Las Vegas Sun

September 20, 2019

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Guest column:

Pre-existing condition is no reason not to be protected

As many as half of all non-elderly Americans have a pre-existing condition, according to the U.S. Department of Health and Human Services.

This number increases dramatically in older age brackets. According to eligibility criteria that were used by insurance companies prior to the implementation of the Affordable Care Act, 75% of Americans ages 45 to 54 and 84% of those 55 to 64 have some type of pre-existing health condition for which they could have been denied coverage. Thankfully, the ACA created rules that prohibit insurance companies from charging higher premium costs or outright denying customers due to pre-existing conditions. Now, with these protections under attack in Washington, D.C., it’s up to us to do what we can to increase the accessibility and affordability of health care at the state level.

There is still so much more we can do to improve health care coverage in Nevada. For example, patients still have challenges accessing treatment options that are covered by their health insurance plans. This occurs when patients cannot find in-network doctors.

In other cases, it happens when health insurance companies fail to let patients or care providers know a specialist is approved for in-network pricing. Insurance companies often have case managers on staff to help their customers find an in-network care provider or to negotiate a one-off contract with a specialist if the insurance company does not have an appropriate provider who is in-network. Insurance companies also typically have hotlines in their policies that people can call if they are having trouble getting access to in-network providers.

Many patients, however, report that when they call these hotlines, it can be difficult for them to get the assistance they need. They say they’re unable to reach a case manager, even when they know that the insurer has someone in that role who should be accessible via the hotline. As a result, consumers tend to find these hotlines to be of little use and feel they are getting the runaround when they are trying to secure appointments with specialists for medical treatment. This is unfair to those who pay their premiums, and that is why I am taking steps to bolster consumer protections in our state’s health insurance market.

This month, Gov. Steve Sisolak signed into law Assembly Bill 170, a measure I introduced with the goal of establishing protections for people with pre-existing conditions. Additionally, the legislation provides the Office of Consumer Health Assistance with new tools for assisting insured Nevadans.

Under AB170, if Nevadans have trouble navigating the insurance process when trying to find an in-network provider, the OCHA will be empowered to assist them with reaching their case managers. This will help consumers avoid exorbitant out-of-network pricing.

The bill also authorizes the OCHA to assist patients with filing complaints with the Insurance Commission. Lastly, the OCHA will now be able to collect data on the number of consumers who experience these issues so that lawmakers can track progress and assess whether further corrective measures are necessary.

This bill is important for improving standards because if you are denied insurance due to a pre-existing condition or cannot get an appointment in a timely manner, you simply do not have adequate access to health care.

Now, Nevadans with pre-existing conditions will still have access to insurance should the ACA be overturned. I would like to thank state Sen. Julia Ratti, who helped in drafting portions of the bill associated with pre-existing conditions, as well as the governor and my legislative colleagues who were supportive in this overall effort to establish these vital consumer protections in our state’s legal system.

Ellen Spiegel was first elected to the Nevada Assembly in 2009. She represents Assembly District 20, which covers sections of central and southeastern Las Vegas.