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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Insurance


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"The business of insurance is regulated principally by the states. Each state has an insurance official who is charged with overseeing the solvency of insurance companies doing business in the state as well as their rates and market practices. Insurance regulation has been subject to increasing external and internal forces in recent years which have forced the states to respond. Fundamental changes in the structure and performance of the insurance industry have complicated regulators' jobs. Competitive pressures have caused insurers to assume greater risk in order to offer more attractive prices and products to consumers, resulting in larger and more frequent insurer failures. Insurance markets have increasingly become national and international in scope as insurers have widened the boundaries of their operations. High costs in some lines of insurance and natural disasters have intensified political pressure to constrain insurance prices and maintain availability of coverage.

The increase in insurer failures and other market problems have raised serious concerns about whether state insurance regulation is adequate to protect consumers. Congressional investigators have questioned whether the states are able to effectively regulate a diverse and global insurance industry (GAO, 1989 and 1991). A report issued by the House Energy and Commerce Committee in 1990, then chaired by Rep. John Dingell (D-MI), criticized state insurance regulators for: lacking adequate resources; using unreliable financial information; failing to coordinate; and performing infrequent and poorly prioritized examinations (Failed Promises, 1990). Various proposals have been offered to impose a greater federal role in areas such as solvency, health insurance, property insurance underwriting and catastrophe insurance. This recent activity is only the latest chapter in a long history of federal-state clashes over the regulation of the insurance industry.

These forces have had a considerable effect on insurance regulatory institutions. Some legislators and insurance commissioners, cognizant of the shortcomings of the insurance regulatory system, initiated a number of significant reforms before critics of the system became aware of the problems. Over the last decade, the states have engaged in an unprecedented program to rebuild the framework for insurance regulation. The lion's share of this effort has been involved in strengthening solvency regulation by establishing more stringent capital standards, expanding financial reporting, improving monitoring tools, and certifying insurance departments. Other initiatives are underway to improve the efficiency of agent licensing and the regulation of rates and policy forms and to expand consumer protections against market abuses. State insurance departments have greatly increased their resources in terms of both people and technology to support these efforts." Insurance Regulation in Transition

ADDITIONAL ARTICLES:

Document Name & Link to Document

Description

File Size /Type

Adolescent Confidentiality and privacy Under HIPAA Adolescents are more likely than adults to have their state-protected right to medical confidentiality violated by providers or insurers 281 kb pdf

An Introduction to Diagnosis-based risk adjusters

 Report for Adjusters for insurance companies

 363 kb pdf

Catholic Health Association of Canada Calls on Government to Compensate All Who Contracted Hepatitis C from Tainted Blood

The CHAC, in union with many other Canadians, strongly urges the federal government to initiate action, with the provincial governments, to provide just, compassionate and prompt compensation for all people who have contracted hepatitis C from tainted blood because of the failure of government to adequately regulate blood safety

 

Claims Against Insurance Companies for Fraud & Bad Faith Insurance companies nationwide have begun using claims handling practices that are aimed at cost containment and building claims profit. This means the insurance companies design practices aimed at delaying the payment of claims and underpaying the fair claim value of a given claim. This is not an ethical practice and violates all insurance industry customs and ethical principles of the insurance industry.  

COBRA: Extending Your Employer-Based Health Insurance

COBRA is a federal law that requires employers to allow employees and dependents losing health insurance to stay on the employer’s plan

 

Congressional members with ties to Pharm. companies The pharmaceutical industry is the most powerful
special interest in Washington. They not only have the money to hire 300 lobbyists on Capitol Hill, contribute $9 million to both political parties and spend tens of millions on advertising, but they have been also to put a number of former FDA commissioners on their payroll
 
Delays, Denials & Deceptions-The truth about LTD insurance Claimants who succeed in the battle for benefits tend to be savvy, articulate and persistent individuals with the resources to obtain sophisticated medical evidence and aggressive attorneys. Poorer, older, less-educated and extremely ill claimants seldom fare as well. The sickest and least privileged among us may be easily brought down by insurance company employees who find them fair game for harassment, deception and intimidation.  

Direct cost of follow-up for Percutaneous and Mucocutaneous Exposures to At risk Body Fluids

Report by the International Health Care Worker Safety Center

48 kb pdf

Directions in HIV Service Deliver & Care for People with HIV/AIDS-The Role of Legal Services In this report, we first describe the methods used to gather information about the legal needs of people with HIV/AIDS and the legal services available to them.  In the findings section, we share what we found out about how legal services help HIV/AIDS clients access and maintain health care.  We look in detail at how legal services help people with HIV/AIDS overcome barriers that directly impede their access to health care.  And we explore the ways that HIV/AIDS-related legal services help clients to meet subsistence needs, thereby keeping them fed, clothed, and  housed prerequisites of good health.   

