Anti-Trust Laws To Cover Private Medical Health Insurance Plans In US

The medical care reform proposal in the United States is expected to make private medical insurance options in the country more comprehensive and reasonable when it comes to claims. To many experts, consumers, and industry critics, subjecting the health care insurance industry to antitrust laws would be advantageous.

John Doe, a 30-year old freelance writer based in New York recently had an unplanned check up with his doctor. He paid $ 300 for the medical service. When he reimbursed the amount from his health care insurer, the company only handed him $ 200. The insurance agency claimed that the amount it paid was the service’s ‘usual and customary rate.’ In this case, there was clearly a $ 100 hole in John’s claim. Policy owners of private medical care insurance plans usually encounter such problems across the entire US.

You might ask the identity behind the ‘usual and customary’ rates for medical services. It is not really a person but a database. Many experts assert that the database used for such rates are intentionally manipulated to push rates downward. This is made possible through the faulty information collected for the system. Many observers also raise concerns about adequacy of audits and appropriateness of pooling procedures for data collection used in such databases. It is not astonishing that several medical care providers use artificially low rates so that reimbursements could be low-balled.

In 1945, a legislation called the McCarran-Ferguson Act exempted private health insurance coverage options from existing federal anti-trust laws. After many decades, there are now proposals to lift that shield to make the health insurance industry subject to anti-trust legislation that cover all other industries in the country, except of course professional baseball. This is obviously and logically part of the long-standing debate about the currently proposed health care reform in the US.

The reform in the healthcare insurance industry would be carried out by the Health Insurance Industry Fair Competition Act, which was passed by House legislators in February 2010. It is still up for final approval and execution. The bill would make medical care insurers subject to similar federal legislation that outlaw bid rigging, price-fixing, and basic market allocations that are now imposed across all other industries. This is expected to be raved about by a lot of people who intend to take full advantage of the use and claims from their private medical insurance options.

Health care insurers, for their part, assert that the bill really is not needed. They claim that they have already been precluded from basic anti-competitive practices under different state laws. They also claim that the majority of them don’t engage in such unlikely practices anyway.

Consumer advocacy groups, on the other hand, point out that issues about medical care insurance claims would not possibly happen if there were no antitrust exemption that spares the health care insurers. Overall, a lot of people hope successfully repealing the McCarran Ferguson law would somehow help ease out the current problems they have regarding their medical care insurance plans.

Read more on antitrust law in health care!