New Guide Details Patients’ Rights, Options When Care is Denied

The Department of Managed Health Care, along with the Foundation for Taxpayer and Consumer Rights and the California Wellness Foundation, released a patients' rights guide Tuesday that explains the process of filing a complaint against an HMO and resolving disputes after care is denied, the Sacramento Bee reports. Although California has passed "sweeping health care reforms" in recent years to give patients "wide latitude" in challenging care decisions, notice of the reforms has been "slow" to reach the 21 million California HMO beneficiaries, the Bee reports. Thus, the new guide tells HMO beneficiaries how to resolve care disputes and explains the rights of the uninsured to emergency care. In addition, the guide details the rights of those with pre-existing conditions to insurance coverage. Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights, said that the guidelines are "a tool kit and compass so patients can have some leverage against HMOs and some direction when they have a problem." Bobby Pena of the California Association of Health Plans added, "It's a good check and balance system, and there's a level of comfort for consumers in knowing they can have an unbiased, fair decision made when they have a complaint." However, Pena added that the guide "overemphasizes patients' right to sue HMOs." The guide is available online at www.calpatientguide.org (Rapaport, Sacramento Bee, 5/9).