New Jersey Department of Banking and
|For Immediate Release
MAY 13, 2002
For Further Information::
SUCCEEDS IN GETTING TAYLOR CASE RECTIFIED
TRENTON- The Commissioner of the Department of Banking and Insurance, Holly Bakke, announced today that a resolution was reached in the case of Taylor Kulak, a six-year old girl who was being denied coverage by her health plan for a doctor-prescribed treatment to isolate the cause of her medical condition.
Governor McGreevey and the Commissioner personally contacted the State Health Benefits Commission to advocate for Taylor to be placed in case management. Case management allows for a more careful review of the circumstances of a particular patient's illness and permits greater decision making latitude for coverage. This morning, a representative from the State Health Benefits Plan confirmed that in response to the Commissioner's request Taylor's case would be put into case management.
Commissioner Bakke explained, "it has been obvious from the beginning that Taylor's case warranted a careful inspection of her circumstances, especially when the same treatment administered in a far more costly and intrusive way would be covered by her health plan. The Department successfully convinced the Division of Pensions and Benefits that based on these circumstances, placing Taylor in case management would be both the financially prudent thing to do, and the right thing to do for Taylor."
Taylor's case has also brought attention to the plight of other patients who may also fit these circumstances. The Commissioner added. "I have directed Gale Simon, Assistant Commissioner for Life and Health, to work with the State Health Benefits Commission to educate plan administrators in all Departments about how and when the case management option could be exercised to control costs and avoid other instances like Taylor's."
Taylor is covered by the State Health Benefits Plan (SHBP), supervised through the Division of Pensions and Benefits, Department of Treasury. The SHBP is a "self-funded" plan for public and government employees. The employer itself funds benefits, rather than the insurance carrier. As a self-funded plan, SHBP is exempt from state regulation, leaving the Department of Banking and Insurance with limited jurisdiction over the matter.
Referring to the Department's action in the face of its limited authority the Commissioner responded, "The Governor issued a challenge to all state Department's at the beginning of his administration to build a smarter state government that works to find solutions that benefit the people of New Jersey. Taylor's case gave us an opportunity to meet that challenge. I am pleased with how this Department came to the Taylor's aid, thinking outside the box. Instead of concentrating on what we could not do, we concentrated on what we could do for Taylor and found a solution that will work for Taylor and for others like her."
The Commissioner also announced the Department's effort to reach out to the legislature to craft legislation that would address the circumstances of individuals like Taylor. "The Department will be working with legislative leaders to draft a bill that addresses situations like Taylor's without opening up a Pandora's box, creating a broad mandate for all drink supplements to be covered. A broad-based mandate of this kind would be extremely costly to the State," she stated.
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