Cardin bill may expand the rights of patients Bill allows outside appeal when private insurers refuse to cover expenses

March 18, 1998|By David Folkenflik | David Folkenflik,SUN NATIONAL STAFF

WASHINGTON -- Patients whose private insurers refuse to pay health care costs would have the right to appeal to an outside panel, under legislation introduced yesterday by Rep. Benjamin L. Cardin, a Baltimore Democrat.

Although federal policy requires an external review of complaints for patients in the Medicare system, private companies offer their customers only an internal appeal.

An official for the Health Insurance Association of America, whose member firms provide policies covering the health care costs of some 60 million Americans, raised objections to the bill without explicitly opposing it.

"All of these things that cost money get passed on to consumers," said Jane Galvin, the managed care policy director for HIAA.

She questioned how the members of the external review panels would be certified and said that top physicians could charge hundreds of dollars per hour to serve.

But Cardin said the companies have a conflict of interest in reviewing their own decisions, especially those that save them money.

"Even if the decision is made appropriately, there's always a suspicion in the mind of the patient that it was not," he said.

Galvin acknowledged that health maintenance organizations combined the provision and the billing of medical care, but said it was a misperception that the companies' internal processes had a built-in bias toward saving money.

Cardin said the measure would not expand the coverage offered by existing policies.

The Cardin bill resembles legislation promoted in the Senate by Joseph I. Lieberman, a Connecticut Democrat, and James M. Jeffords, a Vermont Republican.

Pub Date: 3/18/98

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