The War on Children's Health Coverage, After The Veto

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Children's advocacy groups are spending millions and lobbying Republican Congressmen in a crusade designed to get enough votes to successfully override President Bush's veto of the Children's Health Insurance Program. However, children covered by health insurance have claims denied by health insurance companies as "not medically necessary."

Infant in Hospital

increased denials of medical treatment.

Children's advocacy groups, including the Children's Defense Fund, are lobbying more than thirty Republican Congressmen, in a crusade designed to get enough votes to successfully override President Bush's veto of the Children's Health Insurance Program. However, children's groups claim that even if the override campaign proves victorious, that still may not be enough.

If Congress overrides the President's veto and 10 million more children are made eligible for insurance coverage, obstacles still remain for insured children to actually obtain medical treatment. Children's advocacy groups point out that health insurance companies have resorted to "increased denials of medical treatment." "Not medically necessary" is a common reason given by health insurance companies to deny approval of treatments, especially expensive treatments related to cancer.

Health insurance companies have successfully lobbied for protection from State legislatures. The State of Texas recently revised health insurance laws creating additional administrative hurdles that must be cleared by consumers to dispute a denial of medical treatment. Consumers are required to exhaust insurance company appeals before seeking government and legal assistance. The rub is that insurance companies do not provide information to new policy holders as to rights of appeal or the company's appeal guidelines. Guidelines are not given to policy holders with their policies and are not generally made available on the Internet.

Consumers must possess a certain degree of sophistication to realize the need for appeal guidelines and how to timely request them or lose their right to appeal. Most consumers are not able to decipher insurance policies, request additional information, file appeals and request reconsiderations with the insurance company. After insurance company appeals are successfully completed the consumer must start over with obtaining government rules, laws and forms to continue the appeals process. Most consumers cannot afford a lawyer to appeal an insurance company denial and end up without needed medical treatment for themselves and their children.

Michael Moore's movie "Sicko" exposes how far an insurance company will go to deny medical treatment and services. Denials of medical treatment range from rejection of cancer treatments to denials of plastic inhalation tubes for children with serious asthma, and even refusal to pay for emergency ambulance services because the consumer failed to obtain prior approval.

In addition to denials of claims, insurance companies continue to increase premiums, co-pays, deductibles and keep adding more bureaucratic roadblocks for children who need medical care. Children's advocacy groups say that the President's veto is just the latest in series of setbacks for children's healthcare.

Bill Ogletree is a senior partner with the Ogletree Abbott Law Firm in Houston, Texas, which represents consumers nationwide in claims against health insurance companies for wrongful denial of medical treatment. His latest book is Maritime - Jones Act Law for the Injured Worker, published by Truespring Press and available on

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