San Diego Union-Tribune
Californians struggling to find their way through the managed-care quagmire now have help on the World Wide Web.
Over the last two years, landmark state legislation has revamped managed-care consumer rights in California. To help patients understand what the changes mean and how to get the care they need, a Santa Monica-based consumer advocacy group and the California Department of Consumer Affairs have made a guide available on the Internet at http://www.calpatientguide.org.
The book version will be published in January, with a Spanish-language edition to be available in February or March, said Jamie Court, executive director of the Foundation for Taxpayer & Consumer Rights, the consumer advocacy group.
More than just a primer on California’s health-care law, the guide is meant to serve as a tool for patients in dealing with their health plans, Court said.
Health plan representatives and officials with the state Department of Managed Health Care said yesterday they had not had an opportunity to read the new guide. But a spokesman for the California Association of Health Plans, which represents 36 plans covering 21 million Californians, questioned the motives of the Foundation for Taxpayer & Consumer Rights.
“That organization’s primary concern is about ways to sue a health plan,” spokesman Bobby Pena said. “If that’s the focus of the guide, I think it’s doing everybody a disservice.”
Established in 1985, the foundation is a nonprofit organization with separate divisions that track industries such as utilities and insurance. Since its health-care division was created in 1994, the foundation has been waging an assault on the managed-care industry.
Court said the foundation’s objective in publishing the guide was simple: to give consumers a Rosetta Stone to decipher an arcane health-care system and understand their rights under the new laws.
Two years ago, Gov. Gray Davis signed a sweeping package of health-care bills into law, some of which are about to take effect.
“This guide was created because there really was no one repository for health-care law, especially the laws that take effect Jan. 1,” Court said.
As of Monday, a California patient will have the right to an external review if a health maintenance organization denies treatment recommended by one of its doctors. Most significantly, Californians will be able to sue a health plan if they believe they have been substantially harmed because their plan denied or delayed treatment.
Most of the funding for the guide was provided by the California Wellness Foundation, an independent private foundation created by Health Net in 1992 when it converted from a nonprofit to a for-profit health plan.
In addition to information about state law, the guide contains information about federal laws dealing with managed care. One section focuses on the Employee Retirement Income Security Act of 1974, the federal legislation governing pension programs, which so far has shielded health plans from being sued in federal court.
For copies of the printed version of the guide, which is available free of charge, call the Foundation for Taxpayer & Consumer Rights at (310) 392-0522, Ext. 308.