February 1999 Bulletin

In Brief

California

A bill has been introduced in the California legislature which would require the Department of Corporations to establish an independent medical review system to hear complaints of enrollees whose health care services have been denied, terminated or limited by a plan. The bill, A.B. 55, would make a health service plan directly accountable to patients to ensure that physicians, not the plan, are in charge of patient care. A health care service would be liable for damages for harm to any enrollee caused by its failure to exercise ordinary care.

Oregon

The annual report on consumer complaints about health maintenance organizations in Oregon shows access to physicians was a key concern. The report shows the number of complaints against all health insurers, including HMOs, rose 19 percent from a year earlier.

New York

Complaints against HMOs in New York in 1997 more than doubled from a year earlier, due mostly to complaints from health care providers about late payments of claims. The state insurance department upheld 2,250 complaints against health plans, including 1,400 against HMOs, 300 against nonprofit indemnity plans and 550 against commercial indemnity plans.


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