[Congressional Record (Bound Edition), Volume 145 (1999), Part 14]
[House]
[Page 19455]
[From the U.S. Government Publishing Office, www.gpo.gov]



   SUPPORT THE PATIENTS' BILL OF RIGHTS AND PASS REAL HMO REFORM NOW

  (Mr. GREEN of Texas asked and was given permission to address the 
House for 1 minute and to revise and extend his remarks.
  Mr. GREEN of Texas. Mr. Speaker, last week there was a newspaper 
article that highlighted one of the fundamental issues at the center of 
the HMO debate: Who decides medical necessity, an insurance company or 
our local doctors?
  A doctor was treating a pregnant woman who had obstetric coverage and 
needed a shot to protect her unborn baby from the chicken pox virus. 
Despite the fact that this shot is routine in this situation, and the 
fact that her insurance coverage also covered obstetrical care, her HMO 
refused to pay for that shot.
  The response by the American Association of Health Care Plans was 
that the decision to deny care was probably based on the fact that the 
service was not covered by that woman's health plan. Now it seems it is 
not enough simply to purchase a health insurance that covers obstetric 
care, but HMOs expect every employer in our country to make sure that 
every foreseeable problem or treatment is specifically covered.
  Obviously, that would be impossible, and it is ridiculous to even 
suggest that. If our insurance plan covers a medical condition, our 
doctor should be able to decide how to treat us for that particular 
medical condition.
  The right of doctors to determine medical necessity is one of the key 
issues that has been included in the HMO reform bill that is 
predominantly Democrat-supported.

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