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Insurance Laws Quietly Take Effect

State * Mandates regarding diabetes, contraceptives and psychiatric treatment may give consumers expanded benefits.

February 14, 2000|JANE E. ALLEN | TIMES HEALTH WRITER

The state also is changing the way end-of-life care is provided. By Jan. 1, 2002, terminally ill patients of any age who are members of HMOs will be entitled to hospice care benefits similar to those now provided for Medicare recipients. The law ensures that terminally ill patients receiving in-home hospice care can get coverage for visiting nurses and social workers, while those in residential hospice programs are fully covered.

HMOs didn't oppose the bill, Thompson says, because "to the extent you're able to use hospice, you reduce hospital days and physician visits," resulting in cost savings.

Revisions of an existing law will mean that an HMO patient need not be terminally ill to appeal denial of experimental treatment. The law had required a doctor to certify that a sick patient had less than two years to live before the patient could appeal such a denial.

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By 2001, another HMO reform bill will take effect extending that kind of independent review process to any denial of medically necessary treatment. At the same time, another law will allow patients to sue for punitive damages when HMOs deny them medically necessary treatment.

In addition, beginning on July 1 of this year, medical, hospital and surgical health plans will have to provide "all generally medically accepted cancer screening tests," not only the breast and ovarian cancer tests they now cover.

Health care consumers can best take advantage of new benefits by getting familiar with their plans, Eowan said.

"If they would read their policy, they're better able to access the system and are not running around trying to figure out what coverage they have," she said.

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