Disability Income-Insurance Report

Risk Insights-Magazine Articles: Group long-term disability Insurance, Expands Educational program and Training location, Financial Performance of Disability, Disability, Case Management, Income Protection

751 kb pdf

Employer & Union Plan Sponsors: BENEFICIARIES WHO WILL BE AUTOMATICALLY ENROLLED IN A MEDICARE DRUG PLAN AND HOW THEIR RETIREE COVERAGE WILL BE AFFECTED These individuals may have to choose between remaining enrolled in a Medicare drug plan and losing their (and their spouse’s and dependent’s) employer/union coverage, or keeping their employer/union retiree coverage and opting out of the Medicare drug plan in which they were automatically enrolled even though the Medicare drug plan provides comprehensive drug coverage at minimal cost.  
ERISA Disability Litigation How To Sue Your LTD Insurance Carrier In United States Federal Court Without an Attorney This report is oriented to those persons who are disabled by Chronic Fatigue and Immune Dysfunction Syndrome (a.k.a. CFIDS, CFS, M.E.) and other so called "self-reported conditions" such as Fibromyalgia Syndrome (FMS) and Multiple Chemical Sensitivity (MCS) who must sue to recover long term disability benefits from employee benefit plan providers (insurance companies).  

Financial and Risk considerations for successful disease management programs

Report for insurance industry

211 kb pdf

General Rules About Patient Confidentiality 

This from perspective of an injured workers' advocate:  The confidentiality issue is generally state-law specific, either in the state's WC law itself or other legislation/common law precedent regarding patient privacy.  In our State (NC), WC law provides that the employer or its carrier, usually, is entitled to clinic notes, lab data, from MD treating the work-related injury if it/they are paying compensation, including medical, to the IW.

 

Hepatitis C Virus report for insurance companies

Healthcare workers, public safety workers, and law enforcement workers deserve and should demand protection from exposure to Hepatitis C Virus

417 kb pdf

Healthcare Cost of Hepatitis C-infected Members in a Managed Care Organization

There was a significant patient outlier that had total medical costs of $881.933.  The majority of these costs were related to home care.

 

HIPPA Nondiscrimination Requirements

Summary of the HIPPA law

50 kb pdf

HIV Testing and Confidentiality: Final Report

In Canada, AIDS was treated as notifiable in British Columbia beginning in 1983 under a provincial regulation requiring physicians to report a communicable disease "which becomes epidemic or shows unusual features."1112 AIDS and sometimes HIV was subsequently made notifiable or reportable by legislative amendment in all provinces and territories. Some provinces and territories require nominal reporting of AIDS and sometimes even HIV, while in the others reporting is non-nominal

 

Insurance claims-1998 Legislative Outlook

Current Issues in Employee Benefits

151 kb pdf

Insurance company-tracking claimants

Web site for this company and the benefits that it provides the insurance industry

 

Insurance Privacy Rules

Report for insurance industry on GATT Benefits

336 kb pdf

Legislative Survey of State Confidentiality Laws, with Specific Emphasis on HIV and Immunization This report examines current state and federal law protecting the confidentiality of health information. It focuses on four specific areas: public health information held by government, privately held health care information, HIV and AIDS-related information, and immunization information.
The ways in which our modern medical and public health systems collect, store, and use personally identifiable information have increased both the potential benefits from access to such information and the possible harms from improper uses and disclosures. The report examines the importance of both the collection of health information and the protection of its privacy. The collection and use of health information involves two important goals
 
Medical Malpractice THE PROFESSIONAL-PATIENT RELATIONSHIP (it is a question of law that the court will have to decide early in the case) The threshold question is whether the doctor had a relationship with the patient sufficient to create a duty. A physician relationship is usually a prerequisite to a professional malpractice suit against a doctor. Insurance coverage examination usually creates no duty. Workplace examinations may give rise to a P/P relationship.  
Mental Illness-Disability insurance Claims Not only are mental illness disability claims expensive and complex; they can also take years to resolve.  In this environment of ever increasing mental illness diagnoses, only those with a complete understanding of current treatment protocols, the most recent cases and the latest rehab strategies for getting mental illness claimants back to work will be positioned to lower the payment costs and litigation risks of these claims 267 kb pdf
Mix-up breaches confidentiality of dozens in state AIDS program The state Department of Health Services inadvertently revealed the names and addresses of up to 53 Californians enrolled in an AIDS drug assistance program to other enrollees by putting benefit notification letters in the wrong envelopes, officials said Friday.  

