Hold Harmless Clauses can kill you: Medical freedom at risk

Arizona Daily Independent
Elizabeth Lee Vliet, MD

Dr. Elizabeth Lee Vliet discussed how existing health insurance contracts and the new insurance “exchanges” contain clauses that are other ways the health insurance industry interferes with your economic and medical freedom this weekend. The issue discussed the Enrollee Hold Harmless clause that exist in most contracts between doctors and insurance plans they may contract with, and between hospitals and other health facilities and insurance plans they contract with to provide medical care.

According to Vliet, “such language may sound “harmless” but….they are only holding your health insurance company “harmless”! These clauses may be deadly for YOU, as we shall see.”

Dr. Jane Orient, a practicing internal medicine physician in Tucson, and the Executive Director of the Association of American Physicians and Surgeons joined Vliet on her KVOI AM radio show. Both doctors belong to AAPS. AAPS is the only medical organization in the country to sue to overturn the new 2010 healthcare law. Vliet says that, “AAPS has been a voice for private independent physicians and patients’ medical freedom since 1943.”

Transcript of show:

I’d like to tell you the story of Sandra Lobb. She could be any of us. Tragically, she is dead. She had access to medical care. She had health insurance. She had “coverage” for the treatment she needed.

So what happened? A faceless, non-medical employee of her health insurance plan, hired to review cases and approve or deny treatment, overrode Sandy’s physicians, and decided that “given Sandy’s age and her condition, the cost of the care being prescribed can nott be justified.”

How expensive was her treatment? The particular medical services she needed cost about $7000. Her husband said he would pay cash for her to have this medical care. He knew that without it, she would die. He asks, “Who among us wouldn’t take the responsibility for $7,000 if it meant life or death for ourselves or a loved one?”

But what happened next was truly astonishing. The hospital insisted on discharging Sandra when her insurer denied payment as “unjustified,” and adamantly refused Mr. Lobb’s offer to pay cash for further care. Then, to make matters worse, and to their shock, after the insurance company’s refusal to pay, no other hospital would admit Sandra. Under the Enrollee Hold Harmless Clause, there was no way any hospital – or doctors –could be paid in cash for the services!

Patients think that insurance companies decide coverage, and that doctors decide treatment. Sadly, that is not the case. Doctors who contract with insurance companies, and Medicare, have less and less ability to make treatment decisions for patients. Even though health insurance plans are not supposed to “practice medicine,” in reality, that is exactly what they are doing. In Sandra Lobb’s case, the insurance company decided to terminate her medical care and discharge her from the hospital – not her doctors making that medical decision. After the insurance company decision, the first hospital received no payment whatsoever.

The Lobbs tried to find another hospital for Sandra to have her treatment.

BUT ALL of the hospitals they consulted turned them down, and refused to accept cash for her medical care! Why on earth …in the U.S., the epitome of capitalism and supposedly free markets…why couldn’t the Lobb’s pay cash for Sandra’s needed medical care?

Frank Lobb, a businessman, spent 10 years and 5 lawsuits trying to get answers to these very questions. He was trying to figure out how he might have been allowed to pay for his wife’s medical care. His book, the Great Health Care Fraud, available on Amazon.com, documents what he found, and how it can be risky for YOUR life too.

The key, it turns out, are the Enrollee Hold Harmless Clauses in insurance contracts. Frank Lobb calls them “the beating heart of the managed-care industry’s business plan.” It is a secret the insurance industry tries very hard to keep hidden from you…. though the clauses are in plain sight IF you know what the legal language means, and IF you know where to look in the contract.

And now I’d like to ask Dr. Orient to explain the key concepts of Enrollee Hold Harmless Clauses and how these clauses affect your freedom to pay cash with your own money for medical services you may need.
Welcome to America’s Fabric, Dr. Orient.

