Sussex County Delaware

Patients' Rights
Bill Becomes Law

Patients' Rights ...

Allows Patients to
Challenge HMO Decisions

A measure providing Delaware consumers with an independent alternative for appealing decisions made by their HMOs was signed into law by Delaware Gov. Thomas R. Carper on Tuesday, July 18, 2000.

Senate Bill 299, sponsored by Senator Patricia M. Blevins (D-Elsmere) and Representative Pam Maier (R-Drummond Hill), creates an independent appeals procedure for Delawareans who disagree with healthcare decisions by their HMOs.

Previously, patients did not have an independent alternative for appealing HMO decisions.

Specifically, a patient can now appeal an HMO's decision by requesting a medical review by an independent panel of medical professionals based on medical facts.

Delaware's Secretary of Health and Social Services will administer the grievance procedure and appoint each appeal for review by the appropriate independent medical panel.

For example, an appeal that specifically involves cancer treatment would be reviewed by an independent panel of medical professionals experienced in cancer treatment.

Appeals will be heard within 60 days -- within 72 hours for time-sensitive cases. The panel's decision will be binding on the HMO. Patients will not be charged filing fees for the review.

"Today we're providing Delawareans and their families with stronger voices in the way their healthcare coverage is managed," said Gov. Carper. "By establishing this independent process, we're ensuring that patients have a fair opportunity to appeal medical decisions made by their HMOs -- not by an HMO-appointed group -- but by an independent panel of medical professionals.

"Medical decisions should be made by medical professionals, not by HMO accountants. With this measure, we're helping to ensure patients in Delaware are treated fairly and receive the proper medical attention that they deserve."

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