Bill would allow HMO patients greater choice

March 31, 1994|By John W. Frece | John W. Frece,Sun Staff Writer

Maryland doctors scored an important late-session victory yesterday by pushing from a Senate committee a bill that would require health maintenance organizations to pay part of the cost for patients who seek medical care outside of their HMO network.

The heavily lobbied bill is opposed by General Assembly leaders, big business, organized labor and the powerful insurance industry.

Representatives of the state medical society, however, said that if the bill is passed in the final 12 days of this legislative session, Marylanders enrolled in HMOs will get what they want: the right to choose their own physician and have their insurer help pay for it.

The bill would require HMOs to pay doctors or other medical providers outside their network 75 percent of what the HMO would otherwise pay for the same treatment inside the network.

Patients would have to pick up the remaining 25 percent, plus any additional fees an out-of-network provider might charge.

Opponents called the bill a blatant money grab by doctors, saying it would destroy the low-cost HMO option of medical care, and with it, many of the cost-saving benefits that have made such "managed care" networks increasingly popular with businesses, labor and the public.

"It is a giant step backwards," said Sen. Thomas P. O'Reilly, the Finance Committee chairman and one of two of the committee's 11 members who voted against the bill.

"I hope you all see this bill for what it is. It is an effort on the part of the medical community totally to derail managed care," he said. "Managed care and HMOs are the only thing in this country trying to hold [health care] costs down."

Supporters of the measure called it a reasonable compromise that would balance some of the bottom-line decision making by HMOs by giving patients more control over their medical care decisions.

Mr. O'Reilly, a Prince George's County Democrat who was instrumental last year in drafting Maryland's health care reform law, did what he could to stop the bill.

He delayed a hearing as long as possible, tried to push the measure into a summer study, delayed a vote until a majority of his committee formally petitioned him to bring it up, and then pushed through a series of amendments that could make doctors squeamish about supporting the bill.

"They're trying everything they can to kill this bill," said Joseph A. Schwartz III, a lobbyist for the state medical society. Mr. Schwartz predicted that the bill will be approved by the full Senate.

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