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Rhode Islanders lose access to affordable health insurance as the RI Dept of Health tries to "protect" them from themselves

by Emily Harding

As of  June 2002, Rhode Islanders lost the last of the carriers which once offered affordable comprehensive
health insurance plans to individuals, self-employed and small businesses in RI.

This was due - as  the carriers themselves have explained was their reason for leaving-  to our RI Dept Of Health's Health Plan Certifications Rules and Regulations which force any company offering health coverage to operate like an HMO and to therefore force them to be responsible for doctors' quality of care and doctors malpractice. To view these rules click below.

RI Health Plan Certification Rules and Regulations.

What Dept of Health Officials still don't seem to understand is that insurance companies that allow the certificate holders to go to ANY doctor or hospital anywhere in the country WITHOUT requiring the use of or referrals from a primary care physician aren't set up to monitor doctors quality of care. These types of companies offered plans which allowed the policy holder themselves to shop for their own doctor or hospital and the insurance company was there to simply pay the bills.

Imagine,for example, if your home needed repairs or renovations and a bank gave you a construction loan for the work or a home equity loan to provide the funds to pay for the repairs. Should it be the bank's responsibility to ensure the quality of work
of the contractors you hired? Of course not. This is what RI is trying to do to carriers with indemnity plans and PPO plans where the policy holder controls their own care. 

Now, if the bank gave you the loan on the condition that you use THEIR pre-selected contractors, then it would be reasonable to expect them to be responsible for the quality of workmanship just as an HMO takes responsibility for their providers that s a member of an HMO you have no choice but to use. 

Other healthier states with lower health insurance costs and access to more choices of plans and carriers understand the difference between plans like HMO's that REQUIRE the use of a primary care physician and those that don't.

These carriers that once spent many years in RI and now are no longer here offering their permanent individual and small group plans like they used to include companies like John Alden, Fortis (one of the largest companies in the world), Mutual of Omaha, Trustmark, The Principal Financial Group, Celtic Insurance Company and others.

RI Healthcare Myths:

One of the popular myths about why carriers aren't doing business in RI is that
because RI is such a small state and because Blue Cross has such a large share of the market. There is "not enough profit potential" but the fact that that carriers stayed in RI and were profitable for decades before during and after the HMO failures, proves this wrong.

Another is that they don't want to return and this is not true either as the facts prove otherwise.