[Congressional Record Volume 144, Number 29 (Tuesday, March 17, 1998)]
[Extensions of Remarks]
[Pages E395-E396]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




INTRODUCTION OF ``THE PATIENT RIGHT TO INDEPENDENT APPEAL ACT OF 1998''

                                 ______
                                 

                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                        Tuesday, March 17, 1998

  Mr. CARDIN. Mr. Speaker, I rise to introduce legislation guaranteeing 
Americans one of the most fundamental of patient's rights: the right to 
appeal adverse decisions made by health insurance companies.
  ``The Patient Right to independent Appeal Act of 1998'' ensures 
patients the ability to receive an independent, unbiased review of 
their cases when their plan decides to deny, reduce or terminate 
coverage in these circumstances:

[[Page E396]]

When the health plan determines that treatment is experimental or 
investigational; when the health plan determines that services are not 
medically necessary and the amount exceeds a significant threshold; or 
when the patient' life or health is jeopardized.
  This bill does not expand health plans' lists of covered services, 
rather it guarantees patients and their doctors the freedom to make 
treatment decisions independent of financial considerations.
  Health plans argue that they provide ``the right care, at the right 
time, in the right setting.''
  But just last Wednesday, The Washington Post quoted the chief 
financial officer of a local HMO as he discussed with Wall Street 
analysts the rosy outlook for his company' bottom line. ``Probably the 
brightest spot in our operations is the improvement in our claims 
auditing capability,'' he said. ``We have . . . taken advantage of 
opportunities to reduce current and future medical expenses by more 
closely challenging the contractual and medical appropriateness of 
claims received.''
  In their own words, health plan executives are publicly flaunting 
their ability to find new ways to require providers to refund claims 
they've already been paid for. This should leave no doubt in our minds 
that providing avenues for patients to appeal plan decisions in vital.
  Many health plans have an internal appeals system already in place, 
but quite often these appeals are conducted by the same plan personnel 
who originally denied the coverage.
  The ``Patient Right to Independent Appeal of 1998'' establishes a 
system through which patients can appeal to an autonomous decision-
making body that has no financial incentive to limit health care 
treatment. By passing this bill, Congress can make real progress toward 
providing the American people a sense of security that their health 
insurance benefits will be there when they need them. I urge my 
colleagues to support this essential legislation and guarantee our 
citizens a much needed patient right.

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