If their managed health plan negligently treats or denies covered treatment, they can experience personal injury, become debilitated, lose their jobs, suffer with their family, just as anyone with a physical injury. These patients should not be barred from legal recourse. Rather, the conferees should adopt other procedural provisions, such as strong internal and external appeals procedures and reasonable judicial procedural limitations to prevent frivolous lawsuits. The final accountability provision should not cap noneconomic damages. Rather, the final accountability provision could protect employers and health plans from exposure to potentially outrageous jury damages awards through reasonable compromises that include punitive damages caps and that permit separate proceedings to determine whether punitive damages should be awarded.
Patients have no recourse for the negligent delivery of care.
Patients are injured through both the negligent delivery of care and the denial of care . For example, managed health plans negligently deliver care through procedures that lead to a misdiagnosis or which unduly delay treatment. The final accountability provision should recognize both types of negligence. Patients are denied court access after adverse external review. An external appeal reviewer can make mistakes too and should not act as a court of law to determine causation or injury.