Dr. Orient:
I think it is important to remember, we live in an Orwellian world of newspeak and contradictory meanings. “Insurance” and “coverage” are warm, benign-sounding words. The more, the better. With “universal” and “comprehensive” coverage, everyone would be safe and secure, right? No more worries about families being bankrupted by medical bills, for example.

But there are other more ominous meanings for “coverage.” It can be stifling, restrictive, and limiting. It can refer to coverage of six feet of earth over your grave! And with a health insurance plan, which is really a managed care plan, which is really not the same thing as insurance….the bankruptcy protection is for the PLAN, not for YOU.

Virtually all provider contracts contain the innocuous-sounding Enrollee Hold Harmless Clause. It was written by the National Association of Insurance Commissioners (NAIC), and actually was enacted into state law in most, if not all, states. Officials will say that the purpose of these clauses is to protect subscribers against balance billing. Balance billing means the doctor or hospital billing YOU for the difference between their charges and what the insurance company pays.

What the hold harmless clause actually does is to serve as an absolute roadblock to prevent providers of medical services from accepting any payment, other than deductibles and co-payments, from any source outside the plan for any “covered” treatment. A service is “covered” if it is available under the plan, even if the plan denies payment for it in an individual case like Sandra’s. If Sandra had wanted experimental treatment, or something like cosmetic surgery, it would have been non-covered and her husband could have paid for it.

Dr. Vliet: So even if the insurance plan we buy says something is “covered” it can still be denied for a particular patient. That is just frightening. Why is such a clause needed? Who does it really benefit?

Dr. Orient: Insurance companies will pretend that the Hold Harmless Clause is needed for insolvency protection—but it is really insolvency for the health plan. These clauses actually prevent the hospital, or a doctor, from accepting payment for medical care that the insurance company has decided is not necessary… or desirable… or appropriate for a particular patient. So as Mr. Lobb ultimately learned, it was this clause in the insurer’s contract with the hospital that prevented him from paying for his wife’s treatment. He went to court to try and get an explanation about how he could have paid for his wife’s care, given the language of that clause.

Dr. Vliet: So it wasn’t the language in his contract with the insurance company, it was the language in the hospital’s contract with the insurance company.

Dr. Orient: Exactly. The subscriber never signs this contract with the insurance company, and never sees it. It is the contract between the provider and the insurance company.

Dr. Vliet: Just to be clear for our audience who don’t know the terms we live with every day, “subscriber” means the patient, that means YOU.

Dr. Orient: Exactly.

Dr. Vliet: So why would a health plan want to prevent a Subscriber –or patient – from paying for health care services?

Supreme Court upholds Obama health care law

USAToday
David Jackson

The Supreme Court upheld the health care law today in a splintered, complex opinion that appears to give President Obama a major victory.

Basically. the justices said that the individual mandate -- the requirement that most Americans buy health insurance or pay a fine -- is constitutional as a tax.

Chief Justice John Roberts -- a conservative appointed by President George W. Bush -- provided the key vote to preserve the landmark health care law, which figures to be a major issue in Obama's re-election bid against Republican opponent Mitt Romney.

The announcement will have a major impact on the nation's health care system, the actions of both federal and state governments, and the course of the November presidential and congressional elections.

A key question for the high court: The law's individual mandate, the requirement that nearly all Americans buy health insurance, or pay a penalty.

Critics call the requirement an unconstitutional overreach by Congress and the Obama administration; supporters say it is necessary to finance the health care plan, and well within the government's powers under the Commerce Clause of the U.S. Constitution.

While the individual mandate remained 18 months away from implementation, many other provisions already have gone into effect, such as free wellness exams for seniors and allowing children up to age 26 to remain on their parents' health insurance policies. Some of those provisions are likely to be retained by some insurance companies.

