The next healthcare reform battle involving health plans is now underway as the Department of Health and Human Services debates which diseases, procedures, and tests state-based insurers must cover.
Under a free-market system, health plans could excuse themselves from treatments they said were not scientifically validated, but that’s about to change. And if other recent rulings are any indication, insurers will find themselves on the losing end once again.
Over the next eight months or so, some of the industry’s brightest minds will expand on the predetermined 10 categories—including prescriptions, emergency care, rehabilitation, chronic disease management and preventative services—that were outlined in the Affordable Care Act.
The insurance industry says the 10 categories outlined in the bill are an adequate framework for which companies can build their benefits packages. “We believe that Congress has already specified an appropriate set of ‘essential’ items or services that should be included in the essential health benefits package, and there should be no further defining of specific service elements of the benefit package, such as the number and frequency of services that should be covered,” says Carmella Bocchino, executive vice president of America’s Health Insurance Plans (AHIP).