Approximately 1,600 publicly traded corporations “self-insure” for employee benefit healthcare by establishing a trust for the payment of healthcare expenses. This is cheaper than buying insurance from a commercial insurance company. It also means their policies are not regulated by state commissions.
Most self-insured health plans retain the services of a Third Party Administrator (TPA) to verify eligibility and pay claims. These TPA’s, however, are contractors for the corporations who have hired them. The corporation drives the process. From personal experience, I found that we, as child abuse survivors and users of the mental health system, once again have no voice in how we are treated.
Here is what I went through. A family member, designated as my dependent, was eligible for Social Security and Medicare on April 1 a few years ago. Beginning with the first week in January of that year, I contacted my corporate employer requesting information about our medical options to make informed financial planning decisions. The documents I received were out-of-date, inaccurate and did not discuss mental healthcare options which she needed.
Over the next 3 months, I wrote and spoke with both the CEO’s office and the corporation’s Benefit Line. In March, with time running out, I wrote a letter to the Department of Labor (DOL). After hearing nothing, I called the DOL manager and was told she was on vacation. The last week in March, I drove to the Maryland Insurance Administration in Baltimore, MD. The manager did his best to contact the appropriate authorities, however, since my employer is self-insured, there was nothing more he could do in order for us to make a decision regarding my family member’s mental healthcare coverage.
On April 1, my family member went on Social Security and Medicare. Our only option was to just wait and see what medical coverage and options she had. At the same time, I requested a change in my medical coverage since I was paying about $400 a month with my family member on my policy. Two months later, I received a phone call stating I could change my policy but I only had three days to make a decision. In the meantime, the corporation had collected another $800 in insurance premiums from me.
This is not an isolated incident. It is time for Congress to pass legislation that would require each State’s Commissioner of Corporations to petition the DOL to enter into interagency agreements. These agreements would finally cover each state’s ability to enforce consumer protection rights concerning self-insured ERISA health benefit plans as well as provide binding penalties for non-compliance in a timely manner. In other words, even today in the year 2013, we are at the total mercy of corporate insurance plans and their lack of concern for providing timely, cost-effective physical and mental healthcare to the people they insure. It is a disgrace because it has become a one-sided manipulative machine for corporate profits. Survivors have suffered enough. It’s time to make a change.