Sacramento– The California Senate has passed, by a vote of 21-16, landmark legislation that allows all patients the right to sue their HMO for damages over an unreasonable denial of medically necessary treatment or coverage. The bill, SB 21 (Figueroa), is sponsored by the Foundation for Taxpayer and Consumer Rights (FTCR).
“This bill is the strongest medicine for HMO abuses yet,” said Jamie Court, director of FTCR’s Consumers For Quality Care. “Patients deserve the same legal leverage when dealing with their HMOs that public employees now have. SB 21 provides it.”
Fourteen million Californians with health coverage through private industry do not have the right to sue their HMO for damages until SB 21 is enacted. Public employees can receive damages. Today. patients with private industry coverage can collect only the cost of the treatment denied — not lost wages, other medical bills, etc.
SB 21 is modeled on a successful 1997 Texas Law which has resulted in only one lawsuit, but doctors report that treatment requests are dealt with more fairly since the law has been in effect.
“It is no wonder HMO abuses have become epidemic,” noted Court. “All working Californians should have the same right to sue their HMOs for damages as their public officials now have. Without the threat of damages, patients will continue to have no leverage against billion dollar HMOs that deny and delay medically necessary care.”
Last year, Consumers For Quality Care faxed a different story and picture of another “ERISA Casualty of the Day” — a patient denied treatment by an HMO or insurer and without a remedy–to legislators and the media for five months. This year, the consumer group is tracking HMO liability legislation in 23 states.
Consumers For Quality Care is a health care watchdog project of the non-partisan, non-profit Foundation For Taxpayer and Consumer Rights.