Assures prompt decisions regarding health care coverage determinations, first through the health plan's internal process in a timely manner, then through an independent external appeals process. Ensures that health care professionals are able to recommend the best treatment options and to serve as their advocates. Requires plans and insurance companies to disclose information that could influence a consumer's choice of plans. Creates a Health Quality Council to serve as a resource for Congress and the president by providing scientific evidence and financial and socioeconomic impact of pending legislation about health care quality and consumer protections. The Council would also report on quality improvements in the health care market and set national goals for improving care.
People are now worried that managed care only manages costs and, in effect, rations care.
One consequence of this transformation is that Americans are losing confidence in the quality of care they receive. Based on an analysis by the Lewin Group, the added costs for information disclosure and external appeals requirements are extremely low. The estimated monthly cost per person for comparative information and for external appeals with a three year phase-in is 88 cents. This doesn't take into account market efficiencies and increased competition that the Lewin Group indicates will be achieved with these requirements. Another sizable camp believes that there is nothing wrong with the health care marketplace that can't be sorted out by its own operation.