DISQUS

Bob Kelley · 1 year ago

The last thing we need is a health care plan founded on the ERISA model. At the present time employers are denying just about every claim that comes before them if the cost is high. Entire pensions are being wiped out on baseless technicalities because the employee can only appeal to the company arbitrators who routinely uphold whatever decision the employer's plan managers come up with. Of course, you might be able at some point to get a Federal Judge to review your case but these judges hate these appeals coming to them. The bottom line is the employer can deny your claim and force you to spend years just to get what they should have paid you in the first place. I can't think of a piece of legislation that promotes cheating by employers more than ERISA. You simply are ignorant or a shill for industry.

Bob Kelley

Karoli · 1 year ago

I am neither. I have no affiliation with the health insurance industry but I am a long time third-party administrator for pensions.

I respectfully disagree with you, particularly on the question of claims. Employees have the right to appeal a claim directly with the Department of Labor. In my 30 year career as an administrator, I have dealt with Department of Labor inquiries on several occasions on behalf of employers. The DOL was quite diligent on behalf of the employee, and the process was a simple one for the employee to initiate. In each instance, the dispute was resolved quickly and in no instance was the employee denied their claim.

However, your comment misses the point of the post, which was that for health insurance reform to have a prayer of working, it needs to be standardized on a national basis and not on a state-by-state basis, and needs to have baseline minimums established. While I'm not arguing that the baseline minimums have to be implemented or executed exactly like ERISA, I do believe that the five principles outlined in my post should be the starting point.

JG · 1 year ago

Here's why I think ERISA should be shut down altogether. An uninsured motorist pulled out in front of my motorcycle. Boom, ICU and the works. I paid extra for uninsured motorist coverage, settled with the vehicle insurance for the coverage. All claims made to my health insurance were denied pending signing documents releasing any and all claims to other insurance. Well, I'm not signing that. I paid for the extra coverage so it's mine and they can suck it. All you medical providers can thank ERISA for the non-payment. The only thing this experience taught me is: if you have ERISA health insurance, do NOT spend one penny on any extra coverage by any other provider.

Karoli · 1 year ago

JG,

The provision you describe is not a provision related to any ERISA mandates. It's a standard provision that allows insurance companies to reduce their exposure by offsetting the benefits they pay by the benefits paid through other plans.

We can have a discussion about why you feel it's unfair (I think so too, sometimes), but it's not an ERISA-mandated issue. You'd have the same thing happen with privately-purchased insurance.