Business
N.Y. plans agree to be more responsive
NEWS IN BRIEF — Posted Feb. 28, 2005
Twenty-one health plans doing business in New York have told state Attorney General Eliot Spitzer they will take steps to be more responsive when patients ask for information on which medical treatments are covered.
The agreement with the plans, announced Feb. 10, says that the companies will supply current and prospective plan members with details on the "clinical review criteria" they use to determine payment policies.
A year ago, Spitzer's staff posed as prospective insurance plan members and sent letters to all health plans offering individual coverage in New York. They requested specific details on whether the plans would cover certain procedures, durable medical goods or nutritional supplements. Plans are required to give this information under the state's Managed Care Consumer Bill of Rights, but Spitzer's investigators found in every instance that they either received inadequate replies from the health plans or no replies at all.
Under the agreement, the health plans promise to answer such questions fully, to submit annual compliance reports to Spitzer's office, and to pay $5,000 each to cover the state's costs.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/02/28/bibf0228.htm.
