House Committee Turns Heat on Insurers

Janice Simmons, for HealthLeaders Media , September 22, 2009

While much discussion has focused on how insurance companies are trying to influence healthcare reform legislation, Congress has been turning the tables in recent months—looking closely at how medical coverage decisions and denials of claims are made.

On the Senate side, Sen. Jay Rockefeller (D-WV) sent a letter in August to the top 15 health insurance companies requesting information on what insurance companies do with the premium payments they get from consumers and whether this data is shared with policy holders and potential customers.

And last week, in two days of hearings, Rep. Dennis Kucinich (D-OH), as chairman of the Domestic Policy Subcommittee of the House Oversight and Government Reform Committee, turned the spotlight on how private health insurers make decisions on medical care—particularly what Kucinich called "wrongful denial and delay of healthcare."

"The fact is that in America today, you don't know if your health insurance will take care of your serious medical bills until you become seriously ill or injured," he said during the first day of hearings, which featured several witnesses who had been impacted by insurer decisions on the patient and provider sides.

Some spoke of "life-consuming denial and appeal processes," while others such as Linda Peeno, MD, a physician who formerly worked as a company physician for several health plans, talked about "the abyss between what insurance companies say and what they do."

"The primary purpose of health insurance data collected by the state regulators today is to monitor solvency," Karen Pollitz, a research professor with Georgetown University's Health Policy Institute, told the panel. There is little information "on an ongoing basis to monitor the accessibility, affordability or security of health insurance for consumers."

Pollitz, citing earlier data collected by the full committee, said that when queries were sent out to all 50 state insurance departments, only four states could provide data on the number of rescissions—the process of dropping enrollees from insurance plans—that occurred and only 10 states could provide the number of individual health policies.

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