Patients must be able to appeal plan decisions to deny, delay, or otherwise overrule doctor-prescribed care and have those concerns addressed in a timely manner. Such an appeal system must be expedient, particularly in situations that threaten the life or health of the patient, and conducted by appropriately credentialed individuals. Individuals must have access to an external, independent body with the capability and authority to resolve disputes for cases involving medical judgment. The plan must pay the costs of the process, and any decision is binding on the plan. If a plan refuses to comply with the external reviewer's determination, the patient may go to federal court to enforce the decision.
Consumers have the right to know all of their treatment options.
The Bipartisan Consensus Bill prohibits plans from gagging doctors and from retaliating against providers who advocate on behalf of their patients. It protects providers in these situations from retribution. It also prevents plans from providing inappropriate incentives to providers to limit medically necessary services. Providers should not be discriminated against based on the basis of license in selection for plan participation. The Bipartisan Consensus Bill forbids discrimination against providers based on license, location, or patient base.