Doctors, consumer advocates and a bevy of health care providers hailed the "Patient's Bill of Rights" during a legislative hearing in Annapolis yesterday, while insurers and the business community warned that mandating drugs, specialists and hospital stays could drive costs higher.
The bill, one of Gov. Parris N. Glendening's legislative priorities, "would clearly establish Maryland as a national leader in protecting its citizens from managed-care company abuses," Joan Alker of the Families USA Foundation, a Washington consumer group, told the Senate Finance Committee.
Supporters said the measure would bolster an already strong set of state laws and regulations designed to ride herd on health insurers, including a new procedure for reviewing patient complaints about denial of treatment.
"The governor believes we can do more to make sure Maryland patients have access to the care they need," said Abby Brandel, an administration lobbyist.
The bill would require insurers, nonprofit health plans and health maintenance organizations to offer patients:
Standing referrals to specialists for life-threatening, chronic or disabling diseases.
Access to specialists outside their health plan when the in-house doctors lack expertise in a patient's illness.
Access to prescription drugs not covered by their plan if deemed medically necessary and all other approved medicines have been ineffective or caused adverse side effects.
Minimum hospital stays of 48 hours for a mastectomy or testicular cancer surgery.
The bill also would allow specialists to serve as a patient's "primary care coordinator" when overseeing treatment of a chronic or serious disease, and it would establish the Maryland Insurance Administration as the state clearinghouse on health insurance information.
Insurance Commissioner Steven B. Larsen called the bill's provisions "fair" and "common sense," adding that even he could use help at times dealing with his health plan.
"I'm the insurance commissioner, and I still run into static when I try to get care for my family," he said.
The Medical and Chirurgical Faculty of Maryland, the state's medical society, urged lawmakers to extend the rights to low-income patients in Medicaid managed-care plans, but questioned the mandated hospital stays.
"Protect the doctor to help and advocate for the patient," said Joseph A. Schwartz III, Med-Chi's lobbyist, "but don't make every [patient] stay in for 48 hours."
Psychologists, chiropractors, nurses and midwives, meanwhile, urged that the bill be broadened to let them be considered as specialists coordinating patient care.
Lobbyists for HMOs and other health plans contended that they already give patients standing referrals and access to unapproved drugs and outside specialists, though they usually charge a higher co-pay. They urged lawmakers not to interfere with that practice.
"We're clearly concerned about escalating drug costs," said Pegeen Townsend, a lobbyist for the Maryland Hospital Association.
She attributed 25 percent increases in prescription costs to drug company advertising urging patients to ask for costlier brand-name medications.
State fiscal analysts noted that requiring health plans to pay for drugs not on their approved lists could add $775,000 next year to the cost of the State Employees Health Benefits Plan.
Pub Date: 2/04/99