2002-06-08 / Community

Pheffer Holds HMO’s Accountable

Pheffer Holds HMO’s Accountable

Assemblywoman Audrey I. Pheffer has announced Assembly passage of legislation holding Health Maintenance Organizations (HMOs) and insurance companies accountable for decisions affecting patient care.

"Patients should feel confident that decisions regarding their health and well being are based on medical need and not cost," stated Pheffer. "This legislation will help ensure HMOs put patient care above profits."

Assemblywoman Pheffer's legislation holds insurance companies and HMOs liable for denying or withholding treatment (A.8318). The measure also prohibits insurers from retaliating against health care providers who criticize them for delays or refusals to cover treatment. Currently, state law prohibits most patients from suing HMOs or health insurance companies who deny or withhold treatment.

"Health care organizations should not be allowed to evade liability by claiming they do not practice medicine," said the Assemblywoman. "In reality, some HMOs have become judge and jury with regard to what care a doctor can provide to a patient. This will empower patients to go to court if they feel their health has been jeopardized by their HMOs' decisions."

Pheffer noted the measure will give HMOs and insurance companies incentive to quickly approve necessary treatments. "If HMOs know they will be held accountable for shortchanging patients, they will be likely to put patient care first," stated Assemblywoman Pheffer.

This bill is a part of Assemblywoman Pheffer's on-going efforts to improve health care for all New Yorkers. Earlier this month, the Assembly passed legislation sponsored by Pheffer to improve business practices between HMOs and health care providers (A.8740). This bill shortens the time insurance carriers have to pay undisputed claims and ensures fair and efficient resolution of disputed claims. It also allows for the creation of a Health Insurance Guaranty Fund to prevent health care professionals and consumers from suffering the financial burden when insurers go out of business.

"These bills will help ensure that New York families get the quality and affordable health care they deserve," concluded Pheffer.

The bills are currently awaiting action in the State Senate.

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