April 1998 Bulletin

Bill gives HMO enrollees access to specialists

The Indiana General Assembly has approved legislation which establishes a consumer bill of rights that would allow some patients to see physicians outside their managed care network. HMOs would have to provide enrollees with access to "an adequate number" of medical facilities and physicians, including specialists, and to allow patients to see doctors outside the network if the plan does not offer services to treat a specific medical condition. The legislation was sent to the governor for his signature.

Another bill passed by the Indiana House would ensure that medical decisions are made by doctors and their patients. The bill would require every managed care plan to have a licensed physician as its medical director. The bill would allow physicians to prescribe the medication needed for a patient's condition and require the managed care plan to pay for the drugs, even if they are not normally covered.

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