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Last week’s shocking killing of United Healthcare CEO Brian Thompson reopened a national wound inflicted by the delay and denial of health care coverage to countless Americans.
It was a heinous crime that will never be solved. But the organic and spontaneous outpouring of populist outrage that followed highlighted how many Americans have been cruelly and unjustly denied medical treatment.
This should be a wake-up call to Washington after an election that showed widespread dissatisfaction with the status quo. Despite advances in health insurance coverage and rights, protecting American patients is far from over.
In the 1990s, California pioneered the patient rights movement, giving HMO subjects the right to second opinions, independent medical review of coverage denials, and coverage of certain commonly denied procedures. Many states have adopted California’s model, and President Obama’s Affordable Care Act is an important step in providing coverage to the uninsured and preventing companies from denying coverage to those who want it. Measures have been taken.
However, American patients did not have fair access to justice when their claims were denied. People who buy insurance on their own or get insurance through a government job or program such as Medicare have the right to sue for damages if they believe they have been harmed by an unfair denial. But most of us have health insurance through our jobs, and no matter how outrageous the denial or how dire the outcome, we have no right to sue. More than 100 million Americans have no legal recourse if health insurance companies mess up our claims.
In the 1987 case Pilot Life Insurance Co. v. Dedeaux, the Supreme Court held that people with employer-sponsored insurance do not have the right to sue their insurance company for damages and that the value of denied benefits is The court ruled that there was a right to sue only for If the subject dies, any action is void.
The ruling remains in effect despite numerous attempts to change this, including through Obamacare. This is why insurance companies often act as if they have a license to kill. Insurance companies are rarely legally responsible for the harm they cause by delaying or refusing to pay for needed treatment.
Natalyn Sarkisian, a 17-year-old Angeleno, has become a leading figure in the fight against this injustice. Natalynn, who had recurrent leukemia, had to wait far too long to get insurance approval for a liver transplant that doctors thought would likely save her life. Her mother, Hilda Sarkisian, protested with other nurses at the headquarters of the health insurance system Cigna. When the company finally approved the surgery under pressure, it was too late. Natalynn passed away in 2007, hours after her confirmation. And because of the pilot life decision, the family had little legal recourse.
The Sarkissyan family is campaigning to overturn Pilot’s decision and not leave their daughter’s fate in the hands of others. Congress has made it easier to buy insurance, but it still doesn’t give patients the rights they need after they get insurance: the right to collect damages from companies that do bad things.
This is not difficult. Congress (whose members do enjoy the right to sue over the denial of their own health insurance claims) has many options to limit insurance companies’ exposure to litigation. For example, an insurance company may only be held liable if it shows complete indifference to the patient’s suffering.
Insurance companies are focused on whether patients can take the case to court. At least one company, Aetna, even had a training tape showing how claims are handled differently for companies with and without the right to sue.
When insurance companies do not have a legal incentive to approve claims, they are more likely to deny or postpone claims. It is time for Congress to restore the possibility of justice to millions of people and respond to urgent calls for reform.
Jamie Cote is the president of the nonprofit organization Consumer Watchdog.
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