Massachusetts Continues Developing Patients’ Rights Procedures

Massachusetts health officials on Dec. 20 "tentatively approved" a set of regulations allowing patients who are denied medical services by their insurance providers to take their complaints to an outside panel, the Boston Herald reports. Under the new guidelines, once a patient has authorized the release of his or her medical records, an insurance company will have 30 days to settle the grievance. If the company does not act within that amount of time, the patient wins by default; if the company decides that a procedure is not "medically necessary," the case could be reviewed by an outside agency under contract with the Department of Public Health. The regulations also allow expedited reviews for cases where a delayed decision would pose a "serious and immediate" threat to a patient's health. Dr. Clifford Askinazi, a member of the Public Health Council, said that the new guidelines "serve as both an alarm and a model." Askinazi "worried" about whether the regulations could be enforced, but an attorney for the Department of Health said that compliance with the guidelines could be part of insurance company or HMO accreditation (Szaniszlo, Boston Herald, 12/20).