Thursday, November 18, 2010

Medical Necessity vs (Stupid) Mandates

A dear friend sent me the link to this story:

"Regence BlueShield has been ordered to pay $148,000 to nearly a thousand women who were wrongly denied coverage of prescription birth control ... Regence had denied coverage of IUDs, or intra-uterine devices"

As a tried and true liberal, she was pleased that the carrier was "punished" for failing to provide coverage for these devices. The problem, of course, is that they fail to meet the very basic test of "medical necessity," and should not be covered in the first place. However, liberals like their freedom to indulge consequence-free, and were able to convince the state of Washington to make other people pay for them.

There are virtually no circumstances under which these units are used other than to prevent pregnancy. As we know, pregnancy itself is not a disease or injury. Of course, common sense has no place in these kinds of discussions: like IVF, Viagra and Rogaine, we want what we want when we want it. And just like those three, birth control per se does not meet the definition of medical necessity.

My friend then claimed that Viagra is a covered expense; I replied that this is true only under collective-bargaining agreements and self-funded plans. In other words, you have to specifically add it to get around the fact that there is no medical necessity associated with it.

To put this in its proper perspective, consider this: would you expect your auto insurance to pay for your broken air conditioning? Yes, it's inconvenient and uncomfortable, but one can always roll down the window. And it doesn't necessarily affect your gas mileage (in fact, leaving it off may improve your mpg). Regardless, it's not an essential component, and I can guarantee that you wouldn't like your premium if coverage was required.

Obviously, the carrier had an obligation to abide by "the rules," so I lay the blame for this at the feet of ignorant state legislators who passed the bill mandating this coverage. Their rationale, by the way, was that "failure of insurers to cover prescription contraceptives had amounted to gender discrimination, and that women of childbearing years were spending nearly 70 percent more than men for health-care costs."

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