Insurance reform bills pass the Legislature

Insurance reform bills pass the Legislature

The 2001 session of the Indiana General Assembly ended with two important victories for health insurance consumers. Citizens Action Coalition led the effort to pass bills that will extend the right to external appeal to Hoosiers with non-HMO coverage and create the Office of Health Care Educator to provide information to citizens about their rights and responsibilities as health insurance consumers.

Legislation to provide external appeal to HMO enrollees had passed in the 1999 session. And two bills were introduced in 2001 to extend the right to people enrolled in non-HMO plans. HB1515, sponsored by Rep. David Crooks (D-Washington), and SB365, sponsored by Senator Beverly Gard (R-Greenfield), both passed and were signed into law.

The external appeal law passed this year is almost identical to the 1999 HMO law. Consumers are required to go through the internal grievance procedure first. If they are not satisfied with the outcome, they have the option of filing an external appeal. External appeal gives consumers a mechanism to ensure that decisions about their access to health care are being made by medical professionals with no conflict of interest.

Consumers must pay a $25 filing fee to the Department of Insurance to initiate the appeal, but there are no further costs. External appeal decisions are binding on the health plans, but not binding for consumers. People will still have the option of going to court, if they choose.

SB229, the Office of Health Care Educator, also was sponsored by Senator Gard. As introduced, the bill created the Office of Health Ombudsman, which was envisioned as a way to educate Hoosiers about their rights as health care consumers. But the Department of Insurance was concerned about how the Ombudsman would mesh with its Office of Consumer Affairs. CAC and representatives of the Department met early in the legislative session and arrived at the Health Care Educator compromise.

CAC believes the Office of Health Care Educator will be an important step in helping consumers exercise their rights. Currently, few people realize that state law gives them tools to fight back against their insurance plans. According to a survey by the Kaiser Family Foundation, 89 percent of people don't even know the state agency that regulates health plans.

The Office of Health Care Educator should help to raise the profile of the Department of Insurance and make Hoosiers more aware of the options they have to hold their plan accountable.

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