You don't have to wait on Clinton and the Congress,
progess can me made by your state officials. Looks like more than
a dozen have already acted. State level solutions may be more effective
and flexible anyway.
May 13, 2000
By The Associated Press
OSHKOSH, Wis. (AP) -- People who are denied medical coverage will have their appeals heard by state review boards rather than insurance companies under a new Wisconsin law.
Legislation signed Friday by Gov. Tommy Thompson will create independent review boards that can order health maintenance organizations (HMOs) and other insurers to pay for treatment that the companies initially deny to patients.
"This will help make sure patients' concerns are heard," Thompson said. "Now patients will have a way to fight for the care they need."
Wisconsin joins more than a dozen states that provide patients with independent review of coverage decisions.
The bill had the backing of both consumer groups and insurance companies.
The review panels will include specialists in medicine and will have to make decisions about appeals within 30 days.
"What this legislation does is address a gap in the current law related to medical decisions," said Connie O'Connell, the state insurance commissioner.
The legislation was prompted in part by a 1998 Associated Press report about the difficulties some Wisconsin patients have in resolving disputes with their HMOs.
Wisconsin's new law is better than similar measures in other states because it applies to all commercial health insurance, not just HMOs, said Nancy Wenzel, executive director of the Wisconsin Association of Health Plans, which represents HMOs.
"Wisconsin went beyond an external review proposal for just managed care and instead said all health insurance patients should have the same rights and protections," Wenzel said.