Insured, but claim can be denied for recreational injury
Legislation to Protect Health Insurance Benefits for Motorcyclists Introduced in Congress
Business Wire
April 2, 2007
U.S. Congressmen Michael C. Burgess, M.D. (R-TX) and Bart Stupak (D-MI) have introduced bipartisan legislation to stop insurance companies from denying payments for injuries incurred while participating in certain legal recreational and transportation activities, such as motorcycling and riding all-terrain vehicles (ATV). Identical legislation has been introduced in the Senate by Senators Susan Collins (R-ME) and Russ Feingold (D-WI).
The legislation (H.R. 1076, S. 616) would close a loophole created by the Department of Health and Human Services’ regulations implementing the Health Insurance Portability and Accountability Act (HIPAA) of 1996. As written and implemented, the regulations provide that an employer may not refuse health care coverage to an employee on the basis of participation in recreational activities, but may deny health care benefits if the employee is injured while participating in these activities.
The current regulations would allow health insurers to deny payment for injuries sustained by motorcyclists and ATV riders despite the fact that the individual carried health insurance. This clearly contradicts the intent of the regulation, which was meant to ensure nondiscrimination in health care coverage. This legislation would reinstate the original intent and close the loophole that unfairly discriminates against motorcyclists, ATV riders and other recreationists.
http://insurancenewsnet.com/article.asp?n=1&neID=20070402290.2_1d780008c2416e26
Comment:
By Don McCanne, MD
Think about this for a minute. Private insurers have found a loophole that would allow them to refuse to pay for medical care for an individual for whom they have provided coverage and collected premiums. They don’t even have to refund the premiums. They merely make an arbitrary judgement that their insured shouldn’t have engaged in hazardous recreation, and decide that they shouldn’t have to pay for care for injuries that result from those activities.
Where next? Reject claims for sexually transmitted diseases? Obviously they result from very hazardous activities. And lung cancer or emphysema in smokers? Or HIV infection in individuals with chemical dependencies? Or pregnancy - which, of course, is preventable? Or obesity, diabetes or heart disease in individuals who placed themselves at greater risk by falling short of engaging in an optimal level of exercise?
Looking for loopholes to get out of paying claims for legitimate medical services is a behavior unique to the private insurance industry. That would never happen with Medicare; nor would it happen with a national health insurance program that covered everyone.
Why do we continue to reward the private insurance industry so handsomely for excessive administrative services designed to defeat the very reason for their existence - paying for health care? More importantly, why are we even listening to policymakers who insist in including these thieves in their models of reform?