EXTERNAL APPEALS: Mass. Blues to Allow Second Opinion
Blue Cross and Blue Shield of Massachusetts announced Tuesday it will establish an external review process for patients to appeal coverge decisions. President William Van Faasen said, "Customers want it. Our first objective is to satisfy our customers and support the doctors who care for them." The Boston Herald reports that the move comes as "legislators and Gov. Paul Cellucci (R) [attempt] to force Blue Cross and others to allow such outside reviews." Under the new program, the Blues will first require its members to exhaust a three-step internal appeals process already in place. After that, they may request an external review. Members will pay $100 toward the $300 cost of the review, but the fee will be waived in cases of financial hardship and refunded should the member win (Heldt Powell, 5/26). To handle the appeals, the insurer has contracted with Vital Solutions Inc., a subsidiary of MassPRO, which provides managed care services to various health plans and the state (Pham, Boston Globe, 5/26). State Rep. Harriette Chandler (D) said, "This is a terrific step forward. It shows that they've come to the realization that it is needed" (Herald, 5/26). Becky Derby, spokesperson for Health Care for All, added, "It's certainly a good first step to admit there needs to be a process." She said, however, it would be preferable if the outside reviewer could be selected by the state ( AP/Worcester Telegram & Gazette, 5/26). Derby added, "[I]f they get to set the rules by which patients can appeal, that's inadequate protection for patients." State Sen. Mark Montigny (D) added, "When you have a financial interest, you can't be objective" (Globe, 5/26).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.