Added patient rights sought

Consumer advocates, physicians welcome governor's proposal

`Good step forward'

More protections would mean more costs, insurers say

January 23, 1999|By Timothy B. Wheeler | Timothy B. Wheeler,SUN STAFF

Consumer advocates and physicians applauded Gov. Parris N. Glendening yesterday for responding to widespread complaints about managed health care by proposing a "bill of rights" for Maryland patients.

Health insurers warned that the governor's legislation could raise medical costs and lead to loss of coverage for some people.

Making good on a campaign promise, Glendening pledged Thursday during his State of the State speech to push for more consumer protections against refusals by health insurance companies to pay for the medical care that patients seek.

"He's making another good step forward," said Judy Waxman, government affairs director for Families USA, a national consumer group in Washington. Maryland law already provides patients more rights than most states when dealing with complaints about managed health care, she noted.

The bill drafted by the governor's office would give patients five new "rights" and would designate the Maryland insurance commissioner's office as a central clearinghouse for information about health insurance gathered by state agencies.

The new protections would include greater access to prescription drugs and specialists, and guaranteed minimum hospital stays for certain types of surgery.

Glendening plans to let others carry the fight, though, for the most controversial right he supports -- letting patients sue health maintenance organizations for sub-par care.

Though in the heat of last fall's re-election campaign he advocated giving patients the right to sue, the governor says he will not introduce such legislation. Rather, he will support bills to that effect from lawmakers.

Under Glendening's "bill of rights," patients would be able to get prescription drugs not covered by their health plan if the medicines were deemed necessary by their physicians.

To see specialists, patients could get standing referrals for treatment of a chronic ail ment without having to get approval for each appointment, as many managed care organizations now require.

Specialists also would be able to act as primary care doctors for chronically or seriously ill patients.

Moreover, patients would be able to get referrals to specialists outside the health insurer's network if the doctor had expertise or training not found among the in-house physicians.

Minimum stays

In addition to proposing 48-hour minimum hospital stays for mastectomies and testicular cancer surgery, the bill would guarantee 24-hour stays for lymph node dissection and lumpectomies.

Patients undergoing those procedures could be discharged earlier or have them done as outpatients, if they and their doctors agreed.

Patients who did not stay in the hospital the prescribed minimum time after surgery would be entitled to home visits.

Steven B. Larsen, Maryland's insurance commissioner, said the governor's bill would "close a few of the gaps" in state laws ensuring patient rights, dealing with some of the most common frustrations people have with managed care.

"Almost anyone who has had any kind of nonroutine medical problem has had to go through a number of hoops to get ongoing specialist care," he said.

More staff needed

Larsen said his office would need more staff to serve as a state clearinghouse for health insurance information but suggested that the added cost could be paid for by the health plans.

Gerard E. Evans, lobbyist for two major health insurance firms, said he had not seen the governor's bill. But he cautioned against more required coverage as health insurers struggle to keep costs down.

"Each time we hang one of these ornaments on this tree, it gets more and more expensive," Evans said. "And we are rapidly approaching the point where coverage is going to become an issue. Every consumer wants a Cadillac policy, but they only want to pay for a Volkswagen."

Physician support

Physicians "wholeheartedly support efforts to facilitate patient access to the doctors of their choice," said T. Michael Preston, executive director of the Medical and Chirurgical Faculty of Maryland, the state medical society. But he added that the more than 7,000 doctors his group represents really want to see legislation holding HMOs accountable for refusal of care.

If Glendening's bill of rights is passed many Marylanders still would not have the added protections. The law would cover the approximately half of the state residents who have private health insurance. Companies that are self-insured for their health plans are exempt from state regulations.

Pub Date: 1/23/99

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