lessen the burdens on overwhelmed families

lessen the burdens on overwhelmed families

Hawaii Coalition for Health
302 California Ave., #209, Wahiawa, HI 96786, Phone: 622-2655; Fax: 622-5599;
web: http://www.hawaiicoalition4health.com

Maybe not. In 1999, your legislators passed some very important laws that make available to patients critically needed health services. Your legislators were responding to the concerns of the community members and their own concerns about gaps in health coverage. Many other members of the community worked long and hard to ensure vital services would be available to consumers in their time of need.

HMSA is a mutual benefit society whose highest duty is to look out for the interests of its members, many of whom are themselves employers also interested in adequate coverage for their own health care needs. Yet in a letter HMSA sent to employers (posted on our website http://www.hawaiicoalition4health.com), HMSA implies that it is UNFORTUNATE THAT THE LEGISLATURE PASSED LAWS PROVIDING THESE CRITICALLY NEEDED BENEFITS AND WHICH WOULD HELP TO KEEP A HEALTHY WORKFORCE ON THE JOB:

Contraceptive services. Your legislators were concerned that less affluent women did not have access to affordable birth control unless it was a covered benefit. Providing contraceptive services as a covered benefit ensures that women have a choice of family planning options that fits their family’s needs.

Hospice care. Families with terminally ill members desperately need quality hospice care for their loved ones. In order to when a loved one needs hospice care, your legislators believed it was crucial to enact standards and benefits for hospice care that ease the burdens on family members so they can get back to work.

Medical foods. Your legislators believed it was important to enact this bill to prevent mental retardation and promote survival in children born with an inborn error of metabolism. These foods are not ordinary food supplements, they are critical nutrition requirements for sick babies that are often expensive and unaffordable unless they are covered by health insurance.

Mental health parity. Your legislators are aware that many families in Hawaii must shoulder the burden of caring for seriously mentally ill loved ones. In some cases, the patient needs mental health services weekly or more often. Yet, health plans often limit covered mental health services to as little as once a month. But if someone has a broken leg, they can see a doctor several times a month. Why should coverage for mental illnesses be different from coverage for physical illnesses, especially in light of the tragic workplace violence that Hawai’i is beginning to see? Your legislators recognized this unfair discrimination by health plans and passed a law that prohibits health plans from imposing conditions and limits on serious mental illness benefits.

Patients’ Bill of Rights (PBR). Hawaii’s Legislature is among only a handful of state legislatures that had the foresight to enact a Patients’ Bill of Rights that helps to define consumers’ legal rights relative to health plans. The PBR gives patients the right to

appeal unfair decisions by health plans that deny coverage for promised benefits. The PBR prevents health plans from using "bait and switch" tactics, such as contractually promising members benefits that they then prohibit physicians from providing. Prior to passage of the PBR, there was no State oversight of unfair business practices by mutual benefit societies in Hawai’i. Also, at the time this legislation was passed, HMSA publicly stated that it supported it.

Privacy of medical records. Your legislators acted promptly to prevent medical information from being used improperly, and HMSA was one of the key participants in a process that spanned several years to enact this legislation. HMSA is either being insincere or disingenuous.

Many Coalition members are employers themselves, and the Coalition consistently tries to present solutions to consumer health problems that diminish the burdens on individuals and employers. Employers benefit when mental health and substance abuse coverage is available to employees. Minor incidents of workplace violence can be addressed early on if benefit packages include sufficient coverage for workers’ mental health and substance abuse problems. Early treatment and detection can help prevent outbursts of violence by employees at work or at home that can have tragic results. Substance abuse in particular imposes enormous costs and stresses on families and society, leading to an unproductive workplace, that can be addressed most efficiently through early detection and treatment.

HMSA’s letter to employers exemplifies HMSA’s attitude toward its members and employers who are also HMSA members. You will recall last year HMSA weakened members’ rights by increasing the number of member signatures required to call a special meeting from 100 to 18,000. Obviously, it is impossible for a group of concerned members to gather 18,000 signatures unless they are affiliated with a large and wealthy organization such as HMSA itself. Therefore, it is unlikely any special meetings will be called unless they address concerns of management, not membership.

MAINLAND HMO DECIDES TO LET DOCTORS HAVE THE FINAL SAY

United Healthcare, a mainland HMO, recently announced it was doing away with the practice of requiring doctors and pharmacists to call the plan and ask permission before providing services to plan members. United Healthcare figured out that 99% of the time, the request was approved, so the HMO was spending $100 MILLION just to say "Yes".

In Hawaii, nearly all health plans require doctors and pharmacists to call the plan and ask if they can provide a medically necessary treatment to a patient. In most cases, the health plan employee answering the doctor’s request is not medically trained to second-guess doctors and pharmacists. As United Healthcare saw it, 99% of the time pre-authorization requests are a wasteful practice that alienate both doctors and patients.

But, having a low-level plan employee say "No" to a doctor’s request is not always the worst that can happen. In some cases, a plan employee says "Yes", the service is covered. Then after treatment is provided, another plan employee decides "No", the service is not covered. Who gets stuck with the bill then? Your legislators passed the Patient’s Bill of Rights to provide State oversight of health plans and appeals rights for consumers to help resolve these types of consumer problems.