BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.
To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.
To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.
TRENTON, N.J.-New HMO regulations, including an "HMO consumer bill of rights," take effect March 15 in New Jersey.
Among the patient rights outlined in the regulations:
Only doctors can decide to deny or limit coverage.
Consumers must have a choice of specialists.
'"Gag rules" that prevent physicians from discussing non-covered treatments with patients will be eliminated.
HMOs are required to disclose to patients their payment arrangements with doctors.
Consumers must have the right to appeal a decision to deny or limit coverage, first within the HMO and then through an independent organization.
The independent utilization review organization will issue non-binding recommendations on coverage appeals, and the HMOs must report to the state health department whether they will accept or reject the recommendations.
The health commissioner's office will also compile a yearly report card of each HMO in the state and publish the results of enrollee satisfaction surveys. Every three years, each HMO will also undergo a quality review by an independent organization. That report will be reviewed by the state.
The regulations are the result of a two-year effort involving the state's Department of Health and a committee of HMOs, physicians and consumers. The growth of HMO enrollment in the state to more than 2 million people prompted Health Commissioner Len Fishman to rewrite the 1974 regulations and add consumer protections.
"These are the most progressive, consumer-oriented regulations in the country," Mr. Fishman said in a statement.