Supreme Follies

American Everyman
Scott Creighton

Just a quick note: In a few hours the Supreme Court is going to release it’s decision on the Obamacare (aka the ironically named “Affordable” Care Act) lawsuits brought by 26 different states. I won’t be here when the verdict is released so I will go out on a limb and make a little prediction… the court will support the mandate as “constitutional” but will strike several aspects of the bill as unconstitutional, namely the part that mandates corporations offer coverage to people with pre-existing conditions and the part that keeps them from charging more from elderly MANDATED “customers” (are we really “customers” if we are forced to purchase their deeply flawed insurance scams?). They will do this because to them it is constitutional to force human citizens to buy a flawed product from a corporation but it is unconstitutional to force corporate persons to treat human citizens in a just manner. Plus, there is just WAAAAAY too much money at stake (for those of you who don’t know…

MOST of the industrialized Western nations have a single payer type healthcare system and the big insurance companies have EVERY INTENTION of exporting our system and thus striking this down not only hurts their profits here but also in the future all across the world. Just think about those payment premium profit margins for a second. think about it… think about it…. good. now move on)
The fake left is inundated with dire warnings of life without Obamacare (first suggested by the Heritage Foundation don’t ya know) and the right is being bombarded with renewed threats of the evil soooooocialism (and when I say soooooocialism, Fox News style,  I mean Nazi Germany, Satan himself, and the dreaded social justice… cus that all means the same thing to Fox News viewers and “freedom” loving libertarians who pledge their support daily to the “freedom” of corporations to rip off their customers, pay no taxes for the services they enjoy, and poison our food supply) of single payer healthcare if the court rules in favor of the constitution. The stage has been set. The actors are on their marks. Everyone is ready. Are you?


If you take a look at recent events it’s hard to imagine that anything else could happen. Everything is going the corporate way. From Citizen’s United to Obama’s new “trade” deal, the writing is on the wall, the winds of CHANGE are a blowin. The SCOTUS transformation team just recently ruled to strike down a 100 year old state law which prohibited corporations from dumping unlimited cash into campaign support. Now TransCanada for instance can dump billions of dollars into a local mayoral candidate’s campaign if they desire thanks to the Supreme Follies of the Roberts’ court.

It seems fascism the Washington Consensus is all the rage in DC these days. I don’t expect they will have any problem supporting the clearly unconstitutional personal mandate of the Heritage Foundation Mitt Romney Hillary Clinton Barack Obama “healthcare” plan.

I really hope I’m wrong about this one but it seems it may be inevitable.

Perhaps we can expect some kind of nifty staged distraction to accompany their announcement as well. Lots of people on the left and the right oppose this “Affordable” Care Act. They may need a bigger, juicier story to drown out the wails of dissent from the unwashed masses.

Obama administration has diverted $500M to IRS to implement healthcare law

The Hill
Sam Baker

The Obama administration is quietly diverting roughly $500 million to the IRS to help implement the president’s healthcare law.

The money is only part of the IRS’s total implementation spending, and it is being provided outside the normal appropriations process. The tax agency is responsible for several key provisions of the new law, including the unpopular individual mandate.

Republican lawmakers have tried to cut off funding to implement the healthcare law, at least until after the Supreme Court decides whether to strike it down. That ruling is expected by June, and oral arguments last week indicated the justices might well overturn at least the individual mandate, if not the whole law.

“While President Obama and his Senate allies continue to spend more tax dollars implementing an unpopular and unworkable law that may very well be struck down as unconstitutional in a matter of months, I’ll continue to stand with the American people who want to repeal this law and replace it with something that will actually address the cost of healthcare,” said Rep. Denny Rehberg (R-Mont.), who chairs the House Appropriations subcommittee for healthcare and is in a closely contested Senate race this year.

The Obama administration has plowed ahead despite the legal and political challenges.

It has moved aggressively to get important policies in place. And, according to a review of budget documents and figures provided by congressional staff, the administration is also burning through implementation funding provided in the healthcare law.

The law contains dozens of targeted appropriations to implement specific provisions. It also gave the Department of Health and Human Services (HHS) a $1 billion implementation fund, to use as it sees fit. Republicans have called it a “slush fund.”

