A Pennsylvania bill would create a category of aggravated assault in the state’s criminal code to hold health insurer CEOs liable if a covered person gets an “adverse benefit determination” of a medically necessary benefit that leads to serious bodily injury or death.
Under House Bill 2611, referred to the House judiciary committee June 8, the highest ranking officer at health insurers would be “guilty of aggravated assault” in these cases. According to Pennsylvania law, an adverse benefit determination includes denials, reduced benefits or payments not made in full for the benefit.
“When insurance executives — rather than treating medical professionals — determine patient care, and a decision to deny care leads to serious harm or death, there must be accountability,” Democratic State Rep. Emily Kinkead, the bill’s primary sponsor, said in a June 8 news release.
The bill would not apply to specified disease, TRICARE, Medicare supplement, short-term limited duration, dental-only and vision-only policies, among other policy types with limited scopes.
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