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”.

Login Register Subscribe




Legislation unveiled last week in both chambers of Congress would set broad federal regulations controlling managed care plans.

Among other things, the measure would: prohibit so-called gag clauses; ban incentives to limit the amount of care; and require plans to gather and report performance data, have a clear complaint-handling and appeals process, cover emergency room visits and provide access to non-network specialists as needed at no additional cost.

The measure was drafted in response to a rising tide of consumer complaints against managed care plans.

The federal legislation comes on the heels of a proposal by a group of Republican and Democratic state legislators for a model bill to restrain what they described as "managed care excesses" (BI, Jan. 20).

While we oppose limits on physician communication and participant complaints, we're wary of imposing regulations on plans that will drive up their operating costs for no good reason. And we also fear that this measure could spawn more severe restrictions on managed care plans.

Although the managed care industry always has been a target for consumers and physicians who resent the loss of certain freedoms they enjoyed under a fee-for-service health care model, much of the animus also is due to the managed care industry's own mistakes and shortsighted coverage decisions.

We've said it before, and it bears repeating: The managed care industry has to get its house in order, or else legislators will be happy to do it for them. If legislators do it, the baby will get tossed out with the bath water, and employers will lose much of what's good in managed care in attempts to wipe out what's bad.