The Wisconsin Senate unanimously passed a bill Thursday that would prohibit health care providers from denying coverage for claims involving use of alcohol or controlled substances.
Sen. Robert Jauch, D- Poplar, said while this bill will require providers to give coverage for many incidents involving alcohol use, insurance companies are still allowed to deny coverage to injuries incurred while committing a felony.
“I think this is a proactive step to mandate insurance companies to look out for their customers and to fix a loophole that would deny people legitimate coverage,” Jauch said.
If signed by the governor, Wisconsin would be the 14th state to pass such a law.
While speaking before the senate, Jauch used the example of a 17-year-old who was a victim of a hit-and-run while riding her bike. Despite the accident not being the fault of the teenager, her insurance provider refused to cover the medical costs because the girl had consumed alcohol prior to the accident.
“This is mainly an issue of fairness for consumers who were promised their medical costs would be taken care of, and I don’t see this bill as any sort of huge burden on the insurance companies,” Howard Croft, president of the Wisconsin chapter of the American College of Emergency Physicians, said.
When insurance companies deny alcohol related claims, it is the customers that end up paying the cost out of pocket, University of Wisconsin Health System Director of State Relations Lisa Maloney said. However, when individuals cannot afford to pay the bill, the hospital ends up recouping its losses through increasing costs for all other patients.
“Without insurance companies paying for the injuries, hospitals are forced to take the money out of their charity care money, which is meant to help uninsured patients,” Maloney added.
In the opinion of UW professor Richard Brown, making hospitals that are already cash-strapped pay for such expenses could prove a deterrent for doctors wishing to ask questions to patients about alcohol issues. However, some patients need these talks in order to address a serious problem.
“In the long run, this may actually save insurance companies money, because it will allow doctors to talk with patients to help stop their alcohol problem before it becomes serious,” Brown said.
According to Director of Advocacy for the Rural Wisconsin Health Cooperative Jeremy Levin, the bill is part of a change in policy by the National Association of Insurance Commissioners due to a changing image of alcoholism.
However, Senior Executive Officer of the Wisconsin Association of Health Plans Phil Dougherty said the bill will only have an impact on a certain percentage of insurance plans, as only commercial insurance plans are subject to state laws.
A similar version of the bill is also making its way through the state assembly, and Wisconsin Association on Alcohol and Other Drug Abuse lobbyist Gary Goyke said his organization has high hopes for the bill.
“I’m cautiously optimistic, but seeing that the Senate voted unanimously to pass it shows me that we’re definitely not standing alone,” Goyke said.