ARIZONA: Court Ruling Makes Health Plans Accountable
An Arizona Supreme Court ruling makes the medical directors of health plans accountable for decisions related to denial of care. The Arizona Republic reports that last week's ruling upheld the state board of medical examiners' right to question a Blue Cross and Blue Shield of Arizona medical director's decision to deny surgery to a patient with a diseased gall bladder. While Blue Cross contended that "the board lacked the authority to review their decisions," the court ruling signifies that "[m]edical directors for all insurance companies -- even indemnity plans -- now can be scrutinized." The Republic notes that the ruling, combined with consumer protection laws that take effect in the state this summer, gives Arizona health care consumers "a double-strength pain reliever for their health care headaches." "Together they offer some of the strongest protection in the country against what people call corporate medicine," said state Sen. Ann Day (R), a "constant watchdog of the managed care industry" in the state Legislature.
Several managed care companies "are smarting over the court decision," but they aren't ready to ask the Legislature to try to change state law, said Gay Ann Williams, executive director of the Arizona Association of HMOs. Williams said the "court ruling is overkill," because health plan appeals processes accommodate patient concerns. Mark Speicher, the executive director of the state medical board, said three physicians in Tucson "have already filed complaints against insurers for denying requests to treat patients."
Good Package Deal
The Republic notes that the Arizona managed care consumer-protection package that takes effect in July will require insurers to respond quickly to patient complaints about denial of care. "In the case of a high-priority medical situation," the newspaper reports, "insurers will have one day to respond in writing." Patients can appeal the first decision, and insurers will be required to rule on appeals within 30 to 60 days. As a final recourse, patients can "go to an independent reviewer chosen by the state Department of Insurance." The new laws will override the current system under which patients can either complain to their insurers or file formal complaints with the state insurance department. "I just think that [the appeals process] brings more balance into medical decisions and that the insurance companies better think twice before they try to overrule the primary care provider," said Day (Snyder, 1/26).