Massachusetts Senate To Consider Legislation Allowing Patients To Sue Health Plans

Massachusetts insurance companies, employers and advocates are "gearing up" for a state Senate vote on a bill that would give patients the right to sue their health plans for denial of treatment coverage, the Springfield Union-News reports. The legislation also would require health plans to demonstrate to the state their "financial viability" and would remove a $20,000 cap on HMO malpractice liability. Supporters of the bill contend it is needed to prevent health plans from "abus[ing] patients without fear of punishment." Employers and the health insurance industry, however, say the bill would expose the industry to "unlimited lawsuits" and would "destabilize" the state's health care system. According to a study by the Massachusetts Taxpayers Association, the bill would increase health care costs by 5%. Opponents also say the bill would "supersede" a law passed by the state Legislature in 2000 that created a state ombudsman's office (Lauerman, Springfield Union-News, 4/10). Under the law, Massachusetts patients have the right to request an external review of an health insurer's decision to deny coverage (Massachusetts Managed Care Consumer Advisory Board Web site). Instead of enacting new legislation, health plans would like to give the ombudsman's office the opportunity to "prove itself," the Union-News reports. "Whether you agree with the ability of patients to sue health plans or not, this is not the right bill," Marylou Buyse, president of the Massachusetts Association of Health Plans, said (Springfield Union-News, 4/10).