Printer Friendly

Schools, insurance & your family's financial security.

More than a decade ago, a Long Island family objected to its school district's use of the family's health insurance policy to pay for the physical and occupational therapy in their son's special education program. The family lost that fight at the local due process hearing level and in a state review. However, they persisted and finally prevailed via the U.S. Office for Civil Rights. Ultimately, the New York commissioner of education reversed his earlier position. The precedent set by this case should have protected other families from having to fight the same battle.

Court Fights Continue

It has not happened that way A Tennessee family had to go to court to prevent the school district from using up their son's health insurance benefits which had a lifetime benefit limit "cap." (The school wanted neurological evaluations to understand how to deal with the boy's seizures.) A North Carolina family has been in court for years trying to recover health insurance benefits spent on their daughter's educational program when she was a child. The daughter is now an adult and is expected to need lifelong care.

The most bizarre case occurred in Illinois where a state agency sued the parents of a child who had suffered severe brain injuries and required special education services. The child, who had subsequently died, had won a large malpractice award from the physician who was alleged to have caused the injuries. The state tried to take the money that the parents had inherited from the child in order to pay the costs of the public school special education program the child had received during his lifetime.

Sadly, these cases are not isolated events. These problems could happen to any family that includes a child who receives special education services from a public school. Most of us know the language of the federal special education law assures a free, appropriate public education.

Misinterpretations of the Law

One regulation within the law has been misinterpreted to justify school districts' billing of children's private health insurance coverage. It states that, "Nothing in this part relieves an insurer or similar third party from an otherwise valid obligation to provide or to pay for services provided to a handicapped child (34 U.S.C. [sections] 300.301 (b))." The U.S. Department of Education has clarified that language several times.

The Florida Department of Health and Rehabilitation Services had asked the assistance of the U.S. Department of Education in taking families' benefits due to black lung disease and supplemental security income to pay for their children's education programs! On August 8,1990 the U.S. Department of Education responded:

"The program, including non-medical care and room and board, must be at no cost to the parents of the child. ... The EHA-B [special education law] does allow the State to use available public and private funds to provide for the child ... This provision, however, addresses funds that are available to the State to assist it in providing the child a free education. This provision does not include funds to which the child or parent is entitled."

Misinterpretation Continues

Few school districts have heard about any of these cases or how they were decided. Nonetheless, many school districts are beginning to experiment with some forms of billing of children's private health insurance benefits. A reason this very bad idea keeps recurring seems to be that consultants and billing agents are suggesting to school districts - apparently without telling them of the history of legal failure of this approach that billing children's health insurance policies is a great way to save money Since many school districts are perpetually short of money, they are more easily tempted to try far-fetched strategies such as this one without giving sufficient consideration to the draw-backs or the dangers to the family

Dangers to the Family

Dangers exist both for the particular child and for the financial security of the entire family. A recent finding by the U.S. Office for Civil Rights addressed the risks that families face when schools use their private health insurance benefits. These include:

* Depletion of available lifetime coverage;

* Depletion of annual or service charge;

* Loss of future insurability;

* Premium increase; or

* Discontinuation of coverage.

Families might experience such problems in a variety of ways. If a parent wishes to change jobs or start an independent business, the family may not be able to get insurance with a new carrier at all. Other possibilities include: being subjected to exclusion of the child's condition; being subjected to a time period for which the condition is not insured; or, being able to obtain new insurance only at higher rates.

A child might not be able to be insured at a later date because of a "pre-existing" condition based on records of public school billing of health insurance for a related condition - in spite of the problem of unreliability of diagnoses in young children. Parents employed by businesses with small group insurance plans may actually be fired because use of their insurance quickly drives up the insurance premiums for every group member.

Parents need not be embarrassed about defending their family's financial security. Parents' first responsibility is to securing their own children's future. It is not up to parents to find sources of funding for public school programs. Parents must ignore school officials' arguments about how civic-minded it is to make such a contribution to the public schools. Instead, parents need to realize that, if a parent loses a job because of the school's use of the family health insurance policy, that same school official is unlikely to offer support to your family.

