Secret Video Shows Insurance Executives Discussing Lower Standards of Care For Those Who Cannot Sue

Santa Monica, CA — Hidden in a U.S. Senate bill by Senator Michael Enzi (R-WY) establishing federal association health plans is a provision that will strip an individual’s right to sue their insurer, according to analysis released today by the Foundation for Taxpayer and Consumer Rights (FTCR).

The bill, S. 1955, would extend the so-called “ERISA pre-emption” to any individuals who buy health insurance through professional associations. As a result, individuals who purchase these health insurance plans will loose their right to sue for damages if they are harmed by an insurer’s decision to limit access to medical treatments. The legislation would also override hard-won Patients’ Bill of Rights legislation passed in 41 states, state health insurance coverage requirements and other patient protections.

In his book, “Making A Killing,” FTCR president Jamie Court writes about a secret Aetna training video where executives teach new hires to quickly deny insurance claims brought by those who cannot sue their insurer. See chapter 5, page 123-127. The book is available on-line at: http://www.makingakilling.org

According to the video, when faced with claims for identical medical problems, Aetna separates the claims where no damages are available — those subject to the federal Employee Retirement Income Security Act, or ERISA — from non-ERISA claims, where consumers can sue for damages. Click here for more information.

Dana Christensen of Playa Del Rey, California has joined FTCR in opposing S. 1955 (Enzi, R-WY) after an association health plan sold by the National Association of the Self Employed left her with $450,000 in unpaid medical bills when her husband died of cancer. Dana sued her insurer for fraud, and successfully won payment for the unpaid bills and damages for her husband’s pain and suffering. Under S. 1955, people like Dana who purchase individual insurance policies from professional associations will lose their right to recover damages in state courts.

“Without the threat of legal accountability, HMOs and insurers are free to deny access to care with impunity,” said Jerry Flanagan of FTCR. “The biggest threat to the U.S health care system is that the further loss of employer-based care will force more Americans to buy insurance on their own in a market dominated by insurance companies that operate above the law.”

Click here to read a fact sheet on S. 1955’s impact on an individual’s right to sue.

Already, patients who receive health coverage through a private employer cannot sue for damages in state court as a result of a 1987 Supreme Court decision in Pilot Life Insurance v. Dedeaux which concluded that: “State common law causes of action arising from the improper processing of a claim are preempted.” That errant decision found that ERISA requires those who receive health insurance from their employer to sue in federal court where victims can only recover the cost of the procedure or service denied in the first place — no damages or penalties are allowed. Victims must often wait for long periods before cases are heard in federal courts and attorneys are hard to come by because payment for attorney fees is not guaranteed. If the patient dies before receiving the treatment, the insurer pays nothing. The impact has been devastating for patients’ health. For more information see chapter 5 of FTCR President Jamie Court’s book, “Making A Killing”.

“Imagine if a bank robber only had to return the money he stole. That lack of legal accountability would encourage more bank robberies because robbers know they wouldn’t always get caught and when they did there would be no penalty. Similarly, this Senate proposal would give the green light to insurers to collect our money and block access to life saving medical treatment,” said Flanagan.

For more information on Dana Christensen and S. 1955 visit FTCR’s resource page.

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The Foundation for Taxpayer and Consumer Rights (FTCR) is California’s leading nonpartisan consumer advocacy organization. For more information, visit us on the web at: http://www.ConsumerWatchdog.org