Independent Medical Review Legislation Needed At Federal Level

The article below provides yet another example of how external medical review legislation and oversight is highly fragmented in this country, and needs unification at the national level. It also points to the need for national patient's bill of rights legislation that requires all health insurance payers to submit their appeals to independent medical review, in order to ensure fair and objective evaluation and health insurance coverage decisions.

April 04, 2008

Suit Challenging Role of Regulators in Health Plan Disputes Rejected
California Healthline - http://www.californiahealthline.org/

A panel of the 3rd District Court of Appeals unanimously rejected a consumer lawsuit, ruling that the Department of Managed Health Care does not have to help patients challenge health plans when they are denied medical care or refused coverage for specific treatments, the Los Angeles Daily Journal reports.

The panel issued the ruling on Feb. 29 but agreed to publish portions of the opinion on Tuesday after DMHC officials said they were looking to set a precedent.

Plaintiffs in the lawsuit sought to require the department, which regulates HMOs, to heighten its role in patient-health plan disputes.

Lynne Randolph, a spokesperson for DMHC, said the plaintiffs mistook the duties of the agency and the law does not require the agency to "be the go-between."

Michael McClelland, senior counsel for DMHC, said he hoped the published opinion would inform consumers of their right to an independent medical review in cases where members disagree with health plans' coverage decisions.

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