(Circulation. 2000;102:e9034.)
© 2000 American Heart Association, Inc.
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Executive Order May Secure Patients' Rights While Bill Remains Stalled in Congress
On October 8, the New York Times reported that because members of Congress seem unlikely to agree on a version of the patients\' bill of rights, the White House plans to tighten the federal regulation of private healthcare plans. This would, in effect, secure some rights for patients through an executive order. The Times said the rules would be issued in a final form before Election Day.
The rules will set new standards for the handling of claims under employee health benefit plans; this would be the first such revision since 1977. The new rules could give patients better tools with which to deal with the barriers set up by managed care companies. The new rules have been in the writing stage in the US Justice Department for the past 3 years. Under the proposed new rules, the following would occur.
- The government will set standards for the information insurers must
provide patients about their coverage.
- Federal agencies will establish a 15-day limit on the time insurers can take to make decisions on claims. However, if that claim is urgent, the plan would be expected to decide within 72 hours.
- Rulings on appeals must occur within 30 days unless the situation is an emergency. In that case, the appeal ruling must be made within 72 hours.
- Patients whose claims are denied must be told specifically why and they must be informed of the guidelines or criteria used in making the denial decision.
- When a health plan refuses to authorize an
. . . [Full Text of this Article] - Federal agencies will establish a 15-day limit on the time insurers can take to make decisions on claims. However, if that claim is urgent, the plan would be expected to decide within 72 hours.