Proposed HMO bill doesn't let patients sue

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By Associated Press

Under a new Republican bill introduced Sept. 23, health plans would be penalized for refusing to pay for medically necessary treatment. But unlike two other patient-protection measures pending in the U.S. House of Representatives, the bill unveiled by Rep. John Boehner (R-Ohio) would not give patients the right to sue.

"Patients don't want lawsuits. They want a system that punishes HMOs severely if they refuse to provide the treatment physicians prescribe," he said at a news conference. "Patients want care, not court."

Boehner said his bill would cover the 161 million Americans with private-sector health insurance, as well as the 43 million uninsured. It also would encourage small business to buy health insurance for employees.

Patients would be guaranteed the right to have disputed decisions about HMO coverage reviewed by outside doctors whose findings would be legally binding. Plans that refuse to comply could be prosecuted and fined. The bill also has other protections, including the right of patients to continue receiving care from a doctor who has left their HMO, and the option of choosing a doctor from outside of their network, Boehner said.

Doctors would also be able to tell patients about the full range of treatment options under Boehner's bill. Access to emergency care for all would be guaranteed as well as obstetrical and gynecological care for women.

Boehner opposes two other pending measures because he said both would expose employers to lawsuits and jeopardize employer-based health coverage.

House Speaker Dennis Hastert (R-Ill.) has promised to bring the patient protection measures to the floor sometime next month.

The American Association of Health Plans issued a statement endorsing the Boehner plan as one that "begins to address the real issues without sending costs through the roof or feathering the nest of trial lawyers."