October
2000
Volume
1 Issue 12
Office
of Business Development and Managed Care Operations
|
Updates from…
What’s New…
|
In the waning days of the Congress,
backers of differing versions of the patients’ rights legislation designed to
expand the rights of patients in managed care plans are making a last-ditch
effort to find a compromise. Earlier
this month, yet another version of the bill that passed the House last
October was unveiled; the rewrite allows patients to go directly to court to
resolve disputes with their plan, and adds a $5 million cap on damages. But don’t count on this providing any
momentum towards a compromise – that may come from another effort… With reform legislation
languishing in Congress, White House officials say they will issue rules
before Election Day that will set new federal standards for the handling of
claims under employee health benefit plans giving most Americans with private
health insurance protections similar to those in the stalled patients’ rights
bill. Administration officials
said the new standards, prepared by the Labor Department over the last three
years, would expand the rights of more than 130 million American who received
health insurance through private employers and another 38 million people with
other types of insurance now regulated by the states. The new rules specify what
information must be given to patients, set deadlines for decisions on claims
and establish procedures to help patients appeal the denial of benefits; this
would effectively defuse an issue at the heart of the national debate over
managed care: patients’ perception that they have been unfairly denied care
and have no adequate recourse. Although the new standards
would not go as far as the bipartisan legislation now under debate, it would
make it easier for patients to sue for benefits under existing law. A patient could go directly to court if a health
plan fails to meet deadlines for acting on claims or fails to follow
“reasonable procedures,” as defined by the rules. And the cost of these new
rules? The Labor Department estimated
that businesses would have to spend $155 million on compliance in the first
year, and about $30 million per year thereafter. Needless to say, insurers and employers were quick to say the
costs could be two or three times the official estimates. By the time our next issue
hits the web page, we’ll have more than legislation to think about. Americans will have elected a new
president and we’ll have a whole new chapter in public health policy to
anticipate. I imagine that our second
year in publication will be at least as interesting as the first… The Editor |
|
This bulletin is designed
to facilitate communication among those involved in the administration and
delivery of patient care services at UICMC. We welcome your comments
and suggestions. Editor Mary Gibson Director Roger Carlson |
