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Attorney General Hubert Humphrey III today announced a joint
plan with the state's HMOs to increase consumer awareness
of their rights under the Patient Protection Act.
The law, enacted in 1997 with the backing of Humphrey, consumer
advocates and the Minnesota Council of Health Plans, gives
consumers the right to a great deal of information. Specifically,
the Patient Protection Act requires licensed HMOs to provide
consumers with information about standing referrals, continuity
of care and reimbursement arrangements between health plans
and providers. Prior laws already require health plans to
provide additional information to consumers.
A recent survey conducted by the Attorney General found that
while all of the HMOs contacted provided at least some information,
and every item requested was provided by at least one HMO,
investigators failed to receive the majority of requested
information from more than half of the HMOs. Eight callers
from the Minnesota Attorney General's Office telephoned 13
HMOs licensed to do business in Minnesota.
"HMO members have the right to a great deal of information
from their HMO so that they can be better advocates for themselves
in the health care system," Humphrey said. "But
these rights are meaningless if consumers don't know they
exist. The plan we're announcing today will increase consumers'
awareness of their rights."
In addition to asking for a member handbook and a sample
contract, the investigators inquired about the following five
items:
Standing Referral Policy
- This policy may be necessary for patients with chronic conditions
to see specialists they need on a regular basis without having
to get permission each time.
Plans for Continuity of Care
- Health plan companies must have a written plan that provides
for continuity of care in the event of a contract termination
with a health care provider or if an employer changes health
plans.
Reimbursement Arrangements
- Consumers are entitled to know how their clinic or physician
is paid.
Grievance/Appeals Procedures
- Consumers need to know that if they are denied certain treatment
or have a billing dispute, there is a clear mechanism for
appeal.
Drug Formularies - HMOs
typically manage prescription drug benefits through the use
of a specific list, or formulary. A consumer who uses a particular
prescription drug has the right to know if an HMO formulary
excludes the desired prescription drug.
There is growing concern in the Attorney General's Office
that many Minnesota patients do not know their rights. Based
on the survey, customer service representatives are not accustomed
to dealing with requests for information available under the
Patient Protection Act.
ACTION PLAN
The consumer education plan announced by the attorney general
and health plans includes the following:
Increased Consumer Awareness
- A brochure on consumer rights under the Patient Protection
Act will be made available to HMO members.
- The brochure will also be posted on the council's web
site: www.mnhealthplans.org, and on specific health plan
web sites.
- Specific health plan policies related to continuity of
care, standing referrals, grievance/appeals procedures and
reimbursement arrangements are available from each HMO individually.
- Information included in the brochure and on the web site
will be available to state agencies who help consumers with
questions or problems (Minnesota Departments of Commerce
and Health, and through the Health Department's Information
Clearinghouse).
Consumer Assistance in Health Plans
HMOs will ensure that customer service representatives are
trained to respond to consumer inquiries and are aware of
policies and procedures regarding the Patient Protection Act.
Monitoring Compliance
The survey was targeted to determine whether consumers had
access to certain information. It was not to scrutinize whether
particular policies met the legal standards set out in law
or to comment on the quality of health care provided by HMOs.
[Click here
to view the Consumer Awareness Plan]
Because of the mixed results, Humphrey encouraged Attorney
General-elect Hatch and the newly created Health Care Consumer
Assistance Office to follow up in the future to make sure
all of these goals are accomplished.
"Our goal is to provide useful information to consumers,"
said Michael Scandrett, executive director of the Minnesota
Council of Health Plans, a trade group representing the state's
nonprofit health plans. "That's why we're pleased the
attorney general's office is working with us to increase consumers'
awareness of their rights. We can do better."
A copy of the survey report can be found on the Attorney
General's web site at www.ag.state.mn.us. Consumers can visit
www.mnhealthplans.org for more information on this plan or
other information on how to navigate the health care system.
* * *
Consumer Awareness Plan
While consumer requests for information under the disclosure
requirements of the Patient Protection Act have been small,
health plans supported passage of the law and want consumers
to have as much information as possible.
Public Announcement
Health plans will publicly announce plans to work with Attorney
General Humphrey's office to provide more information to consumers
under the Patient Protection Act. Action steps by health plans
are outlined below.
Consumer Brochure
Health plans, in cooperation with the Minnesota Attorney
General's office, will develop a brochure for consumers on
the Patient Protection Act, and will make that brochure available
to HMO members. The brochure will be posted on the council's
web site.
Specific Health Plan Policies
Specific health plan policies related to grievance/appeals
procedures, continuity of care, standing referrals and reimbursement
arrangements will be made available by each HMO individually.
Information for State Agencies
Information included in the brochure and on the web site
will be available to state agencies who help consumers with
questions or problems.
Customer Service Training
HMOs will ensure that customer service representatives are
trained to respond to consumer inquiries and are aware of
policies and procedures regarding the Patient Protection Act.
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