HHS plans to drain the entire fund by September — before the presidential election, and more than a year before most of the healthcare law takes effect. Roughly half of that money will ultimately go to the IRS.

HHS has transferred almost $200 million to the IRS over the past two years and plans to transfer more than $300 million this year, according to figures provided by a congressional aide.

Kagan Defies Judicial Ethics and Sits on Obamacare Case

PRNewsWire

Larry Klayman

Today, the Supreme Court began oral arguments on the constitutionality of one of the most controversial pieces of legislation in the past fifty years. The Patient Protection and Affordable Care Act, referred to as "Obamacare," stretches the power of the federal government to a level never before seen. Yet this is not the most important decision the Court faces. Justice Elena Kagan, the former Solicitor General, is continuing to illegally preside over a case in which her impartiality has been seriously called into question. 

Freedom Watch was the only group to file an amicus brief on the issue of Kagan's recusal and/or disqualification. Larry Klayman, the founder of Freedom Watch and before that Judicial Watch, has been the most ardent critic of the Court's avoidance of this issue. Never before has a justice, who championed legislation during its passage and crafted a legal defense for it, been able to preside over its validity. In no other court of the United States would this be acceptable. 

The Supreme Court, in a showing of defiance that its impartiality would be called into question, not only refused to hear oral argument on the issue of recusal and/or disqualification from Mr. Klayman, but today Justice Kagan presided over the case. This is consistent with Chief Justice Roberts' outrageous claim that the Supreme Court is not bound to the same ethic standards as lower courts, and that these standards may be "unconstitutional" -- a fabricated position meant only to justify the court's illegal actions. This serves to delegitimize not only this decision but the Supreme Court as an institution. 

Klayman adds, "It is now clear that the Supreme Court considers itself above the law, does not represent the American people and much less the rule of law. This is a formula for revolution."

For more information or to schedule an interview with Mr. Klayman call Tom Madden or Adrienne Mazzone, 561-750-9800 x210. The docket number in the Supreme Court is 11-393, 11-400.

SOURCE Larry Klayman 

Obama healthcare battle moves to US supreme court

Guardian

Justices urged by 26 states to strike down requirement that all Americans have health insurance, with decision likely in midst of 2012 election campaign

The Obama administration has asked the US supreme court to back the centrepiece of the president's sweeping healthcare overhaul – the requirement that all Americans have health insurance.

The appeal was largely expected, as a high court ruling against the law could be a fatal blow to Obama's signature domestic policy achievement, and could have major implications for his re-election bid.

The same day the administration filed its appeal, 26 states and a major business group urged the justices to strike down the entire law, which would have a far-reaching impact on future healthcare coverage for Americans and company costs.

The case is likely to be heard and decided in the supreme court's upcoming term, which begins next week and lasts through June 2012. A ruling is likely in the midst of the campaign for the November 2012 elections.

The administration and the opponents of the law called for a quick ruling by the high court to resolve uncertainty affecting the federal government, states and companies about the law's key provisions that are taking effect.

The 26 states and the National Federation of Independent Business argued in their appeals the entire law should be invalidated because Congress exceeded its powers requiring that Americans buy health insurance or face a penalty.

The Obama administration filed its own appeal in which the Justice Department argued the so-called individual mandate, due to take effect in 2014, was constitutional and said the issue was appropriate for supreme court review.

"Throughout history, there have been similar challenges to other landmark legislation such as the Social Security Act, the Civil Rights Act and the Voting Rights Act, and all of those challenges failed," the Justice Department said.

"We believe the challenges to Affordable Care Act … will also ultimately fail and that the supreme court will uphold the law," the department said in a statement.

White House adviser Stephanie Cutter said the administration asked the supreme court to hear the case "so that we can put these challenges to rest and continue implementing the law to lower the cost of health care and make it more secure for all Americans."