Archive for Tuesday, May 4, 1999

SENATOR PLEASED WITH THIRD-PARTY REVIEW BILL

May 4, 1999

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The 1999 Legislature passed a bill that adds a third-party arbitrator to conflicts between health insurance companies and customers making claims.

A bill passed in the final hours of the 1999 session should help resolve disputes between health insurance companies and consumers denied claims, Sen. Sandy Praeger, R-Lawrence, said Monday.

"The idea is to bring some neutrality to the decisions," said Praeger, who chairs the Senate Public Health and Welfare Committee.

The bill sent Sunday to Gov. Bill Graves -- Praeger believes he will sign it -- sets up a third-party review process.

Under the legislation, a consumer denied a claim by an insurance company could go to the Kansas Department of Insurance and request that an independent panel of doctors review the claim.

The panel would render a decision within three months. Emergency cases would be handled within three days.

Patients filing claims shouldn't expect to win every case, Praeger said.

"In states that have these procedures, it's about 50-50," she said.

Insurance Commissioner Kathleen Sebelius endorsed the bill. It passed the Senate 31-8 and the House 95-28.

Current Kansas law requires insurance companies to conduct internal reviews of appeals by clients. That process will be strengthened with the addition of the third-party assessments, Praeger said.

"We think having the external review in place will make the internal review process work better," she said.

Praeger said the bill didn't preclude patients from filing lawsuits if unsatisfied by the decisions of outside physicians.

Health insurance companies had enough clout to kill the bill, Praeger said, but endorsed the measure during the Legislature's wrap-up session. A conference committee amended the provision into a bill touching on a variety of health issues.

Praeger said third-party reviews would likely be conducted with the assistance of physicians affiliated with the Kansas Foundation for Medical Care, which currently performs health plan reviews in the state.

"We think those decisions ought to be made by health-care providers, people who are trained in the procedures that are being requested," she said.

-- Tim Carpenter's phone message number is 832-7155. His e-mail address is tcarpenter@ljworld.com.

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