180.015 Managed Care Patient Protection

180.015

Managed Care Patient Protection: The Texas Medical Association voted to use its influence to make sure that patient protection and managed health care system legislation includes: language stating that there can be no form of reward or financial incentive to limit appropriate care, including referrals; an affordable point-of-service option so patients have the opportunity to be seen by the physician of their choice outside the plan; and the opportunity for patients and providers to fill out a "report card" at regular intervals regarding the quality of service rendered by the plan. The plan will reveal enrollment, income, amount expended for patient care, administrative costs, and profit. This information will be compiled and made available to patients, health care providers, employers, and plan administrators. In addition, TMA urges inclusion of these provisions in both federal and state Patient Protection Acts to make it clear to managed care plans that their primary function is to ensure that patients receive quality care from physicians of their choice with the major portion of the premium dollar being used to provide medical services (Res. 28K, p 137, A-95; reaffirmed CSE Rep. 1-A-05; reaffirmed CSE Rep. 1-A-15).

Last Updated On

October 07, 2016