PATIENT APPEALS: Consensus Reached In Legislature
Legislators reached a bipartisan compromise yesterday on a bill to allow HMO patients to appeal their plans' decisions to an independent board, the AP/San Diego Union-Tribune reports. The initiative is one of "more than three dozen bills this year to improve the quality of care for the 17 million Californians who get their health care from" HMOs. The idea was promoted by Gov. Pete Wilson's Managed Care Improvement Task Force earlier this year, and was modeled after similar programs in New Jersey and Florida. For a $50 fee, patients will be able to "appeal decisions to independent review organizations that would be hired by the state." Reviews must be requested within 30 days and the denied service would have to cost at least $1,000. Assemblywoman Carole Migden (D-San Francisco), one of the authors of the bill, said that other "commonly denied services with lower costs" might be added if they were identified. Neither Consumers Union nor the California Association of Health Plans were ready to comment on the bill. One of the bill's other authors, Assemblyman Bernie Richter (R-Chico), said, "This is major reform to deal with a very vexing problem" (4/15).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.