Insurers in the hen house

Managed care and health insurance companies currently have the right to deny treatment prescribed by a patient’s doctor. If the patient appeals the decision, the health insurer rules on the appeal. There is no way for the patient to go to an independent arbiter. Regardless of the honor of the health insurer, which some patients may have reason to doubt, they are in business to make a profit and withholding treatment improves profitability. Allowing managed care companies to overrule medical decision-making has an unacceptible fox/hen house ring to it.

Patients rights legislation that would give consumers some independent arbitration and force the insurers to defend their actions in a court of law is overdue. Finally, a bill sponsored by Reps. John Dingell D-Mich., and Charles Norwood, R-Ga., takes control of the appeal process away from the health insurer and places it with an independent review process. If the review finds that the health insurer has denied medically necessary treatment, the patient could sue the insurer.

Opponents of the bill have argued that allowing patients to sue will dramatically increase the costs of health insurance, forcing some employers to no longer provide health insurance to their employees. A Republican version caps the damages the patient could collect at the cost of the treatment denied, thereby adding no additional expense. Both versions include other provisions such as allowing easier access to emergency rooms and specialists, and giving patients more information about how the insurance plans work.

The Republican approach, however, provides no opportunity to collect damages to the patient, and while appealing from a financial standpoint, only encourages health insurers to continue to deny prescribed treatments. If the most insurers can lose is the cost of the treatment they deny, won’t they continue to do? It doesn’t cost them anything to simply say no, while the doctor and the patient have to assemble the appeal, and the patient could suffer without appropriate treatment. And while punitive damage awards could be limited to satisfy bottom-line watchers, Congress should proceed with the idea that health insurers have capriciously injured the relationship between patients and doctors long enough.

Patients rights legislation returns the decision-making power to the doctor-patient relationship, where it belongs. Without the right to sue, there will be no patients rights.