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Informing patients of their vital role in creating a smarter, safer health care system. |
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The Empowered Patient is a 50,000-word book that enables patients and their loved ones to successfully navigate complex medical delivery systems. The book's goal is to encourage, embolden and enlighten medical consumers and their advocates to proactively participate in their own medical treatment.
Jan 20th Release date
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JULIA - PLEASE NOTE - WE ARE STILL FORMATING THIS PAGE SENATOR BARBARA BOXER PANEL ONE: The Consumer Perspective PANEL TWO: The Provider Perspective Another story was given by Dr. Julia Hallisy’s who provided moving testimony of her daughter Katherine's death that was potentially exacerbated by their HMOs refusal to authorize the necessary, specialty care, instead insisting that she see a doctor in the plan. The plan also continued to deny the coverage of prescription drugs claiming that they were experimental. So, instead of spending the last days of her daughter's life by her side, Dr. Hallisy spent her time fighting with the HMO to pay for her daughter's medical bills. The McCain/Edwards/Kennedy bill would have prohibited the HMO from refusing necessary specialty care and prescription drug coverage. Further, Dr. Hallisy would have been able to obtain the specialty care her daughter needed in a timely fashion and she would not be wasting her valuable time on the phone arguing with her HMO over whether they would cover her daughter's pain medication. Brian Schaller gave testimony of his five-year fight with his HMO to cover his wife's health care after she was diagnosed with breast cancer. It is Mr. Schaller's belief that both their oncologist and their HMO were working together to save money by denying necessary care, like access to clinical trials, and hiding the extent of his wife's illness. Under the care of a different physician, Mr. Schaller's wife is improving, but it is still very serious. The McCain/Edwards/Kennedy bill would hold the HMO responsible for their negligent care, prohibit financial incentives to deny care, and allow patient's access to approved clinical trials. Because California did not have a state law allowing HMOs to be sued in court, Mr. Schaller has only been able to hold the doctor - -responsible and not the HMO. Yet, even in his medical malpractice case, Mr. Schaller expressed his difficulty in obtaining representation because of the low caps on damagesAnother important point raised by Mr. Schaller, was the fact that even the mere threat of exposure of an HMOs corrupt practices are often enough to encourage HMOs to do the right thing. The accountability provisions in the McCain/Edwards/Kennedy bill would provide this safeguard. The second panel consisted of health care professions who are on the other side of this issue, and have to deal with these HMOs on a daily basis in an effort to adequately care for their patients. At the hearing, Senator Boxer heard from four doctors, all of which expressed their continual frustration with the managed care system. The doctors raised the following concerns including, the lack of prescription drug coverage; difficulty in authorizing specialty care; financial incentives that encourage the denial of coverage; continuity of care and an inadequate appeal process. An especially troubling comment raised by one of the health care professionals dealt with how the HMO she was dealing with continually changed its rules in order to avoid taking responsibility for authorizing needed medical care. As a result, the panelist stated that she has resorted to sending claims by certified mail, yet the HMO still denies receiving the documents, thus further delaying needed health care coverage.Another reccurring theme among the panelists was the lack of accountability within the managed care system and how HMOs have no incentive to "clean up their act " All of the panalists were consistent in their frustration of spending more time on the phone with the HMOs in order to obtain authorization for minuscule health care services instead of caring for their patients.Everyone involved in the hearing indicated their support for the accountability portions of the McCain/Edwards/Kennedy bill and urged Senator Boxer to not allow the bill to be compromised further. Jamie Court of the Foundation for Taxpayer and Consumer Rights, also mentioned the fact that the McCain/Edwards bill was uniquely drafted so as not to preempt more beneficial state laws like those provided in California. This was a key compromise in the bill that all agreed should not be compromised. All of the panelists reiterated the fact that the accountability provisions in the bill were the only way to "keep the HMOs honest" and to ensure patients access to needed health care services. It was further stated that the Independent Medical Review (IMR) Process included in the McCain/Edwards/Kennedy bill, although necessary, is not enough to help patients who have been wrongly denied health care coverage. Because the IMR is a medical decision and not a legal standard, HMOs would still avoid responsibility for most of the damages they have inflicted upon patients. Thus, only the liability provisions that allow patients access either the state or federal court system will provide patients the protections they deserve. |