A guide to managed health care published

Published on

The San Diego Union-Tribune

When Kathy Olsen’s 2-year-old son, Steven, fell on a stick that jammed into his face in 1992, it set into motion a nightmare that still continues.

The twig penetrated Steven’s sinuses and eventually led to blindness, permanent brain damage and cerebral palsy — all because, Olsen contends, doctors were trying to save her health maintenance organization about $800 for a CAT scan. Olsen believes the scan could have prevented the problems that Steven, now 11, must live with.

Olsen said she and her family tried as best they could to get Steven the care they felt he needed, but without proper guidance they didn’t know where to turn.

Yesterday, flanked by representatives from state agencies and a consumer advocacy group, the Chula Vista resident helped introduce the most comprehensive guide to the state’s managed-care laws in the hope that her case will not be repeated.

“Even if you don’t use it now,” Olsen said, “you need to know what your rights are.”

The news conference, held in the Banker’s Hill neighborhood of San Diego, was part of a statewide effort to get the word out about the 79-page guide. It was put out by the Foundation for Taxpayer and Consumer Rights with help from the California Wellness Foundation, the California Department of Consumer Affairs and the Department of Managed Health Care.

Publication of the guide follows a sweeping package of legislation signed by Gov. Gray Davis in 1999 that changed the health-care environment in California.

A lack of regulation had left patients vulnerable to abuse at the hands of managed care, said Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights, a Santa Monica consumer group. Some of the 1999 legislation took effect Jan. 1, including provisions for the right to an independent review when an HMO denies treatment recommended by one of its doctors, and the right to sue HMOs.

With the new legislation, however, the already arcane managed-care terrain became even more difficult to navigate. The guide, Court said, will help educate the public and serve as “a big stick that consumers can wave” at HMOs.

Such talk concerned a spokesman for the state HMO association, however.

“I applaud any efforts to educate consumers,” said Bobby Pena, vice president of communications for the California Association of Health Plans. “What I’m a little concerned about is (that the document) does have a buyer-beware tone. Contrary to what the document suggests, health plans aren’t out to get consumers.”

The public can get copies of the guide by calling the Department of Managed Health Care (1-888-HMO-2219) or the Department of Consumer Affairs (1-800-952-5210). The guide is available online at http://www.calpatientguide.org.

Copies of the guide also are being mailed to about 22,000 doctors’ offices across the state.

Consumer Watchdog
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