The federal health care contract appears to be illegal, and leaves patients open to being defrauded simply for trying to comply with the terms of the contract. The federal government has the largest contracts with private insurers in the country, so this is a big deal.
Also, the Democratic candidates for President have been holding up federal coverage as some kind of model for health care reform, when federal workers have in recent years been subject to even greater abuses by private insurers than the rest of the insured public. But again, because of the health care reform issue, makes it relevant to everyone.
Basically, the federal contract contains a provision that makes the financial responsibility of the employee/patient depend on what's in the contract between the provider and the insurance company. But that contract is kept secret from the employee/patient. What's more, the federal government and the insurer know in advance that the contract (which controls financial responsibility) will be kept secret from the patient, even though the federal contract makes it seem as if information is readily available (it's not).
What's more, the federal contract is written in such a way that employees are likely to be tricked into making themselves subject to this provision simply by signing the assignment of benefits for insurance documents they are required to sign in order to get care and have insurance billed by a preferred provider.
So basically what happens is that you can carefully choose a preferred provider, carefully study your plan to be sure your care isn't excluded, get the care, comply with all of your responsibilities, and - surprise! - after you get the care, you are stuck with the huge cost. Insurers can't drop people from federal plans, but this tricky clause allows them to essentially do the same thing as post-claims underwriting, but without all those unpleasant state insurance laws to contend with. Federal employees have no advocate or independent protection in this case. The only recourse is with the federal Office of Personnel Management, which negotiates the contract in the first place, so there is a huge conflict there. The OPM doesn't even have any established avenues to solicit or address complaints or problems like this.
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