California Legislature OKs HMO Bill

Published on

Associated Press

SACRAMENTO — Californians would gain the right to sue their health insurers and new insurance benefits under measures approved by the Legislature Thursday and sent to the governor.

The right to sue, one of the most contentious proposals, won Senate approval 22-9. Gov. Gray Davis is expected to sign it.

The proposal would let consumers who suffer ”substantial” physical or financial harm from a health insurer’s decision to delay or deny treatment to sue for the cost of treatment.

The ability to sue over treatment decisions is being pushed by President Clinton in the so-called Patient Bill of Rights. Republicans advocate a more limited bill that gives patients new rights of appeal but no right to sue.

Patients would be guaranteed an independent review of disputed decisions by HMOs and other health plans to put off or refuse treatment recommended by physicians.

Also on the way to Davis is a bill that would require health insurers to cover contraceptives. Other health care bills were expected to pass before the Legislature adjourns Friday.

The breakthrough on the health-care bills came Wednesday after more than a month of closed-door negotiations between the Democratic governor, who stressed a balance between cost and expanded patient benefits, and more liberal legislative Democrats, who wanted stronger consumer protection.

The Legislature’s minority Republicans, who were excluded from those negotiations, questioned the cost and effectiveness of each proposal, but overwhelmingly voted for most of the measures.

Jamie Court of the Foundation for Taxpayer and Consumer Rights, who criticized the secrecy of the negotiations, said the bill giving patients the right to sue ”is the biggest new tool for patients, the one that holds the most hope.”

The measure defines substantial physical harm as ”loss of life, loss or significant impairment of limb or bodily function, significant disfigurement or severe and chronic physical pain.” Financial harm is defined as the cost of treatment.

Consumers could only sue after exhausting all of their rights through the independent review process, and could only seek damages if they were denied ”medically necessary” treatment.

Consumer Watchdog
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