posted
WV RESIDENTS: I urge you to contact your local representatives and ask them to support this bill. It was originally introduced last year and reintroduced today.
H. B. 2605
(By Delegates Ennis, Swartzmiller, Pethtel,
Perdue, Hatfield, Ashley and Border)
[Introduced February 18, 2009; referred to the Committee on Banking and Insurance then the Judiciary.]
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated �33-15-4j; to amend said code by adding thereto a new section, designated �33-16-3t; and to amend said code by adding thereto a new section, designated �33-25A-8i, all relating to requiring accident and sickness insurance providers and health maintenance organizations to cover the treatment for Lyme Disease.
Be it enacted by the Legislature of West Virginia: That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated �33-15-4j; that said code be amended by adding thereto a new section, designated �33-16-3t; and that said code be amended by adding thereto a new section, designated �33-25A-8i, all to read as follows: ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
�33-15-4j. Policies to cover certain Lyme Disease treatments.
Any insurer who, on or after January 1, 2009, delivers or issues a policy of accident and sickness insurance in this state under the provisions of this article shall make available as benefits to all subscribers and members coverage for diagnostic testing and long-term antibiotic treatment of chronic Lyme Disease when determined to be medically necessary and ordered by a physician after making a thorough evaluation of the patient's symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section may not be denied solely because such treatment may be characterized as unproven, experimental or investigational in nature: Provided, That this section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies. ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE. �33-16-3t. Policies to cover certain Lyme Disease treatments. Any insurer who, on or after January 1, 2009, delivers or issues a policy of group accident and sickness insurance in this state under the provisions of this article shall make available as benefits to all subscribers and members coverage for diagnostic testing and long-term antibiotic treatment of chronic Lyme Disease when determined to be medically necessary and ordered by a physician after making a thorough evaluation of the patient's symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section may not be denied solely because such treatment may be characterized as unproven, experimental or investigational in nature: Provided, That this section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies. ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT. �33-25A-8i. Required coverage for certain Lyme Disease treatments. A health maintenance organization issuing coverage in this state pursuant to the provisions of this article shall make available as benefits to all subscribers and members coverage for diagnostic testing and long-term antibiotic treatment of chronic Lyme Disease when determined to be medically necessary and ordered by a physician after making a thorough evaluation of the patient's symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section may not be denied solely because such treatment may be characterized as unproven, experimental or investigational in nature: Provided, That this section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
NOTE: The purpose of this bill is to require accident and sickness insurance providers and health maintenance organizations to cover certain Lyme Disease treatments.
Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
K dad...
Do you have a link for the bill? I'd like to see any strike through sections and amendments, if any are there... and the history if I could.
Also... are any groups in WVA behind this? Do you know how this originated?
Do you know... are the sponsors and cosponsors willing and ABLE to kill it if need be?
Do you know who fought it last year? What was the official end to the bill? Where/how?
I am concerned about some wording changes that could get stuck in there by a number of people/groups not wanting this bill. It is kicking a lot of people in high places and pulling at their wallets.. which is bound to cause a small riot at the least.
And the strong opposition this will have, number one... because of the word "insurance" being in it. Having insurance companies be forced to pay for treatment (unmonitored, unproven and unlimited) will raise some serious objections I'm afraid.
And the fact it takes away power from the medical board will raise flags there perhaps? It says..
"Treatment otherwise eligible for benefits pursuant to this section may not be denied solely because such treatment may be characterized as unproven, experimental or investigational in nature"
The medical board/health depts response (example) will be what if doctors gave patients 63 barrels of frog wings to cure patients? We can't protect patients with this bill.
Or what if they gave them bismuth? Or left them in a hyperbaric chamber for 56 nights in a row.... etc.
And the fact it is confirming there is such a thing as "chronic" Lyme disease, when all "acceptable" (not in OUR eyes- but in others) medical literature specifically states there is no such thing.
Someone may want to watch this section too...
"when determined to be medically necessary and ordered by a physician."
Be sure the word "infectious disease" physician or something similar isn't slipped in there. It has happened before.
