State Agencies, Consumer Group, Physicians Unveil Free California Patient Guide

California patients facing problems with their HMO, concerns over their medical privacy, or questions about their rights under new state HMO reform laws can now turn to a new, free 80-page guide available from state consumer hotlines.

The California Department of Consumer Affairs (DCA), California Department of Managed Health Care (DMHC) and the Foundation For Taxpayer and Consumer Rights (FTCR) announced the availability of 80,000 printed copies of the free guide, which covers issues from how to get copies of your medical records to how to sue your HMO. FTCR prepared the guide with the assistance of the two state agencies. The California Medical Association is mailing copies of the guide to 25,000 of its members for the doctors to display in their offices.

The DMHC also made publicly available for the first time today data about the success of year one of California’s HMO patients’ rights laws — a model for national legislation to be debated in the U.S. Senate next week. There have been no reported lawsuits during the first six months of California’s right-to-sue law, but there appears to be a deterrent effect — with HMOs resolving most disputes with patients earlier so that they do not have to face doctors conducting independent reviews for the state or damage awards.

“California has the toughest HMO patients’ rights laws in the nation and, at this early juncture, they appear to be doing precisely what they were designed to do — deterring misconduct,” said Jamie Court, executive director of FTCR. ” California test drove the patients’ bill of rights and it is a strong consumer protection model for the rest of the nation.”

“The California Patient Guide: Your Health Care Rights and Remedies” is an unprecedented collaboration between FTCR, DCA, DMHC, the California Nurses Association, the California Medical Association, the Consumer Attorneys of the California, state legislative offices, and medical and legal experts across the state. In question and answer format, the guide focuses on informing patients of how to use new HMO patient rights’ laws effective this year, including the right to have denials of care reviewed by independent experts and the right to pursue legal action against an HMO. Other reforms, including the establishment of the DMHC, were effective July 1, 2000.

“If this information had been available when my mother was desperately ill, we would have known our options, and could possibly have saved her life,” said Linda Ross, whose mother died after waiting more than six hours in an HMO’s emergency room untreated when a blood thinner on hand would likely have saved her. Ross helped write the guide. “It is a must read for every California patient and their families.”

“The patient guide is a tool and a compass for HMO patients who too often find themselves alone and without leverage or direction when confronting billion dollar corporations with nearly unlimited resources,” said Jamie Court, executive director of FTCR. “The guide is an owners manual for the patients’ bill of rights. It signals a positive, new direction for California’s HMO regulation when state regulators are willing to collaborate with doctors, nurses, and patient advocates to produce and distribute an owner’s manual for the vehicle of patients’ rights.”

The public can secure the guide by calling 1-888-HMO-2219 (Department of Managed Health Care) or 1-800-952-5210 (Department of Consumer Affairs). An Internet version can be viewed at http://www.calpatientguide.org

Funding from The California Wellness Foundation allowed for the guide’s preparation. For every right enumerated, the guide provides the specific state statutes for patients to cite when seeking care from their HMOs. It includes, among other things, information on patients’ rights:

‘ in the emergency room

‘ to obtain their medical records and to maintain medical privacy;

‘ to effectively navigate through their HMO’s appeals process,

‘ to have a second opinion;

‘ to have a independent party review of denials of treatment by HMOs;

‘ to health coverage for pre-existing conditions;

‘ to file a legal claim against the HMO.

“The Wellness Foundation is proud to fund this unprecedented collaboration between consumer groups, patients, state agencies, the medical community, the legal community and legislators,” said Gary Yates, president of The California Wellness Foundation. “This guide should prove an invaluable tool for patients in need of help.”

The Foundation for Taxpayer and Consumer Rights is a non-profit, non-partisan consumer watchdog group based in Santa Monica, CA. http://www.consumerwatchdog.org.