PATIENTS’ RIGHTS: Bill Would Allow Patients to Challenge HMO Coverage in Court
A California legislator introduced a bill today that would allow patients the right to challenge their health care plan's coverage decisions in court, the San Diego Union-Tribune reports. Assemblywoman Sheila Kuehl (D-Santa Monica) said her bill would ban the current practice in which HMOs place a mandatory arbitration clause in members' policies, a practice which prohibits patients from taking their HMO to court. Many argue that arbitration, an alternative to court that is more expeditious and less costly for managed care plans, infringes on patients' rights. "When we create a right for a patient to sue their HMO and then every major HMO writes a mandatory arbitration clause in their contracts, it nullifies that right," Kuehl said. Last year, Californians won the right to sue their HMO if they could prove that certain coverage denials caused loss of life, significant damage to bodily function or limb, severe or chronic pain or significant financial hardship. Walter Zelman, president of the California Association of Health Plans, said the arbitration provisions placed in members' contracts are "not a loophole to last year's reform [health care] package," but a "faster, more efficient, lower-cost dispute resolution system that gives you all the same rights." Consumer groups, however, maintain that mandatory arbitration clauses hurt consumers, noting that with some plans, the arbitrators are handpicked by the company. Kuehl's bill would still allow a patient to voluntarily submit to arbitration, but only after the dispute arises. Kruel said she wants "to preserve a person's ability to go to court" (Ainsworth, 1/13).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.