Action necessary now on patients' bill of rights
July 15, 2001
Congress is working on passing a patients' bill of rights that will give Americans more access and accountability with their health care insurance. The issue of patient protection has been an ongoing legislative struggle for the past several years.
In the past there were many different forms of legislation and broad disagreement on many of the key issues in this type of legislation. Now, there is a basic agreement on 90 percent of the major patient protection issues.
There is general agreement on several principles that need to be enacted to protect patients including the following:
Providing patients with emergency room and ambulance services without hassle;
Giving patients quick access to physician specialists;
Allowing women direct access to OB/GYN care;
Eliminating "gag clauses" that prohibit doctors from informing patients of treatment options if their health plan does not cover them;
Requiring health insurance companies to disclose "up front" the information about their coverage including covered and excluded benefits, cost sharing requirements, participating providers and patients' rights to appeal denied benefits; and,
Providing an appeals process for patients who are denied benefits, to be conducted by doctors not insurance clerks with a 72 hour decision time frame for urgent situations.
The major point of contention in the current patients' bill of rights debate is how to best hold health insurance companies accountable if they make a decision about a person's health insurance coverage that causes harm to that person. How we deal with this issue of "liability" is the key to getting a good patient protection bill signed into law.
We must make sure that patients have strong protections including the right to sue if harm is proven while at the same time setting up a strong appeal system that weeds out and discourages frivolous lawsuits that would mean higher health insurance premium costs to individuals and their employers.
The patients' bill of rights legislation I am co-sponsoring in the House of Representatives includes all of the major components I outlined above and also allows patients who have exhausted their appeals process to then hold their health insurance company accountable in court if the insurance company is proven negligent.
Patients could go to court for unlimited economic damages and up to $500,000 for pain and suffering. This type of liability provision strikes the right balance between holding insurance companies accountable while making sure health insurance is still available and affordable for individuals and employers who often pay for some or all some of their employees' health care coverage.
The president supports this approach to patient protection legislation and will sign the bill into law if passed by the House and Senate. After years of bickering, the time has come for action. It's time to put the needs of patients first, not politics.
U.S. Rep. Chip Pickering, R-Miss., represents Mississippi's Third Congressional District. Write to him at 427 Cannon Building, Washington, D.C. 20515 or call (202) 225-5031.