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Patients' Rights Tops Healthy Debate List

Article excerpt

Patients and their health insurance rights will be center stage in health care debates at this year's legislative session.

The hottest issue is whether to give patients the right to sue for punitive damages when an HMO denies a service or doesn't act promptly.

Consumers already can sue their HMO to recoup treatment costs or to make the insurer pay for a procedure, but so far health insurers have been exempt from civil lawsuits.

Other health topics that could become an issue in the session include additional mandates to health insurance that would require insurers to cover certain prescriptions and treatments, ways to combat the growing number of uninsured in Florida, increased prescription drug coverage and outlawing the mandatory use of hospitalists by HMOs.

Different versions of a ''Patients' Bill of Rights'' exist already. Proposals in the bill would allow patients to sue their HMO and/or their employers if an HMO doesn't cover a particular procedure or treatment, expand prescription drug coverage and prevent doctors, hospitals and other providers from being able to sue an HMO for unpaid bills.

What the health insurers are looking for is ''fair, reasonable and adequate regulation, not no regulation,'' said Melissa Rehfus, vice president of public policy for Blue Cross and Blue Shield of Florida.

In terms of a bill of rights, insurers don't think one is needed.

''At this point, [the bill of rights] is a wolf in sheep's clothing. What we will be doing is trying to shift the debate to patient protections,'' Rehfus said.

Nationally, interest in a patients' bill of rights has been brewing for some time. Florida's legislators have seen the HMO accountability portion for several years.

Consumers argue that protection is needed against health insurance companies that sometimes deny or delay claims approval without consulting physicians. Consumers say they also don't have a way to hold their health insurers monetarily accountable for the companies' claims handling decisions.

''HMOs should be held to the same legal standards as physicians and hospitals,'' said N.H. Tucker, past president of the Duval County Medical Society. …