Texans have a right to know exactly what their health insurance covers, and on March 25 the Texas Medical Association joined legislative leaders to launch an initiative to give them that right. TMA began its grassroots outreach campaign "Patients' Right to Know" to engage Texans in an effort to pass legislation that would reform health insurance, making it much easier for patients to understand.
At a capitol news conference, TMA President Josie R. Williams, MD, said patients and employers "deserve to know more about their health care dollar" and what it actually buys.
"We believe our patients have a right to know what's covered in their insurance policy. We believe our patients have a right to know whether their doctors and hospitals are in their network," she said. "We believe that our patients have a right to know when and how an insurance company may cancel their policy. And they have the right to know how much extra they will have to pay for health care services that they receive."
To guarantee those rights, TMA is backing a package of health insurance reform bills that establish a health insurance code of conduct and require insurance companies to provide a "soup can" style label on their policies that clearly outlines costs and benefits.
The proposed Health Insurance Code of Conduct Act, Senate Bill 1257 by Sen. Kip Averitt (R-Waco), would:
- Require health plans to receive input form an outside party before they could cancel the insurance of a very ill or injured patient who starts to run up high medical bills;
- Prevent health plans from increasing the cost of insurance for no reason;
- Help patients and employers determine how much of their money the insurance companies actually spend on health care vs. advertising, big bonuses, or profits.
- Prevent health insurance companies from selling doctor's contracts behind their backs; and
- Make health insurers stop telling patients that some doctors are better than others based on insurance claims.
Senator Averitt said SB 1257 would be an important tool in helping Texans better compare insurance companies and the policies they offer. "Insurance premiums are going up," he said. "Texans want to know that their level of coverage corresponds to the premiums that they're paying." Rep. Craig Eiland (D-Galveston) is carrying the companion legislation, House Bill 2750.
The health insurance label bill - SB 815 by Sen. Kirk Watson (D-Austin) and HB 1932 by Rep. Senfronia Thompson (D-Houston) - would require a standardized format for health plan marketing materials that allows an "apples-to-apples" comparison of health insurance products.
Three other bills filed by Sen. Wendy Davis (D-Fort Worth) would require health plans to disclose how much of their premium dollars is actually being spent on health care, give the Texas Department of Insurance more oversight over health insurance premium rates, and prohibit insurers from arbitrarily revoking patients' health insurance coverage.
"Right now the health insurance system that we have is simply not working," Senator Davis said. She added that her bills and others in the TMA-supported package would bring "more accountability, transparency, and responsibility to the health insurance industry in Texas."
Rep. Todd Smith (R-Euless) is the House author of the legislation on policy cancellation. "As a matter of basic fairness, the insurance consumer should have the right to have a decision that is made by the insurer to cancel a policy subjected to an independent third-party review just as decisions to refuse medical bills based on medical necessity issues are currently subjected to that sort of review," he said.
The Patients' Right to Know campaign calls on patients and physicians to help make insurance more accessible and transportable.
Among other tools, TMA created www.meandmydoctor.com , a Web site with a grassroots action center where patients can write their legislators in support of health insurance reform bills. Educational materials also will be displayed in physician offices to inform and engage patients.
You also can join the Patients' Right to Know cause on Facebook .
Action , April 1, 2009