Fw: Dr. Kolb on: Cosmetic surgery is the example used for exclusions in insurancecoverage.

[Guest guest]

From: " ilena rose " <ilena@...>

Sent: Tuesday, July 31, 2001 1:52 AM

Subject: Dr. Kolb on: Cosmetic surgery is the example used for exclusions in

insurancecoverage.

> " Dr. Kolb " <drkolb@...> wrote:

>

> In my experience precerting explants for silicone disease, most companies

> still cover the surgery including Medicare and Medicaid if certain

criteria

> are met. A few insurances exclude complications of cosmetic surgery such

as

> some BCBS plans, Champus and Humana. You should look in your insurance

> contract for this exclusion prior to seeing a doctor and if you have it

you

> should consider your option of changing insurance companies to one that

does

> not have this exclusion. .

>

>

>

>

> ----- Original Message -----

> From: ilena rose <ilena@...>

> <Recipient List Suppressed: ;>

> Sent: Sunday, July 29, 2001 7:19 PM

> Subject: Cosmetic surgery is the example used for exclusions in

> insurancecoverage.

>

>

> > Ilena,

> >

> > Article uses " cosmetic surgery " as an example of exclusions of coverage

> > in insurance plans. No doubt this is due to the increase of

> > complications resulting from cosmetic surgery. Do you know the

percentage

> > of policies that now specifically exclude it? The additional five

> > surgeries that I required were covered (at least up until 1994,) but

> > complications such as mine were eliminated from the plan altogether.

The

> > policy was also revised to specifically disallow short and long term

> > disability compensation for leave as a result from cosmetic surgery.

> >

> > flamingo2001@...

> >

> >

> > http://www.dallasnews.com/national/430672_patients_29nat.html'>http://www.dallasnews.com/national/430672_patients_29nat.html

> >

> > Suing in state courts central to patients' rights debate

> >

> > Plans offer more options for treatment and denied-claim appeals

> >

> > 07/29/2001

> >

> > By Anjetta McQueen / Associated Press

> >

> >

> > WASHINGTON - Consumer-friendly. Generous jury awards. That's what state

> > courts have become known for - and it's why they have emerged as a

> > battleground in Congress over how to hold health plans responsible for

> harm

> > to people they insure.

> >

> > Proposals offered by both parties would expand the medical treatments

that

> > health plans must offer their patients. Patients also would have more

ways

> > to appeal plans' decisions to deny coverage.

> >

> > Legislation favored mostly by Democrats would allow patients to pursue

> > legal claims for injuries in either federal or state court.

> >

> > GOP leaders have resisted attempts to push cases into state court. A

1974

> > federal pensions and benefits law confines most cases against HMOs and

> > other employer-sponsored health plans to federal court.

> >

> > For now, federal courts are the main venue to sue over denied care that

> > results in injury or death. Advocates say patients are blocked from

state

> > courts, and therefore unable to seek damages for loss of income, pain

and

> > suffering, or pursue punitive judgments.

> >

> > " A family loses a loved one and gets turned away from state courts;

> another

> > patient loses a limb and their case gets heard, " said Fort Worth

attorney

> > Young, who has sued plans under the Texas law. " Current

law

> > is just too vague. This is the reason we need a good bill. "

> >

> > Nine states have laws allowing patients to sue health maintenance

> > organizations; several dozen more are considering it. Premiums have

risen

> 4

> > percent to 6 percent in most of those states - an insignificant amount,

> > advocates say, but too much, according to opponents.

> >

> > While at least 38 states cap damages in certain cases, opponents worry

> > about the instances where states allow unlimited jury awards against a

> > single health plan or employer.

> >

> > Democrats say President Bush's latest designs for patients' rights would

> > create a shield for employers looking to deny workers' claims as a way

to

> > save money.

> >

> > The president's compromise would steer lawsuits involving HMO care to

> > federal courts, but allow some cases to be heard in state courts -

> > particularly if they apply to the local medical malpractice laws, said

> > sources familiar with the plan, speaking on condition of anonymity.

> >

> > Mr. Bush and other opponents want to let an independent review panel

> > resolve dispute, and worry that would not happen if the Democrats' bill

> > becomes law.

> >

> > Most state laws cannot affect patients in employee-sponsored health

plans

> > protected by the 1974 federal Employee Retirement Income Security Act.

> > Other privately insured people enjoy the full force of the state laws.

> >

> > Courts have allowed some patients to sue HMOs in state court for

> > substandard medical care, such as naming a plan in a malpractice case

> > against a doctor.

> >

> > Yet the ERISA law prevents patients from suing in state court for

coverage

> > decisions; a plan's stated policy not to pay for cosmetic surgery, for

> > example. The bills in Congress would not change that.

> >

> > Supporters of Texas' patients' rights law and the Democrat-backed plan

in

> > Congress argue that health plans that agree to cover a treatment in

> general

> > but reject a doctor's recommendation in a specific case are making

medical

> > decisions, not coverage decisions based on contracts. Patients in those

> > disputes should have the right to go to state court.

> >

> > " There is no point in giving patients rights and then pre-empting state

> > laws designed to enforce those rights, " said Rep. Dingell, D-Mich.

> >

> >

> > ------------------------------------------------------------------------

> > Online at: http://www.dallasnews.com/national/430672_patients_29nat.html'>http://www.dallasnews.com/national/430672_patients_29nat.html

> >

> >

>

>

>