WASHINGTON, D.C. - The U.S. Senate Committee on Commerce, Science, and Transportation held a full committee hearing on Consumer Choices and Transparency in the Health Insurance Industry.

Wendell Potter, Philadelphia, Pennsylvania, Health Insurance Industry Insider

 

Nancy Metcalf, Senior Program Editor, Consumer Reports

 

Karen Pollitz, Research Professor, Georgetown University Health Policy Institute

“When insurance companies fail to meet their obligations to these people, it literally becomes a matter of life and death. Consumers can’t make real choices because the insurance industry doesn’t use standard language or definitions.   And consumers can’t challenge insurance companies’ decisions because the companies don’t explain the terms of coverage in clear, understandable language. This is absolutely unacceptable to me.”

“To help meet Wall Street’s relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment.”

“Consumers need to be told, in big letters, what their policy’s out-of-pocket limit is, and right next to it, in equally big letters, if there are any expenses that don’t count towards that. They need to know approximately what their out-of-pocket costs will be for expensive treatments such as cancer chemotherapy, or heart surgery, or infusions of patented biologic drugs. They need, in other words, a fighting chance not to be ripped off by junk insurance.”

“To make coverage differences more obvious to consumers, a series of ‘Coverage Facts’ labels could be developed that simulate the medical care claims patients might have under several expensive conditions, such as breast cancer, heart attack, diabetes, or pregnancy. Insurers would be required to take these standardized scenarios, ‘process’ the simulated claims under policies they sell, and then, for each policy, present a detailed summary of what would be covered and would be left for patients to pay.”