Now that she is pregnant again, her doctor wants her hospitalized in the last few weeks leading up to delivery. Her HMO has said no. She would like to turn to experts to get an outside opinion that the HMO would have to follow. Unfortunately, no HMO in North Carolina currently has an independent board where a patient can appeal a decision to deny care. HMOs get to pick their own appeals board members and provide the board members with meeting facilities and compensation for their time.
Independence is forgotten as HMOs can choose people most sympathetic to their position.
A truly independent appeals process increases everyone's confidence that an HMO's decision to deny care is sound and not just a desire to put profits ahead of patients. North Carolina's HMOs have reacted to this inexpensive and popular reform with a massive lobbying campaign in the General Assembly to gut and delay this needed patient protection. Worst of all, anticipating that legislators might eventually make them liable for mistakes in denying care that hurt patients, they slipped in a provision that would prevent patients from successfully taking them to court if a patient who was hurt thought the appeals board decision was flawed. They know that legislators are ready to finish up here in Raleigh and want to go home to campaign. HMO executives might be happier, but patients will suffer.