BILL STYMIES COVERAGE DENIALPosted On: Apr. 20, 1997 12:00 AM CST
SACRAMENTO, Calif.-HMO medical directors who deny coverage of medical procedures would first have to examine the patients themselves under legislation approved by a California Assembly panel.
The bill by Assemblywoman Liz Figueroa, D-Fremont, received a boost when a former medical coverage reviewer for Louisville, Ky.-based Humana Inc. testified before the committee about her work denying patients doctor-recommended treatment to save the plan money.
Linda Peeno, who now is a medical ethicist at the University of Louisville, said she was frustrated by using "my medical expertise for the financial benefit of the company."
A.B. 794, which also would require HMOs to publicly disclose their criteria used for denial of treatment, was approved 12-0 by the Assembly Health Committee last week and now will go to the Assembly Insurance Committee.
The bill is the latest in a string of anti-managed care legislation the committee has approved. Other bills the panel approved would ensure that patients are seen in a timely manner, require health care providers respond within four minutes to patient phone calls and guarantee coverage for a second medical opinion if patients ask for one.