davidj8121 said it best - "If we want to get the attention of the health insurance industry lets all get together and file a $100 million dollar (or whatever the number may be ?? ) class action lawsuit against the insurance companies that are the cause of the problem. If a good firm thinks we have a case they will take it on a contingency basis ( no fee to us unless we win)."
Unfortunately, a lawsuit would just get thrown out. The reason this would happen is because of ERISA. To quote my paper that Texas-T posted above, here's an explanation of how ERISA does not allow individuals to file lawsuits against insurance agencies:
"Recent Supreme Court rulings have further interpreted ERISA to cover employer based health plans, for which the law was not intended to do. As a result of this interpretation, policy holders of employer based health plans can only sue their health plan for coverage in Federal court.
"ERISA's regulation of managed care organizations stems from its preemption clause (29 U.S.C., section 1144(a)) which states that "[ERISA] shall supersede any and all State laws insofar as they relate to any employee benefit plan." This clause has essentially "prevented states from regulating the activities of employee based health plans," which has provided health insurance agencies with more power to determine which procedures they cover while simultaneously holding them less accountable for their decisions.
"Two Supreme Court cases have further reduced the liability for managed care organizations. On June 21, 2004, the Supreme Court "effectively immunized managed-care organizations (MCOs) from liability for negligent decisions about the care of patients in private employer-sponsored health plans" in its ruling in the combined cases of Aetna Health v. Davila and CIGNA Healthcare of Texas Inc. v. Calad. Davila and Calad sued their managed care organizations under the Texas Health Care Liability Act, which is a state statute that holds managed care organizations liable for negligence "when they fail to exercise ordinary care in making decisions about whether treatment is medically necessary for a patient." Because CIGNA and Aetna are "ERISA plans", CIGNA and Aetna argued that ERISA preempted the Texas statute, and that the case must be resolved in Federal court under ERISA to recover insurance payments due for the two plaintiffs' procedures.
"The Supreme Court gave a unanimous decision that ERISA "provides the exclusive remedy for patients in ERISA plans when an MCO denies benefits – even if the denial is based on a decision that the disputed care is not medically necessary for the particular patient." Many fear that because of this decision, health insurance agencies will "have little incentive to make medically appropriate decisions if the only penalty for wrongful conduct is no more than what they should have paid for in the first place."
"According to Dr. Mike Magee, ERISA "has become the central pillar of defining the roles and responsibilities of the health insurance industry's managed care organizations. More specifically, it's used to define the extent of their liability for both health benefits and the fallout of decisions to extend, or not to extend, coverage for a wide array of health services."
(Resources:
Cornell Law School. U.S. Code Collection
http://www4.law.cornell.edu/uscode/html/uscode29/usc_se...0001144----000-.html
Cornell Law School. U.S. Code Collection
http://www4.law.cornell.edu/uscode/html/uscode29/usc_se...01003----000-.html#a
National Conference of State Legislatures. "Maryland's Fair Share Health Care Fund Act Overturned in ERISA Challenge" (1/29/2007)
http://www.ncsl.org/programs/health/fairsharenews.htm
Hellinger, Fred J, Ph.D. and Gary J Young, Ph.D., "Health Plan Liability and ERISA: The Expanding Scope of State Legislation." February, 2005. American Journal of Public Health.
http://www.pubmedcentral.nih.gov/art...?artid=1449155
Mariner, Wendy K. "The Supreme Court's Limitation of Managed-Care Liability." 2004. New England Journal of Medicine
Magee, Mike. "The Laws that Protect Managed Care" Health Politics.Org.
http://www.healthpolitics.org/progra...t.asp?p=erisa)
It's quite unfortunate that this has yet to be amended. While trying to get the attention of the public through Oprah and Michael Moore may or may not be the best idea, my advice is to write your congressmen and women, and your state's senators. Explain to them the frustrations and pain you all have had to endure. Mention ERISA. Cite Texas-T's World News Tonight video to show that this is debilitating. Call your local news. There have been stories done in Florida, California, D.C., and I think Boston on local news stations about patients with back pain who have been denied coverage for ADR.
There's a lot of work to be done, but there are also many quality resources to get in touch with to help make a difference. Let's not limit ourselves to Michael Moore and Oprah.