HMO APPEALS: Maryland Process Is Little-Used
While polls indicated that Maryland residents supported a recently enacted law creating a state appeals process for HMO coverge denials, the option has been little used by Marylanders since the law's passage, the Washington Post reports. In January, the month in which the law took effect, only 13 appeals were filed. By March, the figure had climbed to 69 appeals, the greatest number to date.
State Insurance Commissioner Steven Larsen said that rate pales in comparison with the 7,000 to 8,000 other complaints for health and life insurance his agency receives annually. Larsen said, "I'm encouraged that the numbers aren't higher. It indicates that things aren't as bad as people thought they were or that (HMOs) have taken steps to improve their internal reviews." The statistics also show that most complaints thus far have been simply remanded back to an HMO's own internal appeals process "because patients hadn't exhausted their chances there." But, the Post notes, the new law is still helping patients: It provided that the attorney general's Health Education and Advisory Unit assist patients in navigating HMO appeals processes, and also required HMOs, when denying a coverage request, to inform patients they could appeal (LeDuc, 5/31).