Healthcare Reform Key Issues Unresolved

Jan. 5, 2010, Capitola, CA: Both the US House ofmedical networks charge medical practitioners a fee
Representatives and the US Senate have yet tofor inclusion in networks.
address important details affecting patient care.The patient's right to choose their own medical
Oversight concerning the determination of medicalpractitioner is not federally guaranteed by law.
necessity as well as provider network inclusion issuesAdditionally, there is no guarantee an insurance
have greatly affected medical reimbursement andcompany will pay for medical services and patients
patient access to care. Many insurance companiesoften have no way to determine what will be paid
reimburse medical expenses based upon auntil after a claim is submitted and a response is
determination of medical necessity by the carrier'sgenerated the insurance company's claims
claims department. In the absence of externaldepartment. The federal government seeks to
oversight or regulation, the insurance carrier is free tomandate health insurance coverage for all US citizens
deny care based solely upon a private internal review.yet has not stipulated that insurance companies must
Another key issue not addressed is how providerreimburse patients for medical expenses nor is there
networks create financial barriers to care. Manylanguage to address oversight of the determination
insurance carriers reimburse medical expenses atof medical necessity.
lower rates or refuse reimbursements forThe determination of reimbursements is often based
out-of-network providers. Medical practitioners mayon what is termed as 'usual and customary.'
also be excluded from insurance company networksInsurance companies have sole discretion over this
for a variety of reasons. Practitioners may beaspect of reimbursement for general health insurance
required to limit medical procedures for patients andpolicies and may choose to exclude many
the number of office visits as a precondition forprocedures, office visits, and medical tests whether
inclusion in the insurance network. Medical practitionersor not teams of doctors agree that such medical
may also be required to accept lower rates ofservices are vital to the patient's survival, recovery,
reimbursement for services provided to patients asor comfort.
another precondition to network inclusion. Some