2004-04-23 / Community

Pheffer Aims To Increase HMO Accountability

Pheffer Aims To Increase HMO Accountability

Assemblywoman Pheffer has announced that the Assembly has passed legislation she sponsored that holds health care maintenance organizations and insurance companies accountable for denying or withholding necessary patient care.

"This bill will ensure that important medical decisions will be made by people most qualified to make them – doctors – and not bureaucrats who lack expertise and patient knowledge," Assemblywoman Pheffer said. "This legislation will help ensure HMOs put patient care above profits."

The Assembly’s legislation holds insurance companies and HMOs liable for consequences of denying or withholding treatment (A.5733). The measure also prohibits insurers from retaliating against health care providers who criticize them for delays or refusals to cover treatment.

"There’s more than just money at stake when insurance and HMO executives refuse to cover medical treatments," Assemblywoman Pheffer said. "Their decisions sometimes mean the difference between life and death."

Assemblywoman Pheffer urges patients who have been denied coverage for treatment recommended by the doctor to turn to New York’s managed care external review law (Ch. 586 of 1998). The law gives patients the option to seek an outside medical review if that situation occurs. To receive an external appeal application, call the Department of Insurance at 1-800-342-3736 or the External Appeal Consumer Information Line at 1-800-400-8882.

Assemblywoman Pheffer is also continuing her efforts to ensure New York’s families are receiving quality, affordable health care by fighting for a fair, responsible budget. The governor’s proposed health care cuts and taxes – to the tune of $1.5 billion – would have a devastating effect on the state’s job market and health care coverage.

"New York can’t afford to sacrifice the quality of health care available to our families," Assemblywoman Pheffer said. "I will continue to ensure our families get the care and respect they deserve, and support legislation that ensures health care providers make first-class patient care a priority."


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