FOR IMMEDIATE RELEASE CONTACT:
JON L. SHEBEL, PRESIDENT & CEO
MARCH 3, 2000
PHONE: (850) 224-7173 E-MAIL: jshebel@aif.com
INTERNET: http://aif.com
AIF
PROPOSES HMO PATIENT PROTECTION ACT OF 2000
TALLAHASSEE-- Today, Associated
Industries of Florida (AIF) released its Patient Protection Act of
2000. The legislative proposal was developed on behalf of Florida's
employers, employees, and their families, to protect and ensure their
access to quality and affordable health care in Florida.
A number of anti-HMO bills have already been filed for the 2000 session, the most
dangerous of which, from the business community's perspective, is the so-called
Patients' Bill of Rights. The AIF bill was developed in response to the attacks on
the state's managed care system. Its main features are steps to codify the
state's existing HMO consumer protection laws and to beef up the appeals process for
HMO subscribers.
"The patients' bill of rights legislation has little to do with protecting
patients and everything to do with ruining HMOs' ability to control the costs of
health care," said Jon L. Shebel, AIF's president & CEO. "The goal of
AIF's legislative proposal is to improve the climate for everyone involved, not
destroy it."
Many Florida employers have seen double-digit increases in their health insurance this
year and no relief is in sight in the immediate future. Rising premium costs are coming at
a time when the numbers of uninsured are also beginning to grow.
"Most Floridians who enjoy private insurance receive it through their
employers," said Shebel. "Protecting access to affordable health care is based
on more than concern for workers. It's a bottom line issue for us."
Shebel took issue with the negative picture of HMOs painted by the trial lawyers'
media campaign. "You don't hear the stories about how HMOs are improving the
lives of the chronically ill," he noted. "You don't read stories about the
studies showing that HMOs provide better treatment outcomes for patients."
AIF is responding with a public information campaign to inform Floridians about the
impact of anti-managed-care legislation on their health insurance. The campaign will run
during the session and up to the November elections.
AIF's legislative proposal also includes funding for a public information campaign
run by the Florida's Agency for Health Care Administration (AHCA) to spread the word
about the state's process for resolving managed care coverage disputes. "Only
trial lawyers want to resolve these disputes with lawsuits," said Shebel. "A
medical malpractice claim takes, on average, 54 months to resolve. We've already got
an appeals process in place that can resolve a dispute in 48 hours and we're
proposing other patient-friendly options to resolve disputes. The problem seems to be that
nobody knows about it."
Associated Industries is a statewide employers association representing more than
10,000 businesses who collectively employ more than 1 million people. Member companies
range from large multinational corporations to small family-owned enterprises. AIF is
commonly known as "The Voice of Florida Business."
For a full copy of AIF's HMO Patient Protection Act of 2000, contact Dwight
Sumners, AIF vice president – corporate communications, at (850) 224-7173 or by
e-mail at dsumners@aif.com.
This legislation clearly identifies the principles
of consumer protection that the laws afford HMO patients. Florida
consumers can expect high standards of quality care, ready access
to specialists, confidence in the financial solvency of their health
plan, continuity of care when their doctor leaves a panel or the
patient changes insurers, and an inexpensive, efficient manner of
resolving complaints.
Medical Doctors Must Make Treatment Coverage Decisions
This legislation mandates HMOs use only licensed
medical doctors in denying coverage for treatment which requires
medical judgement and training. Denials will be based on the treating
physician's failure to meet prevailing medical standards of
care.
Mandatory External Review of Medical Necessity Decisions
All patients currently have the right to appeal
HMO decisions to an internal review process. This proposal creates
the right of patietns to access an external panel of medical experts
outside the HMO if the HMO disagrees with the medical necessity
of a particular treatment.
Strengthening the State Panel for Patient Appeals
Since approximately half of the disagreements that
come to the Statewide Subscriber Assistance Panel are related to
disputes over the terms of the patient's contract, this provision
adds an attorney specializing in contract law to the panel.
Currently, the HMO can appeal decisions of the
panel to the administrative hearing process; however, the member
is limited to seeking redress in the courts. This provision affords
the patient the right to an administrative appeal also.
Public Awareness and Assistance for HMO Patients
The state will undertake a statewide awareness
program of the protections afforded Floridians. A consolidated "Hot
Line" for electronic and telephone access for all complaints
and inquiries will empower citizens to better protect themselves
when they have health care needs. Part of this program mandates
all managed care organizations, health care facilities and physicians
post signs advertising this service to patients.
Protecting the Patient from Unwarranted Billings
This provision clarifies that physicians and other
providers cannot send bills to patients or subject those patients
to collection agencies when those patients are HMO subscribers receiving
covered services.
Mandated Health
Benefits
This provision establishes a formal, actuarially based
process for the legislature to use when expanding the health benefits
that must be purchased by Floridians. Also, it allows small employers
to choose health benefits of their choice without state mandates.
516 North Adams Street ● Post Office Box 784 ● Tallahassee, Florida 32302-0784 ● Phone: (850) 224-7173 ● Fax: (850) 224-6532 ● www.aif.com
