DOL Report Flunks a Major Test

Margaret Dick Tocknell, for HealthLeaders Media , May 4, 2011

With that kind of faint praise I could hardly wait to get my hands on the DOL report. It is 62 pages of tables, text and data, some rehashed from other reports and a lot of it from 2008, which is a lifetime ago in terms of the economy and healthcare.

There is some new information on 12 selected benefits: ambulance services, durable medical equipment, diabetes care management, ER visits, infertility treatments, kidney dialysis, maternity care, organ and tissue transplantation, physical therapy, prosthetics, gynecological exams and sterilization.

But here's the rub: for a report that's supposed to help guide decisions about what constitutes essential healthcare benefits, it's very light on what is actually covered. Part of the problem stems from the definition of "covered" used in the report, which requires that health plan documents specifically mention the service as covered to be counted as covered. If a service isn't mentioned its falls into the "not mentioned" category, which the report explains means the service may or may not be covered. Huh?

For six of the 12 benefits the "not mentioned" percentage is larger than the "covered" percentage. What does that tell anyone who is trying to justify identifying one benefit over another as essential? If you followed the logic of the DOL report you'd give ER visits the nod over diabetes care management.

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