Thanks to Obamacare, the quality of many Americans’ current healthcare is gradually declining. A story that made national news described how children “are being denied specialty treatment by insurance providers on the Washington Health Benefits Network.”
Administrators at Seattle Children’s Hospital said in January they predicted this would happen, and it’s even worse than they expected. Patients being denied specialty treatment at the hospital by insurance providers on the Washington health benefits exchange. Children’s filed request on behalf of 125 of their patients. Of those, they say they got only 20 responses, eight of which were denials.
Dr. Sandy Melzer says all this comes after reassurances of certain unique specialty cases would still be covered: “Well, some of the patients who were denied are ones who clearly would fall into that unique category. A two-year-old with new significant neck mass that was being evaluated for infection or malignancy, an older child with a chronic severe medical condition requiring multidisciplinary care here, a baby that had a skull abnormality.” Children’s went ahead and treated those cases anyway, but Dr. Melzer said they can’t afford to keep doing that it way.
Now, the hospital is suing.
Seattle Children’s Hospital is taking legal action to correct a “false promise” of Obamacare. With only two out of the seven plans offered under Washington State’s health-care exchange covering treatment at the hospital, one of the state’s key providers of specialized pediatric care, it will sue the state’s insurance commissioner for “failure to ensure adequate network coverage.”
“The exclusion of a major provider like Seattle Children’s for a major insurance network in this market is unprecedented,” said Dr. Sandy Melzer.
For instance, CBS reported that four-year-old Kate Fink was denied coverage at the hospital for a ruptured eardrum because the plan her family purchased on the exchange didn’t include Seattle Children’s in its network. The insurance company originally authorized treatment for the girl at the hospital, but the family found out four days later the decision had been reversed because the hospital was out of network. Melzer said this was not an isolated incident.
“We’re seeing denials of care, disruptions in care. We’re seeing a great deal of confusion and, at times, anger and frustration on the part of these families who bought insurance thinking their children were going to be covered, and they’ve found that it’s a false promise,” he said.
For the time being, Seattle’s Children Hospital is paying for coverage for 200 families like the Finks, but those families may be on the hook for bills down the road.
“While many are quick to blame insurers, the real culprit is the Obamacare provision under which health insurance exchange bureaucrats are excluding insurers who offer policies deemed to allow “excessive or unjustified” health care spending by their policyholders,” say Burke Balch and Jennifer Popik of National Right to Life.
“Under the Federal health law, state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers … based on a pattern or practice of excessive or unjustified premium increases.” The exchanges not only exclude policies in an exchange when government authorities do not agree with their premiums, but the exchanges must even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount,” they explain.
They conclude: “This evidently is creating a “chilling effect,” deterring insurers who hope to be able to compete within the exchanges from offering any adequately funded plans that do not drastically limit access to care. When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less–or nothing–for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.”