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Attorney At Law
FIRM THAT INSURES LAWYERS ALMOST ENDS UP IN COURT.
Post-Dispatch Medical Writer
The dispute involved surgery on attorney's
13-month old girl insurer, bar group reach accord
By John G. Carlton
Published St. Louis Post-Dispatch
If Abraham Lincoln had followed another calling -- if he had been, say, president of United Healthcare instead of President of the United States -- he might have offered the following advice:
You can raise all of the people's health insurance rates some of the time. And you can raise some of the people's health insurance rates all of the time. But lawyers are not some of the people. In the days before managed care, of course, the "old railsplitter" pursued a career in politics. But that imaginary advice might have proved helpful in recent months as United Healthcare negotiated new health insurance coverage with one of its longtime clients -- the Bar Association of Metropolitan St. Louis.
Today, both sides say they expect to reach agreement soon. Whatever
misunderstandings they've had are behind them, but last week, things
weren't quite so cozy. The long-simmering discussions nearly reached
a boiling point, fueled by a volatile combination of triple-digit
rate increases, the refusal to authorize previously planned surgery
on a 13-month-old girl, and lawyers who make their living suing insurance
companies. "Exhibit A" is the brief-but-pointed telephone conversation
between local litigator Herman Praszkier and an official
at United Healthcare.
At issue was insurance coverage for Praszkier's 13-month-old daughter, who was born with a congenital condition that would require two operations to correct. Since long before the little girl was born, United Healthcare has offered group health insurance to members of the bar association. Late last summer, Praszkier and other lawyers covered by that plan got some bad news: United Healthcare would not renew their policies.
The company agreed to extend coverage for another two months, and it promised to offer new policies with guaranteed acceptance to those it had previously covered. For most people, rates would remain the same. For many others, however, there would have to be some adjustment.
In September, Praszkier's daughter had the first
of her two scheduled surgeries. Later that month, he was notified
of his new rates. His coverage would cost 40 percent more; his wife's
would increase by 20 percent and his daughter's health insurance premium
would jump by 200 percent. But when the first bill arrived last month,
the monthly premium for Praszkier's daughter had gone from
$104.14 to $424.15 - an increase of 306 percent. "That's what I used
to pay for my whole family," Praszkier fumed. He
complained to anyone who would listen. But Praszkier is a prudent
man. He recognized that his daughter was scheduled for another operation
on Nov. 11. So he paid the new monthly premium of about $1,000 - under
protest. Early last Thursday morning, Praszkier got a call
from an insurance clerk at St. Louis Children's Hospital. He was told
his daughter's operation was off. It seems that when she called United
Healthcare to verify his daughter's insurance, the clerk was informed
that the little girl was no longer covered. A second call produced
the same result.
Anyone else with a health insurance problem might get mad. But Praszkier isn't anyone else with a health insurance problem. He's a lawyer who spends much of his time suing doctors and insurance companies. A few moments later, he was on the phone with officials at United Healthcare. As it happened, he explained, he was already planning a visit to St. Louis Circuit Court that very afternoon. Unless this little misunderstanding was taken care of right away, he said, he would be more than happy to file some additional legal paperwork naming United Healthcare as a defendant. A half-hour later, Praszkier was back on the phone with the hospital. What a helpful insurance company, the hospital clerk told him.
They called down here just a few moments ago to explain it was all a mistake. Of course the little girl was covered; the surgery could proceed. Earlier in the week, United Healthcare had another change of heart. The company decided it would renew the group plan after all. And it would extend the old policy for another two months. Company officials will meet with the bar association today to iron out the details. Ken Klein, the association's executive director, concedes that negoti ations with United Healthcare have produced "some frustration." But he said he's confident they can reach an agreement.
There is a lesson here, Praszkier said: "When people get a denial from an insurance company, they think they have to accept it. But they don't. They can appeal. We do it all the time on behalf of our clients. We've even agreed to take some cases without charge for patients who wouldn't otherwise have access to a lawyer." United Healthcare declined to comment on the Praszkier case or any deeper meaning it might contain.
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