MANAGED CARE: USA TODAY SALUTES DIRECT ACCESS
A USA TODAY editorials commends those HMOs that are "takingThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
the edge off their rigid" specialist referral policies. The
editorial states that the direct access policies adopted by some
plans, which allow members to see "in-network specialists" for an
added fee, come "not a moment too soon" because the "rising
public clamor about tightfisted health plans is beginning to
attract the attention of state Legislatures." According to USA
TODAY, "[I]f HMOs don't begin to answer the frustration of their
members, politicians are likely to do it for them."
SPLIT THE DIFFERENCE: USA TODAY notes that the "more
limited forms of direct access" already used by health plans are
only "compromises" of the traditional managed care model:
"After the first visit, most care still must be pre-approved by
the HMO." The editorial notes that the "traditional alternative"
for many health plan members, the point-of-service option, "comes
with significant out-of-pocket costs, putting it beyond the reach
of many consumers." Therefore, direct access to in-network
specialists is "one intriguing way to split the difference" on
other more restrictive policies.
HONOR ROLL: USA TODAY applauds three managed care plans for
implementing new direct access policies: Blue Shield of
California for allowing their patients to self-refer to
specialists (see AHL 6/18); Santa Barbara, CA-based Monarch
Health System for allowing their primary care doctors to refer
patients to specialists without pre-approval; and Minnesota-based
United HealthCare for allowing enrollees "to see network
specialists whenever they wish" (6/25).