Advocates Release New California HMO 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 an interactive Internet guide for help.
The Foundation for Taxpayer and Consumer Rights (FTCR) announced today an Internet guide to help Californians understand and utilize their rights as managed care patients under new health care laws. The interactive patient guide, the first to deal with California’s new patient protection laws, is posted at http://www.calpatientguide.org. It explains the provisions of landmark HMO reform laws to take effect January 1, 2001, including those allowing patients the right to sue their HMO and have independent reviews of treatment denials. For every right enumerated, the guide provides the specific state statutes for patients to cite when seeking care from their HMOs.
“The California Patient Guide: Your Health Care Rights and Remedies” was drafted by FTCR and the California Department of Consumer Affairs with the advice of medical experts, legal scholars and state officials. Funding from the California Wellness Foundation allowed for the guide’s preparation. It includes, among other things, information on patients’ rights:
o in the emergency room
o to obtain their medical records and to maintain medical privacy;
o to effectively navigate through their HMO’s appeals process,
o to have a second opinion;
o to have a independent party review of denials of treatment by HMOs;
o to health coverage for pre-existing conditions;
o to file a legal claim against the HMO.
“This first-of-its-kind guide is designed to be a compass for the maze of managed care and California health care law,” said Pam Pressley, FTCR staff attorney and editor of the guide. “Patient rights without an owner’s manual to explain them are useless. The patient guide provides comprehensive health care information, defines key health care terms and gives citations to useful statutes that can help patients be their own best advocate. The guide also points patients to the appropriate health care agencies and advocates so that they don’t have to waste time figuring out who to call.”
A printed version of the guide will be available in late January and distributed through FTCR, the California Department of Managed Care, the California Department of Consumer Affairs, and various clinics and consumer groups. Patients can obtain the printed version by calling FTCR at (310) 392-0522 ext. 308. A Spanish-language version will be available in print form by March of 2001.
The California Department of Consumer Affairs has provided technical assistance with editing, layout and publication of the guide. In addition to several medical and legal experts, the following groups also lent their support to the publication of the guide by allowing representatives to serve on an editorial committee: Health Administration Responsibility Project (HARP), California Medical Association, California Nurses Association, California Healthcare Association, Olsen Coalition for Patient Rights, and L.A. Coalition to End Hunger and Homelessness. In addition, several patients who had struggles with their HMOs played a key part in preparation of the guide. Quotes from patients who have prevailed over their HMO are included in the guide.
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.