ANNAPOLIS – One lawmaker referred to the two state workers responsible for handling a blizzard of complaints against health maintenance organizations as “the dynamic duo.”
But help could be on the way.
A bill heard jointly Wednesday by the House Environmental Matters and Economic Matters committees would streamline the HMO grievance procedure, boost the number of state employees who handle complaints and create a new panel to hear appeals of grievances.
Kevin Simpson is director of the current two-man Health Advocacy Unit in the state Attorney General’s Office, which mediates disputes between HMOs and their clients. His office is the first stop for disgruntled consumers who have had their medical claims rejected or delayed by their HMO.
Simpson said consumer complaints about HMOS rose 50 percent in 1997, to about 800 cases. His office was able to resolve about 80 percent of those cases in 1997, he said.
The bill heard Wednesday would budget $223,000 next year to hire four consumer affairs supervisors and two legal affairs secretariess for Simpson’s office.
It also calls for spending another $142,000 to hire workers for the Maryland Insurance Administration, allowing that agency to take a more active role in settling HMO disputes. That money would be used to hire two insurance supervisors, two medically certified supervisors, and two office secretaries.
Although HMOs are currently required by law to have an internal system for addressing complaints, the bill would standardize and streamline the system. It would require, for example, that HMOs reply within 30 days to customer complaints and queries, and even faster in emergency situations.
Del. John Donoghue, D-Washington, the chief sponsor of the bill, held up a 6-inch thick manila folder full of what he said were HMO consumer complaints from the past year.
He also brought along his own physician, Dr. Frederic H. Kass III. He recalled the plight of a patient diagnosed with terminal cancer who had to wait nearly two months just to find out her HMO would not pay for an experimental treatment.
While the Maryland Insurance Administration and the Department of Health and Mental Hygiene both have jurisdiction in HMO cases, Simpson’s office is the first stop for many HMO clients with a gripe.
The bill also allows the insurance administration to set up a special panel of state medical professionals to hear appeals of cases decided by Simpson’s office.
The decision of that panel would be binding, according to the bill, although it could be challenged in court if either side in the dispute wanted to push it that far.
Lobbyists for the HMOs said they were generally pleased with the proposal, except for one provision that would give the state more control over the current internal grievance process.
The state currently certifies the grievance procedures used by the HMOS. Under the bill, the employees who handle the grievances would also have to be certified.
The committees took no action on the measure Wednesday.
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