Florida Times Union Examines Effect of Georgia’s 1999 HMO Reforms

The Florida Times-Union on July 14 examined the results of Georgia's patients' rights laws, which took effect in 1999, and found that the "statistics are encouraging." The laws allow managed care patients to request an independent medical review in disputes with their health plans over treatment denials and to file suit against their HMOs after they exhaust the appeals process. In the past three years, HMO patients have won 34 of 98 appeals considered by independent review panels, and in 15 additional cases, the health plans decided to provide treatments that they initially had denied before the panels reached decisions. Managed care patients have filed no lawsuits over treatment denials in the past three years, the Times-Union reports. Kirk McGhee, executive director of the Georgia Association of Health Plans, said, "(HMOs) have probably settled more (cases) internally." In addition to an independent review process, the laws established a "consumer-choice" program to allow managed care members to select physicians outside the networks of their health plans. However, the program requires HMO members to pay 17.5% more in premiums -- a requirement added at the request of health insurers -- and most "aren't rushing to sign up for the coverage," the Times-Union reports. Cathey Steinberg, the state's consumer insurance advocate, "blames" the added premium requirement for the low rate of participation in the program. Brent Layton, an insurance industry analyst, said that the program has encouraged health insurers to increase the number of doctors within their HMO networks (Williams, Florida Times-Union, 7/15).