Push to force insurers to cover alcohol-related injuries - WKOW 27: Madison, WI Breaking News, Weather and Sports

Push to force insurers to cover alcohol-related injuries

MADISON (WKOW) -- A number of state lawmakers and health care professionals want to make sure health insurance coverage is not denied when someone uses alcohol and is then hurt.

Lawmakers in the assembly have yet to consider the ban on denying coverage.   A companion proposal passed the senate unanimously.

Dr. Stephen Hargarten of the Medical College of Wisconsin said emergency room physicians are sometimes reluctant to screen a patient for alcohol use over the health insurance consequences.

"Emergency physicians all know the drill:  Don't screen unless you want to put the patient's well-being at risk.   We view the health insurers as potential adversaries, not partners in the challenge to reduce alcohol-related injury and death."

But Wisconsin association of health plans spokesperson Phil Dougherty said his member companies act responsibly when it comes to claims involving alcohol.

"They do not deny coverage based on alcohol consumption."

The association of health plans includes companies such as Dean, Physicians Plus and Humana.

Self-insured plans are federally supervised and not subject to the proposed ban on denials.

Denials have occurred.   Family members of Marquette University student Isabel Ries said coverage of Reis' $25,000 in medical treatment was denied because Ries was legally intoxicated when her bicycle was smashed into by a hit-and-run driver.

UW Hospital surgeon Dr. Lee Faucher says with his hospital being a Level one trauma center, physicians are obligated to determine if alcohol or other substances are underlying health issues for emergency room patients.

Hospital spokesperson Susan Lampert-Smith said a recent study showed as many as 25% of emergency rooms admissions involve alcohol use.

Faucher says a law is needed to insure care is covered.

Faucher fears a slippery slope, if there is any ambiguity, "What could be next is the situation of the insurance coverage... of the lung cancer patient being questioned because they were a smoker."

Under the proposed law, insurance companies could still deny coverage if the injured person used alcohol and was in the commission of a crime, such as repeat drunken driving.

Online reporting by Tony Galli and Steve Korioth




Powered by Frankly