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Conn. Doctors Seek to Amend Insurance Law
April 20, 2006

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News Summary

A Connecticut law that allows insurers to refuse to pay for injuries sustained while victims were under the influence of alcohol or other drugs should be repealed, physicians say.

The Associated Press reported April 16 that Mark Kraus, chair of the Connecticut State Medical Society's committee on addiction medicine, told state lawmakers that the exclusion law effectively prevents doctors from screening patients for alcohol or other drugs, out of fear that the test results could result in nonpayment by insurers.

As a teenager, Oliver Bishop IV got into a one-car accident and sustained multiple injuries; when tests showed that he had a .165-percent blood-alcohol content at the time of the crash, his insurer -- National Health Insurance Co. -- refused to pay his $242,235 in medical expenses. A federal appeals court sided with the insurer.

"I would never have gone out and purchased a health insurance policy if I had been aware there was an alcohol exclusion in it," said Bishop's father. "We purchased this health-insurance policy to protect my family and it was not a cheap policy. We were paying hundreds of dollars a month to cover any and everything and it just didn't happen."

Kraus said that the law is preventing doctors from providing addiction counseling in emergency rooms and hospitals, which could prevent future readmissions for alcohol-related injuries. Researchers say about 40 percent of people admitted to trauma centers have alcohol in their bloodstream.

"People who come to the emergency-room department should be screened and should have some brief intervention, minimally," Kraus said. "It seems that we have to make a decision because the private sector is again shirking their responsibility on the public sector and someone is paying for it."

Colorado recently repealed its exclusion law, and Hawaiian lawmakers are considering a similar proposal. But repeal legislation failed in Illinois and Wyoming.

The Connecticut bill is thought to have enough support to pass the legislature. Most large insurers in the state already cover alcohol-related injuries, but companies like Anthem Blue Cross and Blue Shield don't support the repeal because they consider it a mandate.

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