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Eric T. Schneiderman

Eric T. Schneiderman

Posted: November 6, 2009 01:59 PM

Ian's Law: Protecting Patients From Insurance Industry Abuses

What's Your Reaction?

This week, I proudly introduced Ian's Law in the New York State Senate to protect patients from egregious insurance industry practices. Among other things, it makes it illegal for insurers to drop entire classes of insurance as a pretext to deny coverage to individual policyholders.

Here is a clip of the story from CNN:

The bill is named for Ian Pearl, a 37-year-old man with muscular dystrophy who lost his insurance when Guardian terminated the entire class of policies in the State that covered Ian and others. Mr. Pearl became ventilator-dependent in 1991 and relies on a skilled nursing benefit under his insurance policy to receive care that has kept him alive since he suffered respiratory arrest.

An internal document from the insurer, released as a result of a legal challenge, showed that company officials justified dropping the entire line of policies statewide in order to get rid of "the few dogs", like Ian Pearl.

The practice of terminating an insurance policy line as a pretext to dropping coverage for individuals who need it most is not only absolutely disgraceful - it's a matter of life and death. This bill holds the insurance industry accountable and protects patients like Ian - and other individuals who have paid for insurance coverage - from being thrown off when they get sick.

Ian's Law requires insurers to prove they are not dropping a line of coverage as a pretext for dumping an individual policyholder. That means:

* Insurers must get permission from the Insurance Department to drop a line of coverage - and notify impacted policyholders when they apply.

* Insurers must show the following to the Insurance Department: the claims and premium rates for each policy issued in the class, the historical profits and losses for the line of policies, and any other information requested by the Department. The Department must look at this information to determine if the dropping of a class of policies statewide is merely a pretext for dropping coverage of a particular individual.

* Policyholders are given an opportunity to comment on the impact of the dropped policies, and the Insurance Department must take these comments into account.

Ian's Law also empowers consumers to challenge insurance companies in court if they discontinue lines of coverage in violation of the new law. In addition, policyholders with severe disabilities will receive at least 18 months of coverage if they lose their policies due to the cancellation of a class of policies. (Current regulations require such care for only 12 months.)

These people are not dogs, they are the struggling families behind the paperwork, and we have a moral obligation to protect them from abusive insurance industry practices.

While I strongly support the federal health care reforms that include a robust public option, the states much do much more to protect people like Ian from these abhorrent practices. With New York leading the way, I am confident that we will pass these laws across the country.

 
 
 
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07:01 AM on 11/07/2009
Well that sounds all well and good Eric as long as there's a way to pay for a class of policyholder who can literally bankrupt a health insurance provider. We have no idea of future epidemics or treatments for existing diseases that will create $1 million/year patients in the system. In Mr. Pearl's case, when he was diagnosed with his condition, he had the option of being treated at a specialty facility or round the clock in-home care one would expect from a person worth $100s of millions. He chose the latter at the enormous cost of fellow policyholders. If 1 in 1000 policyholders were in this category that required this extraordinary care, then those other 999 policyholders would have to pay an extra $1,000 in yearly premiums to make up the cost. Perhaps in 8 years, that would go up to an extra $2,000...

You get the point. Maybe 10 years from now there will be treatments to benefit the quality of life of those with autism at a cost of $1 million per patient, and if you take the rate of those who are born with autism (1 in 100), you can see that would add $10,000 in added premiums per person. Countries who provide "free healthcare" more and more and going to run into this enormous ethical challenge as the stem cell and biotech research Democrats rallied for in 2004 find more treatments for diseases, and your solution will only exascerbate this fiscal problem.
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tonedef
Tragically, my micro-bio remains empty, soulless,
01:09 PM on 11/09/2009
The insurance companies can afford it easily. They can afford ten times that much easily. No sympathy for these companies - and it shouldn't cost other policyholders a dime. It should come straight out of the ridiculous profits that insurance companies make across the board.
05:28 PM on 11/06/2009
Thanks to New York State Senator Eric Schneiderman for taking action where others wring or throw up their hands.
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tonedef
Tragically, my micro-bio remains empty, soulless,
01:10 PM on 11/09/2009
Agreed. States can pioneer a lot of social justice that the Federal government seems to keep bypassing.