Much ado about nothing Featured

9:53am EDT July 22, 2002

As a manager, if I make a decision that endangers a worker’s health or safety, I hold part of the blame for any resulting injury suffered by that worker. If I were a health insurer, however, and I made a decision that adversely affected the health of a policyholder, apparently there would be no legal consequence of my actions.

That’s what some state lawmakers were telling us would happen if House Bill 4 passed through the Ohio Legislature without reinserting a provision that specifically gave patients the right to sue their insurance companies over treatment decisions and coverage disputes. What hogwash!

Where is it written that a health insurance company can’t be sued by a patient? It’s been done before in courts all across the country, and I’m sure it will happen again, regardless of what Ohio’s so-called “Patient Protection Law” now says. Anybody can sue anybody else for just about anything these days. They don’t need a state legislature to give them permission.

Now, as many of you know from my past columns, I’m not one to advocate lawsuits. I tend to believe our society has become far too litigious and that there are often more constructive — and less expensive — methods to resolve such differences.

The state legislature has set forth such an alternative in House Bill 4. An external review process was included in the version of the bill passed in June, allowing patients involved in a dispute over the medical necessity of a treatment to have an independent medical panel or physician determine whether coverage is appropriate.

While that’s all well and good, it does not specifically preclude a patient from taking his or her insurer to court if the external review process does not yield a satisfactory result. If it did, I’m sure the courts would find House Bill 4 unconstitutional in and of itself.

After all, doctors can be sued for malpractice. So why not insurance companies? It’s essentially the same thing if a patient is denied coverage for a medically necessary, physician-recommended treatment and, as a result of not receiving this treatment, the patient’s condition worsens or even leads to his or her death.

Negligence ought to be punished. And as for those who fear health insurance rates will skyrocket under the threat of patient legal action, insurers will only realize additional expense if they, in fact, have been acting with negligence.

The insurance business, by definition, is risky and potentially quite costly. Insurers unwilling to take on the risks inherent to their business ought not to stay involved in health insurance. It’s not just about making money. It’s about making money in a responsible fashion.

Good health care isn’t cheap. It never has been. That’s why people buy insurance. An insurer is supposed to act in the best interests of its policyholders — not just its shareholders. When that doesn’t happen, that insurer will wind up in court. And that’s going to happen whether or not the state legislature says it can.

Nancy Byron (nbyron@sbnnet.com) is editor of SBN Columbus.