1.
Computers. I would like to say tat my Vista computer problems are easing....but that would be a lie. I did have enough crash free time yesterday to balance our checkbooks/bills in Quicken (all 3 months dating back to when my older computer died). This means that - once again - I am not online or reading mail.
2.
Healthcare. One issue that has been overlooked - until recently - in the healthcare debate is how certain federal laws already give health care insurance companies and employers wide discretion to deny health claims with little or no penalties.
Under ERISA (a law created in the 70s to protect pensions and retirement accounts), health care plans funded by employers face no penalties or liability if the employer hired claims administrators falsely deny a health care claim. In fact, if you were to sue you would have to prove that the claims administrator acted arbitrarily and capriciously. In laymen's terms this means you will need to find a memo that says:
"I think we should deny this claim because I think the person is really a donkey in disguise and we don't insure donkeys." The memo that says:
"We can deny this claim even if we have objective medical evidence to support it because (a) we were able to find one doctor in the world who agrees with us and (b) this is an ERISA claim. In fact, thank God this is an ERISA claim 'cause if this were any other claim we'd have to pay it.." Well that memo would not help you win your case. And yes there have been those memos.
Currently 170 million Americans get their health care insurance from employers. Many employers over 5000 workers are "self funded" - that means the employers pay the claims costs and they hire the United Health Cares and the Kaisers and the other insurance companies to administer the claims (for a transaction fee). The claims administrators use their own insurance claim guidelines and also negotiate fees with the hospitals and doctors on behalf of everyone - both the insurance carriers own clients and the employees covered under the 'employer plan.' But the money to pay for the employee medical bills comes from the employers. Thus, your claim is subject to pension and retirement laws - not bad faith insurance law.
If you buy health care insurance on the open market (or if your employer does), then it falls under insurance state laws. if the insurance company wrongfully denies your health care claim under state insurance law, you can sue and get penalties and recover for the loss of life. Or recover damages to pay for your loved one's ongoing medical care if the person is injured or made more ill because of the claim denial.
Under ERISA all you get is the value of the health care benefits that were denied. If you're dead....well, no need for that health care.
So when you hear pundits talk about doing away with those pesky state laws that make it so hard for health care insurance companies to do business across state lines ..or pundits talking about changing the laws to make certain that *all* employers won't be required to abide by state health care insurance laws...they're talking about extending ERISA to privately purchased health care plans.
Check out your employer health care plan and remember... your health care is already being rationed and if you have employer funded health care insurance, well you're already living under a different 'standard of care.' ... More
here and
here
[A Dreamwidth post with
comments | Post a Dreamwidth comment| How to use OpenID]