National Health Interview Survey (NHIS)

NHIS survey

178 kb pdf

Perspective-magazine: health care fraud

Mid-way through article: Corporate Healthcare Fraud

346 kb pdf

Proposed Rules Revising Medical Criteria for Evaluating Immune System Disorders Pre-test Public Health Counseling vs. Informed Consent Law—View from the AIDS Coordinating Committee Pdf 152

Provider Excess Insurance

Report for the insurance industry

462 kb pdf

Release of Behavioral Health, Developmental Disabilities, HIV, and Substance Abuse Information: Guidelines for Legal Compliance Hospital, physician practices, and other health care facilities are repositories for much medical information.  Safeguarding the confidentiality of such information is a significant issue for any hospital or other health care entity that keeps patient medical records to maintain patient confidence and to avoid liability.  Because damages could ensue should inappropriate disclosure occur, patient records containing behavioral health, developmental disabilities, HIV, and substance abuse information must be handled with special attention, in accordance with state and federal laws, rules, and regulations.  Individuals involved in health information management should be well-informed about patient confidentiality requirements overall and should also track these areas carefully to develop and implement appropriate policies and procedures governing the release of patient information 50 kb pdf

Risk and Management of Blood-Borne Infections in Health Care Workers

Report in ‘Clinical Microbiology Review"

354 kb pdf

Structural Change & Regulatory Response in the Insurance Industry

The business of insurance is regulated principally by the states. Each state has an insurance official who is charged with overseeing the solvency of insurance companies doing business in the state as well as their rates and market practices. Insurance regulation has been subject to increasing external and internal forces in recent years which have forced the states to respond. Fundamental changes in the structure and performance of the insurance industry have complicated regulators' jobs.

 

Subjective Symptom Disability Claims-CFS, FMS, and MCSS We do warn readers, however, that calling Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical Sensitivity Syndrome "subjective symptom disabilities" can be a bit misleading -- as Altzheimer's Syndrome can be diagnosed without having to perform a brain autopsy, these serious (and overlapping) physical conditions are in no way "subjective" themselves (that is, all in the experience of the patient) -- all three produce verifiable physical symptoms that can be recognized by a physician with up-to-date information about these disease syndromes. However, there are no objective tests approved by the CDC or the FDA as "proof" that a patient has any one (or more) of these three disease syndromes. That is not quite the same thing as saying the symptoms are entirely subjective, and the reader must take care not to form the impression that these diseases are diagnosed by patient self-description alone: they are not. To repeat: the problem is that there is no "marker" (such as deterioration of the myelin sheath that appears in the spinal fluid of an M.S. patient) that can "prove" definitively whether or not a patient has CFS, or FMS, or MCSS. The insurance companies are saying, in effect, that until such a marker is found, patients who are sufficiently unfortunate to suffer from these diseases are not insured under regular policies.  

Tampering With Prescription Drugs?

Some prescription drugs are tampered with as they pass through several middlemen on their way to the local pharmacy, reports 60 Minutes correspondent Bob Simon. What’s more, if the drugs’ manufacturers find out, they are not required to tell patients or the FDA that the drugs could be dangerous.

 

The Hepatitis C Epidemic: Looking at the tip of the Iceberg

Report for insurance industry on Hepatitis C Virus

445 kb pdf

The Hepatitis C Epidemic:
A Significant Risk for Workers’ Compensation

The Hepatitis C Virus epidemic brings large risks to workers’ compensation programs and requires new risk management techniques. The workers’ compensation industry has generally not recognized these risks, although it is becoming aware of the new challenges that the Hepatitis C Virus epidemic brings. There is much uncertainty about employers’ and insurers’ liabilities for Hepatitis C Virus-infected workers. The authors intend that, by presenting the results of our actuarial analysis, this report will help define the issues and that our recommendations will reduce the industry’s long-term financial exposure.

 

The Myth of Workers' Compensation Fraud In recent years, the insurance industry's focus on cheaters and malingerers helped push through national workers' compensation reform, a profitable cost-cutting campaign supported by outrage over alleged abuse of the system. The problem, however, is that the fraud image is false for the vast majority of workers' compensation cases. Studies show that only 1 to 2 percent of workers' compensation claims are fraudulent. Certainly, the tens of thousands of workers killed every year were hardly aiming for a free ride on their employer's tab.  

The Other Drug War

Pharmaceuticals’ 625 Washington Lobbyists

318 kb pdf

Winning Affordable Medications for all Americans

Testimony of Alan Sager

27 kb pdf

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