New Bill Introduced to Implement Patients' Rights Legislation Help Provided to People Denied Health Care

(Washington, DC) New legislation introduced today would establish managed care consumer assistance programs, or ombudsmen, in each state. The new programs would help consumers resolve problems with their health plans early and would greatly reduce the need for future litigation in the area of wrongful denial of care.

The legislation introduced by Senator Jack Reed (D-RI) would give consumers a place to turn when they feel they have been wrongfully denied care from their managed care plans and would help them understand their rights and responsibilities within their health plans.

"Americans are confused about their health care options. They don't trust their managed care plans. They don't know what their rights are when they are turned down for a test and they don't know what they need to do to appeal a health plan decision they don't agree with," said Ron Pollack, Executive Director of Families USA. "Independent consumer assistance programs will help consumers navigate the ever-changing health care system and will help consumers resolve problems early, preventing the need for more contentious disagreements with their health plan later on."

Many bills being considered in this session of Congress include the establishment of an internal and external appeals process for consumers who feel they have wrongfully denied care from their managed care plans.

"Without some form of assistance, these appeals programs will be of little use to consumers," added Pollack. "A strong consumer assistance program will help make these new rights a reality for patients in managed care plans."

Consumer assistance programs established by the Reed legislation would:

• provide comparative information to help people select health plans most responsive to their families needs;
• operate 1-800 numbers to answer questions and complaints;
• help health plan enrollees, who feel that they were wrongfully denied care, with non-litigative appeals -- both appeals conducted by health plans and administrative appeals independent of health plans;
• make referrals, as appropriate, to health plan administrators, employers, regulators, and others; and,
• document the inquiries and complaints received so that all stakeholders in the health care system learn about emerging consumer concerns.

Consumer assistance programs have already been established for Medicare and long term care patients. These programs have helped millions of patients better understand their rights and helped them get the care they need. In addition, the state of Vermont, New York City and most recently Virginia have established consumer assistance programs for managed care patients. Other voluntary programs exist in California and Florida.

"If any of the managed care bills in Congress passes this session, a whole new series of rights will be established for patients in managed care plans," added Pollack. "But without a real way to find out about and implement these new rights, these protections will only be protections on paper. Consumer assistance programs will make these protections real for American consumers."

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Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.

1201 New York Avenue NW, Suite 1100 · Washington, DC 20005
202-628-3030 · Email: info@familiesusa.org · www.familiesusa.org