| CASAGRANDE AND ANGELINI PATIENT RIGHTS APPEAL NOTIFICATION BILL MOVES THROUGH COMMITTEE |
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Legislation sponsored by Assembly Republican members Caroline Casagrande and Mary Pat Angelini that will require hospitals and physician offices to make more widely available information about a health care appeals program was approved today by the Assembly Health & Senior Services Committee.
Casagrande explained that very few residents are aware of the low-cost program which they can utilize to have a determination made by an independent panel of physicians as to whether a medical procedure is medically necessary if it is first denied by their insurer. She added that in a state with 2.9 million people enrolled in HMOs or other managed care programs that make them eligible for the appeals program, only 326 residents filed appeals through the program during the first six months of 2009. The fee for the appeal is $25.
The Independent Health Care Appeals Program, administered by the Department of Banking and Insurance, was established to protect patient rights in the event a health insurance carrier denies, reduces or terminates a patient’s benefits. The program allows patients to appeal an insurer’s panel doctor’s decision through an independent medical necessity or appropriateness of services review. The appeal review does not include any decisions regarding benefits not covered by the insured’s health benefits plan.
“The program is one of the best kept secrets in health care for both patients and health care providers, which is a shame because I’m certain many people have been unjustly denied benefits for needed treatments,” said Casagrande, R-Monmouth and Mercer. “Too often, patients and their families think they have no other recourse when they are denied coverage for a medical procedure. Many face what they believe is a hopeless situation, but the good news is the insurer’s decision isn’t final. The program opens another avenue of hope.”
“This bill is essential in helping to protect the rights of patients,” said Angelini,
R-Monmouth. “Dealing with a medical condition can be an extremely stressful and overwhelming time for patients and family members. Requiring hospitals and physicians to take steps to ensure patients are fully informed about the appeals program and the options that are available to them will help to alleviate confusion and prevent situations from unnecessarily ending up in court.”
The bill, A-1816, requires hospitals to provide information about the Independent Health Care Appeals Program in a conspicuous place in each of its waiting rooms for the general public. Hospitals must also provide training for appropriate staff to enable them to provide information, and respond to questions from patients and individuals about the operation of, and how to apply for, the program. Physicians are also required to post information about the program in a visible place in the patients’ waiting room within the medical office.
The legislation is the result of an experience Casagrande had with her insurer who declined to cover services contrary to recommendations of treating physicians. During her efforts to appeal the insurer’s decision, she found out about the Independent Health Care Appeals Program. Although Casagrande won her appeal internally, during the process, she found that the program is highly underutilized.
“Medical debt caused by wrongful failure of an insurer to properly cover medically necessary treatment can push a family into bankruptcy,” said Casagrande. “This program can help protect patient rights, but it isn’t of much use if the public doesn’t know it exists.”
To speak to an Independent Health Care Appeals Program representative, call 1-888-393-1062.
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Layli S. Whyte
Communications Director
12th Legislative District
Senator Jennifer Beck
Assemblyman Declan O'Scanlon
Assemblywoman Caroline Casagrande
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