Chico Personal Injury Lawyer - Miscellaneous

Poizner Proposes to Undo Garamendi’s Good

Amber Wheat — Mon, 09 Feb 2009 17:33:17 GMT

When Lt. Governor John Garamendi was California’s Insurance Commissioner, he worked to protect insurance consumers. Among his many causes was that of prohibiting insurers from reducing group disability insurance benefits to account for pensions, workers’ compensation payments, or wages. During his second term as Commissioner, Garamendi tried to stop this practice without regulations in place. He was subsequently sued by disability insurance companies who claimed they could not be held to rules that were not clearly spelled out.

Garamendi drafted the regulations and they were implemented after he left the commissioner’s office. They state quite clearly that pension payments, workers’ compensation payments, and estimated earnings received by a policyholder while they are disabled cannot be taken into consideration to cut the amount of benefits.

California’s current Insurance Commissioner is Steve Poizner, after already starting to undo regulations affecting rates charged for different insurance policies, has now set his sights on these rules that spell out what the disability insurers can and cannot do. He maintains that the Commissioner has the right under the law to restrict the reductions of benefits based on those factors and that a law is not needed. He calls it “red tape” and unnecessary.

Recent history shows that the regulation is necessary to enforce the law. And quite frankly, it seems unfair to make insurance companies follow regulations that are ambiguous and easily changed by the mind of one man. It’s like playing a board game when you don’t know the rules.

For everybody’s sake I hope that the regulations will stay in place. What harm is there in having a clear understanding of the rules? Of course, the insurance companies don’t want the rules spelled out because then they would be expected to follow them. They claim that policies are written based on the additional income... well, they shouldn’t be. If you know you’re not supposed to do something, why do you operate your business as if you’re going to do it anyway? The fact that the law is being enumerated should not change anything, but the insurers claim that rates will go up and many more people will not be able to afford disability insurance at all if this rule is not rolled back.

It is true that we don’t want to have libraries of regulations upon regulations upon regulations, but I how can we expect anybody to follow the law if it is unclear and unspecific? There is a middle road that must be found, but until then, err on the side of caution. I would prefer to know what is legal and what is illegal to make the most informed choices.

Originally posted at InjuryBoard by Amber Wheat

The California Supreme Court on Balance Billing and Healthcare Providers

Amber Wheat — Tue, 13 Jan 2009 12:12:17 GMT

I first heard of balance billing from my mother. I had gone to a doctors appointment, I paid my co-pay, and a couple of weeks later, I got a bill from their office. I asked my mom why I was being charged more money when I already paid my co-pay. “Isn’t the health insurance supposed to pay for the rest?”

We took a look at my statement and, sure enough, the insurance had paid for fifty-five percent of the bill. My mother told me that I may or may not be responsible for the difference in what the doctor thinks he’s owed and the price agreed upon in the contract between the insurance company and the doctor’s medical group. We looked up my policy and because of the type of visit, I was responsible for the balance.

That was my first run-in with balance billing. Then I read a very disturbing article from the Wall Street Journal about how emergency physicians and hospitals are balance billing customers who are not responsible for the charges. This is being practiced throughout the U.S. and many people don’t know that they don’t have to pay. It really depends on your insurance plan. But when it happens, the patients have to not only battle the doctors, but the insurance company as well. People are getting taken advantage of. Emergency patients are often not in any shape to be asking questions and confirming that the doctors who are trying to save their lives are in their networks.

As a legal assistant, I know all too well how expensive some of these emergency visits can get, especially in certain parts of California. Thankfully, California regulators recently made balance billing illegal if the charges were for emergency services and the patient is insured. The California Supreme Court backed up the new regulations in a court ruling that stated “Emergency room doctors may not bill the patient for the disputed amount.” If they want their money, they will have to fight with the insurance company. Fair enough, isn’t that why we have health insurance, so we don’t have to deal with conflicts like this?

There is, of course, a catch. Physician groups are worried about medical care providers who don’t sign up with insurance networks. It is true that they have every right to choose not to contract with health insurance, but does that mean they are precluded from billing insured patients at all? Doctors work hard and hospitals cost money (they don’t grow on trees). Insurance networks only pay a small percentage of what the out-of-network doctor bills (remember the fifty-five percent). How would you like to only get paid half of what you thought you earned?

The New York attorney general’s office is currently involved in an investigation as to how the insurance companies come up with what is a reasonable-and-customary fee. I am truly interested in this because I wonder how much health care really costs. Should doctors really get paid $200 for spending fifteen minutes with me?

Maybe Kaiser has the right idea. An insurance company with their own doctors and hospitals. It seems like a conflict of interest to me, but I still don’t fully understand the relationship between health insurers and healthcare providers. At least with Kaiser, you can be fairly certain that all the doctors are in-network.

Originally posted at InjuryBoard by Amber Wheat

Explosion Injures Pine Grove Man

Amber Wheat — Fri, 26 Sep 2008 18:29:20 GMT

Authorities believe a propane tank exploded when propane vapors were ignited. The fire is still under investigation. The man inside the building suffered severe burns to his head and chest, but is thankfully, alive.

Property owners are warned to keep an eye on propane tanks and to make sure that they are in proper condition. Leaks and damage can cause major damages. If you are the owner of the tank or the land the tank is on, you can be held liable for injuries, property damage, and even emotional distress brought on by an explosion. I don’t know how expensive maintenance on those things are, but I’m sure it is not as bad as it would be if the worst was to occur.

Propane is dangerous, but highly useful if taken care of properly and used responsibly.

Originally posted at InjuryBoard by Amber Wheat