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Press Release July 23, 1998 |
Contact: 202/462-6262 |
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WASHINGTON – The recent effort by congressional Republicans to write a law allowing patients to appeal decisions by managed care officials who delay, deny or terminate medical care is "woefully inadequate", according to an analysis of the legislation by Consumers Union, publisher of Consumer Reports magazine.
"We believe real reform demands and appeals system that gives patients access to an independent entity to settle disputes over medically necessary care," CU’s legislative counsel Adrienne Mitchem told a Capitol Hill news conference Thursday. "Unfortunately, the Republicans’ bill allows plans to exert too much influence over the external review process, which calls the integrity of decisions into question."
At issue the appeals process contained in the GOP "Patient Bill of Rights" that was unveiled last week. The CU analysis found serious flaws on five fronts: scope, financial barriers, speed, exclusions and bias. The real "Patients Bill of Rights" authored by Democratic leaders scores better on all five areas, according to CU, and consumers should "accept no imitations".
The GOP appeals process is extremely limited in scope, allowing only certain types of decisions to be reviewed and providing that managed care plans -- not the doctor – set the criteria for the review. Furthermore, patients, their physicians or representatives are prohibited from making any presentations before the reviewer.
Another concern is the financial barrier set by the GOP bill, which would exclude any appeals for procedures that cost less than $1,000 even if the condition is life threatening. Denying appeals for treatments below this threshold could be crippling for individuals and families on tight budgets, Mitchem predicted.
Unlike the 72 hour reviews required under the Democrat’s bill for urgent cases, the GOP version of the "Patient Bill of Rights" does not call for a shorter time frame for emergencies. Their deadline of 30 business days, which amounts to six weeks, puts patients in need of emergency care at a disadvantage. Moreover, the clock does not start ticking until the managed care company selects a reviewer or delivers the paperwork – two steps without any deadline.
The decision to exclude 38 million people from this reform merely because they work for state or local government or have individual policies is shortsighted, she said.
Finally, Consumers Union has expressed concern about bias on the part of the reviewer. The GOP bill creates a potential conflict of interest by requiring that the managed care companies select the external entity themselves.
