Kentucky

Imagine this situation.  You are in a car wreck and have $10,000 in medical benefits and lost wages protection.  You also have health insurance, but nothing to cover you for lost wages.  The current law allows you to reserve all or part of this $10,000 in benefits (called Personal Injury Protection benefits or PIP) for your wage loss and to direct those benefits to which provider of service you deem necessary.

Why is this important?  If you are seriously injured and will be unable to work for several months, how are you going to replace that income loss and pay your other bills? 

Today you can reserve and use your PIP benefits soley for wage loss and let your health insurance pay for the medical bills.  This maximizes your insurance benefits so that the two can work hand in hand.

If Rep. Jim Gooch, Jr. has his way and House Bill 478 passes, then you can kiss those benefits goodbye!

The hospital ER will get paid right off the top and you could potentially lose all that wage loss protection in one day EVEN THOUGH YOU HAVE HEALTH INSURANCE WHICH CAN PAY IT!

The hospital ER (or other emergency treatment provider) will get paid dollar for dollar off the top and without consideration of the fact the patient has other health insurance, and you can get nothing to cover wage losses.

Hospitals and health insurance companies have typically entered into agreements or payment schedules which provides for dicounts, copays, etc.  When a hospital bills PIP there are no discounts for services and if Rep. Gooch has his way, the hospital gets paid before you do and gets paid from PIP before you do.  Hopsital wins, PIP insurer win, and health insurer win.  You the consumer lose, your family loses too.

The hospitals win, the health insurers win, and the auto insurer wins too. 

Who loses?  The injured insured - YOU - loses as debts mount up for housing, heating, water, food, etc.  Your family loses too.

Should you be surprised by this?  Absolutely not as Rep. Gooch is listed as an "insurance agent" at his bio page at http://www.lrc.ky.gov/legislator/H012.htm.

Take a look at this bill at -

HB 478 (BR 1561) - J. Gooch Jr

     AN ACT relating to insurance.
     Amend KRS 304.39-020 to provide under the definition of "medical expense" when a medical bill shall not be presumed reasonable; define "emergency care"; amend KRS 304.39-210 to require medical expense benefits for providers of emergency care to be paid by the reparation obligor directly to persons supplying products, services, or accommodations to the claimant; provide that basic reparations benefits be paid without regard to fault and be primary except for benefits payable under a workers' compensation law; require a provider of services for medical expenses, other than medical expenses billed by a hospital or other provider for emergency care or inpatient services rendered at a hospital, to submit claims to a reparation obligor within 45 days from the date the services are provided; amend KRS 304.39-241 to provide exception for emergency care services where the reparation obligor pays the provider directly; amend KRS 304.39-270 to permit a reparation obligor to require a person to submit to a mental or physical examination by a health care provider licensed in Kentucky; require the reparation obligor to pay for the costs of the examination; create new sections of Subtitle 39 of KRS Chapter 304 to permit a reparation obligor to submit a claim for an independent review of reparation benefits to determine if the medical expenses furnished to a reparation insured are medically necessary or reasonable; permit a reparation obligor to contract with a private review agent to perform independent reviews of medical expenses; restrict disclosure of medical records or other confidential medical information; require written notice of decisions to the reparation insureds and providers; define "adverse determination"; require every reparation obligor to have an appeals process to be utilized by the reparation obligor; permit the appeals process to be initiated by the reparation insured or a provider acting on the insured's behalf.

     Feb 6-introduced in House
     Feb 7-to Banking & Insurance (H)

http://www.kentuckyvotes.org/Legislation.aspx?ID=58850

Don't let the nice sounding title and purpose of this legislation fool anyone that the underlying purpose will put money in the hospital and insurance companies hands.

It is classic anti-consumer, pro-insurance, and pro-big business and hospital legislation.  It was tried last year, and did not make it.  Don't let it happen this year either.

I encourage you to contact their elected representative on this legislation and express your non-support.  It is an anti-consumer piece of legislation that denies the citizens of the benefits of their premiums. 

If you do not want a loss of benefits or coverages, then you are encouraged to contact your representative to OPPOSE HB 478.

You can call the Legislative message line at 1-800-372-7181 to voice your support or opposition. 

You may also call your legislator directly at 502-564-8100.  If he or she is not available, leave a message for him/her to call you back.

For assistance in tracking down your legislator, try the state's official web site:

• http://www.lrc.ky.gov/Legislators.htm at the state.
• http://www.lrc.ky.gov/whoswho/email.htm for legislator email information.