HMO Review Panels

* Recently the California HMOs announced with great fanfare their “voluntary” adoption of “independent” external review systems (Dec. 3). As the applause dies down, it’s time for a reality check. The need for accountable external review systems was created by the inherent inability of the HMOs to put patient health ahead of bottom-line profits.

A truly independent external review system would, by definition, have to be created by people other than health plan executives. Last year health plans brought external review reform to a halt over details such as whether the consumers would have to pay for the right to a review, whether all claims could be reviewed, whether the results of the review would be admissible in court and, most importantly, whether the HMOs could be held liable for the consequences of their bad decisions.

Even the more limited state-run independent review panels for experimental treatments have run into serious problems finding any truly independent reviewers not connected with health plans. HMOs have a bad track record on protecting consumers through so-called “independent” systems, as evidenced by their notoriously skewed binding-arbitration panels.

If the health plans really want to impress us with their voluntary behavior, they can voluntarily stop using federal ERISA laws as a shield in court and voluntarily comply with the laws of this state to produce better quality care. Steps like that would impress the health consumers of California. This move shouldn’t.

MARTIN GALLEGOS, Chair

Assembly Health Committee

Sacramento

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The California Assn. of Health Plans is an organization of the HMO industry and the HMOs are its members. If these people chair an independent panel of decision-making doctors, will they be an independent panel of foxes taking decisions for us chickens?

LESTER KUSHNER

North Hollywood

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Re “HMOs Can’t Self-Reform,” Commentary, Dec. 4: I was an insider for 20 years in the managed care world. I know the tricks of the trade used to delay and deny care in order to save money. And two years ago I became a victim of the system when benefits were denied, putting my health, safety and financial survival at risk.

The only way to ensure accountability by all managed care companies is to give us the right to sue when benefits are wrongfully denied. Health care is the only industry we cannot sue for damages, if we get our coverage through work and are harmed by bad decisions and bad behavior.

Of course the HMOs have announced a voluntary review system. They are scared to death that Sen. Barbara Boxer (D-Calif.) and next year’s Congress will pass a law that holds them truly accountable.

JUDY R. LERNER

Studio City