This section states.. "shall make available as benefits to all subscribers and members coverage for diagnostic testing and long-term antibiotic treatment of chronic Lyme Disease.."
First of all, Disease should be spelled with a small "d".
Second, the insurers may say they already pay for diagnostic testing and they do (to the benefit of the ducks with patents).. and wording could be added to the bill to reflect using only duck labs... and not our labs.
And it doesn't state what, if any criteria would be applied to the tests? CDC positive only? Lumbar puncture for neuro required? CDC surveillance criteria used?
I don't know what 1-9 referrs to.. too tired to grasp it all tonight.
But these are some of the reasons why I'd like to see the history and link if you have it.
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
BTW- You said..
"WV RESIDENTS: I urge you to contact your local representatives and ask them to support this bill. It was originally introduced last year and reintroduced today. "
May I suggest?
You might want to let the folks know who are working on this...
If people want to support it... be sure to have them state that they want it ONLY if worded in the language it is in here and now.. once that is checked over by Lyme literate lawyers and doctors in the know.. and other experienced folks.
Otherwise, you could have a bill with 20 changes slipped in there, making it worse for folks. And your legislators would then THINK.. because they got calls and letters... that you supported it.. and could very easily pass it through without a second glance.
Please remember...
Once it is law.. it is next to impossible to get it changed. It rarely happens... and it could take years.. if ever it would be changed.
posted
#1 The bill is a near mirror of a similar bill that was passed in Rhode Island.
#2 - It originated and came to be because of my wife's activism efforts. It was ALL her doing and no other people or organizations in the state have been involved as of yet.
#3 - My late father was a member of the WV House, so I certainly know how the law works and how changes can be made!!! I am also working toward following in my father's footsteps and running for a house seat in the near future.
#4 - My wife and I are working VERY closely with the reps that have sponsored this bill and they are keeping us informed every step of the way, even at the slightest hint of wording changes.
#5 - It was tabled on its third reading last year when it was decided that it would be beneficial to have a better understanding of the reasons behind it's need. It was then placed in an interim study for the remainder of last year.
#6 - To date, there have not been any strike throughs or amendments.
#7 - I know every sponsor and co-sponsor of the bill, many VERY well and both my wife and I have spoken to them in conference style conversations on a number of occasions throughout the prior year.
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
K'dad...
So sorry to hear about your father's passing. I can tell you were proud of him... and my bet is he felt the same about you.
I am tickled that you can answer these questions and have done so for me and others. Much appreciated.
Nice to know you have some experience too... and are already aware of how bills can be "hijacked" to be more harmful than good.
I've had to learn that lesson the hard way after reps introduced bills with no prior input from the community, then they made changes throughout the process, which was VERY stressful.
So as I learn more about politics now... I tend to watch closely and tear apart everything from day one so I can TRY to be prepared for the worst.
Since you know how laws work in WVA... could I possibly ask you another question? This is actually probably just a standard one.. but I'll give it a whirl.
I am totally unfamiliar with and don't understand what this section means below. The bills I've seen didn't have this part attached, nothing like it actually... and I can't seem to grasp what this means... not at all.
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Provided, That this section does not apply to insurance coverage providing benefits for:
_____(1) Hospital confinement indemnity; _____(2) Disability income; _____(3) Accident only; _____(4) Long-term care; _____(5) Medicare supplement; _____(6) Limited benefit health; _____(7) Specified disease indemnity; _____(8) Sickness or bodily injury or death by accident or both; and _____(9) Other limited benefit policies.
`````````````````````````````````````````````
I am not asking what each of those things are... just how they fit?
Example- Is this saying that if you have a Medicare supplemental policy that this act would or would not be applicable? Are they exempt?
Another example from above- "(2) Disability income"-
If someone is on SS disabilty.. or work related disability...
Are the providers in that case exempt?
I've read and reread that part over and over and it still doesn't make sense.
Sorry to take up your time with this... and you certainly don't have to reply.... but any sharing that would educate me would go a long way in the future.
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