To protect their family's financial security, parents can:

* Withhold insurance ID or Medicaid ID numbers from schools. In the mountains of forms that parents are asked to complete by schools, some information may not be appropriate for schools to ask - or for parents to give. Unless parents consent to the use of a health insurance policy (or Medicaid benefits), the school has no legitimate need to know, your identification numbers. You have a right not to give them this information. Not giving them the information guarantees that they will not use your health insurance benefits. Just draw a line through the s aces on an school forms that ask for your insurance policy numbers or write "refused" in the blanks.

* Just say "No".- Public school insurance billing creates many risks for families and offers them no conceivable benefits. Under these circumstances, it is surprising that any parents ever consent to insurance billing. School officials may try to persuade you to permit billing. When your child's future and your own financial stability are at risk, it is not a good idea to "give in" simply to please the school officials unless you are absolutely certain that no harm will come to your family as a result.

Some school districts are offering selected safeguards - such as agreeing to return the money within a year if it is needed. Look at those safeguards very carefully. Decide if they protect against all possible risks. Consider the possibility that suing the school district may be necessary to get the promised compensation.

* Do not cheat. If school personnel suggest that allowing them to use your insurance is a "good deal" because the school will pay the family's deductible and co-payments and the family can then use their insurance policy "free" - beware! Check with the insurance company to be sure it is aware of this possible "bargain" and agrees to allow it. Cheating on an insurance policy could cause its cancellation or result in an action against you for fraud (which has both civil and possible criminal penalties).

If you are the least bit unsure how what a school proposes to do will affect your family's insurance status, check with your insurance agent. If you have a group health insurance policy from your employer, check with the personnel officer who handles employee benefits and review the school's documents before you sign them. Even if you are already participating in such a public school-operated billing plan, it is a good idea to review the documents you signed with your insurance company. You may be able to minimize any possible damage.

* Get help. Don't be intimidated by any hint that your child will not receive appropriate services unless you consent to the use of your private health insurance policies. Many private attorneys will represent you even if you do not have the means to pay a private attorney - because the law provides a way for them to recover their fees in cases where you win the dispute.

Advocacy organizations may also provide attorneys and advocates to assist you. Many have reduced fees or no fees at all for legal and advocacy services. Examples of this kind of organization are:

The National Association of Protection and Advocacy Systems, Inc. 900 Second Street NE, Suite 211 Washington, D.C. 20002 (202) 408-9514

The American Bar Association Center on Children and the Law 1800 M Street NW, Suite 300 Washington, D.C. 20036 (202) 331-2250

The U.S. Office for Civil Rights will investigate allegations involving insurance billing where it denies children access to a free education. You don't need an attorney to seek their assistance.

* Put your family first. While this may sound selfish, the public schools' dream of huge savings has not come true. First, not all parents have ever consented to insurance billing - even when they have incorrectly been told that they must consent. Second, some schools that have tried to do billing have gotten involved in costly court battles which they tend to lose. Finally, all of this billing requires staff time and expertise which also costs money. An honest, non-coercive billing program with adequate internal accounting controls is likely to lose money for the school district. Parents who refuse to participate in public school health insurance billing plans may be doing the taxpayers of their community as much of a favor as they are doing for their own families.

Joy J. Rogers lives in Park Forest, Ill. and holds a Ph.D. in psychology and education from the University of Michigan. She is a professor of counseling and educational philosophy at Chicago's Loyola University. Rogers is a member of the Matteson School District #1 62 Board of Education and the Scouting for Persons with Disabilities Committee of the Chicago Area Boy Scout Council.
COPYRIGHT 1991 EP Global Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:injustice of schools using family's health insurance to cover cost of special education
Author:Rogers, Joy J.
Publication:The Exceptional Parent
Date:Sep 1, 1991
Previous Article:School mainstreaming contest winners, 1991.
Next Article:School bus safety.

Related Articles
Continuing coverage as circumstances change.
California County Provides Children's Health Insurance.
Dental Care for People With Disabilities: Prospects & Problems.
Informing empowering and keeping parents involved. (Special report: Part II: the decision and the battle).
Limited access to health care a serious problem for Montana. (Kids Count).
Health care sales pitch; Insurance now a must.
Considerations for the military child with special needs transitioning to adulthood.
Educating the child with a disability or other special needs.
Mandates coverage keeps people uninsured.
Ailing college health programs: cures for college-sponsored program woes.

Terms of use | Copyright © 2016 Farlex, Inc. | Feedback | For webmasters