BILL TO CONTROL US HEALTH INSURERS

The chairman of the American Medical Association, Lonnie Bristow, has joined with Senator Paul Wellstone in proposing legislation to regulate the techniques used by insurers to control health costs.

Under the proposed Patient Protection Act, health plans would be required to disclose the standards used to select and exclude doctors from their networks, and doctors could appeal against exclusion. Doctors could not be dismissed from a health care network without cause, and nurses or clerks could not deny payment for a medical service; these decisions could only be made by doctors specializing in the same field as the doctor performing the service. A health plan that limited access to doctors would have to give patients a chance to see doctors outside its own network.

Patients would have the right to know whether their health plan was paying their family doctor a bonus for holding the line on expensive tests. Health plans would also be required to tell their patients upfront which treatments are covered and which are excluded, how to seek approval for expensive treatments, whether any bonuses or financial incentives for doctors could affect the quality of care, and what surveys say about consumer satisfaction with the plan. They would have to let people know if they rely on cost factors in choosing doctors.