Saturday, July 5, 2008

Health Benefits Denied


I know this is off topic for me, but this seems to be a growing problem. People invest their whole lives, put their trust into a company and then when they turn around and ask for what was promised to them. They get the back of a hand. It is just not right. I am not for universal health care. As I do not want the government running anything else, as they can barely tie their shoes and I also do not want to pay other peoples bills. But something has to be done about this. What was the point of these poor people paying for benefits?


Employers use federal law to deny benefits
Saturday July 5, 11:31 pm ET
By Mark Sherman, Associated Press Writer
Workers -- and some judges -- frustrated in legal fights over benefits with large employers


WASHINGTON (AP) -- Dying of cancer, Thomas Amschwand did everything he was told to make sure his wife would collect on the life insurance policy he had through his employer.
"He was obsessed with dotting every `i' and crossing every `t'," Melissa Amschwand-Bellinger recalled about her husband, who died in 2001 at age 30.




But Spherion Corp., the temporary staffing company where Amschwand worked, told Amschwand-Bellinger she would not receive any of the $426,000 in benefits she believed she was due. When she went to court, Spherion succeeded in getting her lawsuit thrown out. The Supreme Court on June 27 refused to review the case.

Amschwand-Bellinger received a refund of the few thousand dollars in insurance premiums she and her husband dutifully had paid. The total, she said, would not cover the costs of his funeral.

The story has played out often under the federal Employee Retirement Income Security Act. Designed to protect employee benefits, the law has been used by employers as a shield against suits.

Federal appeals courts, interpreting Supreme Court decisions dating to 1993, consistently have said companies that offer health, life and retirement benefits under ERISA cannot be sued for large amounts of money, or damages. Instead, they can be sued only for typically smaller sums such as Amschwand's insurance premiums.

Several federal judges have bemoaned the unfairness even as they have felt constrained to rule in favor of employers.

"The facts ... scream out for a remedy beyond the simple return of premiums," Judge Fortunato Benavides of the New Orleans-based 5th U.S. Circuit Court of Appeals said in the Amschwand case. "Regrettably, under existing law it is not available."



Link to article

7 comments:

Foxie said...

so why haveprivate pay insurance ifyour gonnaget raped for the benifits you havebeen paying for ..says alot about greed and theamerican dreamdoesnt it? I think we should have a basic Universial health insurance package for everyone .. you wantbetter ? BUY your upgrades .. that makes sense to me anyways. Everyone will then have a basic health care pack for most things and wellness care for all families

Anonymous said...

The are several problems with Universal health care. #1 Whenever the government gets involved they totally mess things up! Don't believe me, then aswer a few questions if you can. What was the high school graduation rate prior to manadatory public education? What was the literacy rate? You will find that they were actually higher than they are now. Socialist/liberals love public education because it has allowed them to indoctrinate our children to their worldview. Did you know that medicare came about because they lost their insurance when they retired or their insurance carriers denied them coverage. In the 80's when the government realized how much of a drain this program was gonna be on the nation's budget they partnered with the Insurance companies to make HMO's who were guaranteed the medicare dollars if they took those patients. So, not only do we pay medicare taxes, the beneficiary pays premiums, and we pay their insurance company again in higher premiums to pay for the medicaid and medicare patients. Didn't you know? Social Security came about in the New Deal after the Depression. In typical Socialist fashion instead developing a system where each person has an account that they control, and build for their retirement. Socialists put it all into one pot, which they constantly borrow from so it really isn't secure, and it really isn't guaranteed.
#2 In every country where they have socialized medicine and that is what Universal Health Care is, They have waiting lines for just about every procedure. Wealthy people from those countries come to the US for treatment because they know it will be good and it will be immediate. Do you understand people die just waiting for a procedure. It's called rationing and it's called triage. Only the sickest get in first. With things like cancer, waiting is just not an option. Here in our present system they get treated right away, and humanely.
#3 They problems we do have with our health care system won't be fixed by UHC, it will make everything 1000X worse.
-We need to get away from employer based health insurance. Yes, they can offer it, but we should be able to continue the insurance even if we are no longer employed with them. Buying insurance on our own should be made much easier also, especially for all those small business and independent business people. (Americans be required to set up Health Savings accounts, the amounts in these accounts would accrue year after year. If Americans took say $5000 from their federal taxes and put it into a HSA to pay their premiums and copays etc. They would have a say in just how much insurance they'd buy and how they would use it. Presently, people aren't aware of how much medical tests and procedures costs. If it was their dollar, coming from their HSA, then they'd be more careful. What we need to get away from is the thought that everything should automatically be paid by the insurance Co. The insurance should be used more judiciously. For example, if $1000-$2000 comes out of your pocket first before the insurance company kicks in, then insurance would be used for what it is meant for, not every visit. Your insurance company would still negotiate the prices for you. We also need a system where the Doctors/Nurses get paid for health teaching and reinforcement. It has been shown that those offices that have great diabetic teaching, their patients have better control of their diabetes. So maybe a bonus each year for each patient they get and keep healthy.
-Present insurance policies do little to cover alterrnative medicine. Even Chiropractic and Accupuncture isn't covered to the extent that western medicine is covered. Both of those methods aren't experimental and have been around for thousands of years. If you have your own HSA, you could buy insurance to cover Dental and vision and pay for those alternatives out of your own pocket, or maybe the insurance companies should be required to at least let you use visits and subequent payments to these practitioners as part of your deductible.
Granted...
This won't solve the problem for everyone right away. We will still have people on Medicaid and Medicare. Some on the low-cost state insurance policies. But, in time those relying on the low-cost state insurance policies may no longer need them after they have set up an HSA and been able to pay for their insurance. Medicare could be drastically cut also. If insurance companies aren't allowed to cut older people's insurance when they retire or reach a certain age. Many well off Seniors would be able to pay for their own insurance but, aren't given the chance. For example, my Dad didn't stop working until he was 75 years of age. He lost his medical when he was forced to retire. He applied for medicare and had to apply for SS in order to get medicare, even though he didn't need the SS and would have been able to pay insurance premiums but no company would insure him. So, if you've been able to save in your HSA, whatever the reason for the unemployment you could still pay for your insurance until the amount ran out. Maybe in the future we could eliminate the Medicare program all together by changing the laws regarding retirees. This would be real empowerment! This by the way doesn't include illegal aliens.
Lotus

Anonymous said...

I do believe this topic is misnamed. The person's health benefits weren't denied according to the article. His wife wasn't able to collect on his life insurance through his work.
This is a tradegy you bet, the problem is the law, which needs to be changed.
Lotus

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The Volpé Consortium, Inc. is an independent business consulting and project management firm specializing in the areas of Business Operations, Project Management, Technology Solutions, and Training. Since our founding, our mission has been to partner with clients to integrate conflict-free consulting and deep subject matter expertise for senior management, resulting in sustainable solutions to complex business challenges.Our services have been proven to drive success across multiple industries and business disciplines. Please use the menu system on this web site to navigate our services portfolio.

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