Rep. Clem's mother-in-law: "Hey Regence, I'm not dead."

Chip Shields

Rep. Clem's mother-in-law: "Hey Regence, I'm not dead."

Azusa Suzuki, Carol Suzuki's mom and Rep. Brian Clem's mother-in-law, testified in my committee today to tell Regence Blue Cross Blue Shield of Oregon that she is not dead yet.

Regence denied her major medical claim on the basis that she was dead. For five years she gave evidence to the contrary and they still wouldn't pay. She was testifying in support of SB 719 in my committee, which would remove the exemption that insurance companies enjoy from the state's Unfair Trade Practices Act.

What do your think? Should insurance companies be subject to the state's Unfair Trade Practices Act?

Comments

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    Everybody should give Regence a call and tell them that they are not dead yet.

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    I'm pretty sure there's a Monty Python skit somewhere in there. It would be funny if it were not so tragic. I'm sure Ms Suzuki's problem will now be promptly fixed by Regence, but every day thousands of Americans face similar problems with their insurors. What recourse do people who are not the mother-in-law of a state legislator have short of passing SB 719?

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      I'm pretty sure there's a Monty Python skit somewhere in there. It would be funny if it were not so tragic.

      I had the same exact reaction Sal.

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    Chip, they can't make such enormous profits and pay their CEOs such lavish salaries, and pass profits to shareholders if they pay every friggn" claim! What would happen if customers exploited every loophole, dodged every obstacle and penetrated the bureaucracy? Isn't the job of an insurance company to help "our people?"

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    I'm sure Ms Suzuki's problem will now be promptly fixed by Regence

    Actually, no.

    According to her testimony, Regence refused to fix it. It's been over five years now.

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      Corporate execs tend to respond to this kind of public exposure in much the same way that roaches tend to scatter when you shine a light on them.

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    I would laugh and think this was a Monty Python skit, were it not really and on a serious subject.

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      "not real" (damn auto-correct).

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      The Regence effort to claim Rep. Clem's mother is dead may go down in history as being as stupid as the move by the Allegheny Airline flight attendant who said the plane was overbooked and kicked Ralph Nader off.. . . leading to the FAA rule that you now must be offered money or free flight.

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    Absolutely -- insurance companies are getting a free pass now. I know many families with Autism who are being illegally denied medical coverage, which should be guaranteed by Mental Health Parity -- but have no way to enforce their rights. One family did spend $300,000 in legal fees to successfully win a court order for reimbursement of $30,000 in autism-related medical costs (McHenry v PacificSource), but most of us don't have the resources to do that. Minnesota has this kind of law already, and the Attorney General there has been very successful in enforcing the rights of common citizens to have their insurance claims honored.

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    Would the bill to make the insurance companies subject to the Unfair Trade Practices Act give the Insurance Division enforcement power? Or whom else?

    One of the highly touted of the recent federal PPACA health care reform was that is supposedly bans unfair "recisions" (cancellation of coverage) when patients make expensive claims, except on the basis of fraud or misrepresentation. However, that's not that different from the current situation -- recisions generally are based on insurer claims of misrepresentation, often involving issues not related to the claim in question.

    This is just one example of potential unfair trade practices in health insurance.

    PPACA is not self-enforcing. Enforcement will lie with the states which regulate insurance.

    I think insurance companies should be included under the Unfair Trade Practices Act just on principle, but wonder if the existing terms of the Act or special provisions in SB 719 relating specifically to the insurance trade will provide the Insurance Division with the power it needs to enforce the "patient protection" parts of PPACA?

    If not, we may need additional legislation.

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    There was a really interesting point made yesterday at the hearing that I think needs to be emphasized. The insurance companies were saying "people can always sue for breach of contract", BUT it was noted that if you do that, you can't recoup legal fees. Only actual damages. Putting it into the UTPA would allow you to get legal fees covered. That's key because the cost of litigation is not cheap.

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    If Insurers were regulated under the Oregon Unfair Trade Practices Act, would that also mean they can no longer quote benefits to patients or providers and then claim they have no obligation to honor their own quoted benefits? I would LOVE that. If Nordstrom's misprices something, they can't come back to me after I have purchased it and claim that they charged me the wrong price. However, insurers do this ALL THE TIME -- telling patients (and doctors) that certain doctors are in-network and their services will be paid under the in-network benefit. Then they turn around & claim that is not so.

    Recently have had several insurers pay at the in-network discounted rate, while charging the patient the out of network deductible. Sounds like double-dipping to me, yet we can't get them to stop because they are exempt from any laws that would prevent this.

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    My guess is that Regence will fix this one issue, since it's had some sun shining on it thanks to Ms. Suzuki's testimony, Rep. Shield's blog post, the Oregonian's mention, etc.

    Then Regence will issue a statement about having the highest standards for customer care, yadda yadda. But they will continue to throw everyone else under the bus.

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