UPDATES: GROUP BROADENS PATIENT RIGHTS

WASHINGTON-Managed care organizations should make it easier and faster for patients to appeal a denial of treatment and also should cover emergency room care for alarming symptoms that turn out to be not serious, the nation's leading health plan advocacy group says.

In voluntary guidelines for its members, which include virtually all major managed care companies, the American Assn. of Health Plans said last week that patients have the right to know why a treatment was denied and how they can file an appeal, and that a quick appeal should be guaranteed when the patient's health or life is in danger.

The group also set policies on emergency room treatment, broadening recommended coverage from clear-cut emergencies to "those that arise suddenly and require immediate treatment to avoid jeopardy to a patient's life or health" based on symptoms being presented. The guideline, if followed, would be a liberalization of policy for plans that withhold payment for emergency room visits deemed frivolous.

Earlier, the association told member plans that managed care doctors should tell patients more, including how they are paid, and released a suggested code of conduct instructing member plans to provide patients, on request, precertification and other utilization review procedures.