On August 3, the American Psychological Association (APA) released an analysis of the profits that insurance and managed care companies can generate by investing the money saved while denied claims are in appeals process. The analysis found that they could generate interest income of up to $280 million each year if as few as one percent of claims are denied and then reversed following an independent review process.
"While an independent review process may reverse inappropriate denial of services, there are no incentives to insure that correct decisions are made by the managed care company to begin with. In fact, there is a considerable financial incentive to deny care and simply assume an incorrect decision will be overturned later. Holding insurance and managed care companies legally accountable for inappropriate denials is one good way to ensure a correct decision about care is made at the start," says Russ Newman, Ph.D., JD, executive director for professional practice at the APA. "Those opposed to health plan accountability stay focused on the claim that costs will increase' if patents have the right to sue for denied care. "What they don't tell you about is the money they stand to make by simply denying a claim and waiting for the review process to overturn the decision."
Patients must have the right to sue for coverage that is denied. It is the only incentive health pans would have to do what is right for consumers. In the 2000 elections we must support those elected officials and candidates who will fight to insure that we are protected.
One Example of Government working for you
On August 16, 1999, Ohio's Supreme Court struck down a legislative attempt to limit the damages injured citizens could recover in lawsuits, holding that the "tort reform" bill passed by the state legislature was unconstitutional. The Ohio constitution provides that: "All courts shall be open, and every person, for an injury done him in his land, goods, person, or reputation, shall have remedy by due course of law, and shall have justice administered without denial or delay." And "[t]he right of trail by jury shall be inviolate."
When the legislature, in their latest insurance industry-big business backed tort reform bill, appeared to ignore the court's previous rulings that said that limiting your access to the courts was unconstitutional, it incurred the wrath of the court. Justice Alice Robie Resnick wrote the Court's opinion, saying the bill marked "the first time in modern history that the General Assembly has openly challenged this court's authority to prescribe rules governing the court's of Ohio." She added that the court alone should determine whether any laws violate the constitution and that "the people can never be secure under any form of government where there is no check among several departments."
High school civics classes have long taught us about our "checks and balances" system in government, whereby the different government branches have the ability to make sure that one of the other branches does not extend their prescribed authority or abuse their power. In this very instance, Ohio's Supreme Court exercised a sorely needed check on an out-or-control legislature that had pandered to the special interests of big corporations and the insurance industry at the expense of Ohio citizens.
The legislature passed the misguided "tort reform" bill because they believed that "horror stories" that the insurance industry and corporations were telling of a court system that was out of control, hampered by frivolous lawsuits, and a lottery for folks like you and me. According to their "stories," you would have thought that huge punitive damage awards are handed out every d ay, when in fact a study found that only 364 of 762,000 cases resulted in punitive damages, or 0.047 percent. If you believed their stories and propaganda, you would have thought that more and more liability claims are filled every year, when in fact a study of 16 states showed that the number of liability suits has declined by 9 percent since 1986. If you believed the "tort reformers" you might think that the McDonald's coffee drinker laughed all the way to the bank, when in fact she was an 81 year old grandmother who suffered serious third-degree buns from the scalding coffee and she settled for about $600,000 after a judge reduced the jury award.
The "tort reformers" have not given up, even though "their" legislation has been declared unconstitutional. Legal scholars, political scientists and consumer advocates have concluded that the picture they are painting is distorted. Now they are attacking the very Supreme Court Justice who in writing the Court's decision performed her constitutional duty to protect Ohio citizens. They are now spending thousands of dollars to run radio ads criticizing Justice Resnick (who will not be up for reelection for another 12 months) and the Supreme Court.
We should all be proud of the four members of our state's highest court who stood firm against powerful corporate interests and defended our individual, constitutionally protected rights!