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Insurers Disputing Covering Pre-Existing Conditions for Children – Time for Algorithmically Centric Digital Laws

Posted Mar 29 2010 7:17am

When you read stories like this, it’s again one more reason to keep the “private” or public option open.  Insurers have big budgets for legal costs and this seems to get added right to the cause. 

We do need digital laws that contain algorithms “spelled out explicitly” as to how things will function and how the laws are applied.  If we keep using this same old format of 3000 pages of text, it will continue with interpretation issues.  Healthcare cures and research all revolve around algorithmic formulas so why not the laws that govern as well.  All the new drug treatment plants revolve around the information that is created from software that interprets our DNA and the analysis of changing the way certain genes and proteins act and react in our bodies.  It’s all about the software and information given that helps us interpret which direction to go for the cure, same should be done with health insurance. 

Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!

This TED video from this year spells out the problems pretty clearly.  I have been writing about creating digital laws now for healthcare for the last couple of years and perhaps we are getting closer to this reality.  Old methodologies die hard and remember we are fighting with swords and they have machine guns when it comes to the battle ground, in other words they have the accelerated business intelligence technology and infrastructure to challenge and potentially defeat those who are attempting to create worthwhile solutions that actually help the average citizen instead of lining the pockets of investors.  BD 

WASHINGTON — Just days after President Obama signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.

Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.

Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.

“The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform,” said Representative Henry A. Waxman , Democrat of California and chairman of the Energy and Commerce Committee.

Consumers will soon gain several other protections. By July 1, the health secretary must establish a Web site where people can identify “affordable health insurance coverage options.” The site is supposed to provide information about premiums, co-payments and the share of premium revenue that goes to administrative costs and profits, rather than medical care.

In addition, within six months, health plans must have “an effective appeals process,” so consumers can challenge decisions on coverage and claims.

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