I'm not clear on this one point in the Prez's healthcare plan.

[valerief]

If I have employer insurance, I can't choose the public option. So when I get sick and my employer insurance denies my claim, can I get the public option then?

I know the insurance companies can't refuse to take anyone on for a pre-existing condition and can't cancel or weaken the policy once you get sick, but can they still deny claims at their criminal rate?

[Eric J in MN]

1. No, you couldn't get the public option as long as you had private insurance. NT

NT

[valerief]

3. Thanks, but my question was about when the insurance company denies me.

Without coverage, I'm just paying premiums for nothing. Can I cancel and get the public option, since my insurance won't provide coverage but will continue to take my premiums?

[Eric J in MN]

6. If your employer makes insurance coverage optional, then maybe.

If your employer makes insurance coverage mandatory, then you couldn't choose the public option.

You would have to sue the insurance company for refusing to pay for valid treatment, same as now.

[valerief]

7. Thanks. That's if you survive long enough to sue. nt

[liberalpragmatist]

2. Hm. Not totally clear, I think.

First off, the public option being closed to most people is not a new feature - it's a feature of the House bill itself which was revealed in July.

It is possible that you would be eligible for the insurance exchange and the public option if for whatever reason you can't get coverage or good coverage through your employer. Most people wouldn't have that option, however.

[valerief]

4. The way it sounded last night was you could get the public option if

an insurance company didn't take your premiums. However, if the insurance company takes the premiums but just denies your claims, that's just like not having insurance at all. It's *solely* extortion. So, in that instance, I wondered if the public option would be an option.

The prez didn't say anything last night about claim denial, that I can recall. It was that ins cos had to provide coverage, i.e., take your premiums. Didn't say they couldn't continue to deny your claims.

[T Wolf]

5. There is nothing, and will be nothing, in the law that is finally passed, that will restrain

the insurance corps from denying any claim that they want to deny.

the only "safeguards" are that they have to accept you (and your premium payment) and cannot charge you a higher premium than other "in your group."

But they can deny any claim for an (or no) reason and you will be stuck with that bill and debt.

The Obamacare defenders never address that issue.

[Clio the Leo]

8. Because the entire industry will become much more competitive....

..... they'll be less likely to do that. Insurance companies will no longer be able to pick and choose who they care for. If a company is not taking care of its customers it will lose money.

[branders seine]

9. How will the entire industry become more competitive?

I see no mechanism in the plan to drive "competitiveness."

[TheKentuckian]

10. Regulatory reform is supposed to make that scenaro impossible

This is why Obama has been trying to get anyone to look at the whole picture rather than completely focusing on the option portion.

The option is the brakes on the car to stop it if insurance continues to roll out of control, not the whole vehicle.

[valerief]

11. He didn't mention claim denials last night, though. nt