Ep 168 What you don't know about insurance contracts with Frank Lobb
Summary
The meeting featured Frank Lobb, a former Navy pilot, discussing healthcare insurance contracts and their impact on medical care. Lobb shared his personal experience of losing his wife after being denied healthcare coverage, despite offering to pay out of pocket. He explained how his investigation through legal proceedings revealed that healthcare insurance contracts are secret, state-approved documents that effectively allow insurance companies to ration healthcare. Lobb discovered that these contracts, standardized around 1990, contain provisions that prevent patients from paying for care when insurance denies coverage. He emphasized how the Consumer Financial Protection Bureau's recent involvement has shifted the burden of proof for billing accuracy to healthcare providers. The discussion highlighted how the current system disadvantages both patients and healthcare providers, with Lobb suggesting that medical organizations like the AMA should push for contract reform.
Chapters
Introduction to Frank Lobb and His Healthcare Experience
Frank Lobb introduced himself as a former Navy pilot who became involved in healthcare contract analysis after personal tragedy. He shared his experience with DuPont's Clean Air Act negotiations, demonstrating his ability to analyze complex legal situations despite not being an attorney.
Personal Tragedy and Legal Investigation
Lobb described how his wife's illness led to his investigation of healthcare contracts. Despite offering to pay, multiple hospitals denied care after his insurance company's denial. Through legal proceedings, he gained rare access to typically secret insurance contracts.
Evolution of Healthcare Insurance System
Lobb explained how healthcare insurance evolved from a simple fee-for-service model in 1929-1930 to the current complex system. He highlighted the Supreme Court's 1990 ruling that confirmed insurance companies' right to ration healthcare.
Contract Structure and Patient Rights
Lobb revealed that unlike other insurance types, health insurance operates on a single contract system. He emphasized that patients don't actually have contracts with their insurance companies, only providers do.
Consumer Financial Protection Bureau's Impact
Lobb discussed how the Consumer Financial Protection Bureau's involvement has shifted the burden of proof for billing accuracy to healthcare providers, potentially creating leverage for system reform.
