctors and hospitals for Obamacare patients have marred an otherwise successful rollout of the federal healthcare law in California.

Limiting the number of medical providers was part of an effort by insurers to hold down premiums. But confusion over the new plans has led to unforeseen medical bills for some patients and prompted a state investigation.

More complaints are surfacing as patients start to use their new coverage bought through Covered California, the state's health insurance exchange.

"I thought I had done everything right, and it's been awful," said Jean Buchanan, 56. The Fullerton resident found herself stuck with an $8,000 bill for cancer treatment after receiving conflicting information on whether it was covered....

My experience with United Healthcare in 1997 was an example of how they attempt to avoid paying legitimate claims. I suffered an accident regarding my face and had to go to the emergency room. My policy required me to pay $50.00 for an emergency room visit. 

I had to endure a surgical procedure to begin to mend from the accident. I was taken from the ER to a surgical suit and then to a medical floor to recover from anesthesia. What made it worse was the day of the week, it was Sunday. An on-call maxillofacial surgeon had to be called in and the surgical staff as well. It slowed things down a bit. But, even with all that I was discharged from an ER eleven and a half hours later. 

United Healthcare refused to pay the claims. I paid the $50.00 deductible to the hospital and the physicians and anesthesia nurse continued to advocate for payment. They stated they knew it was covered. I provided them a copy of the insurance policy.

Within the policy it clearly stated any ER visit would remain same until 23 hours after ER entrance of the patient. I was well under 23 hours and the surgery was an emergency measure. I had to file a complaint to the state insurance commissioner via USPS Certified Return Receipt. I sent a copy of the complaint to United Healthcare with the same mailing certification. Two days after mailing I received a phone call from my oral surgeon's office stating the claim had been paid in full. End of discussion.