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HMO Regulation

February 11, 1997
By: Sarah Coleman
State Capital Bureau

An HMO policy is under the scalpal at the state capitol. Sarah Coleman reports from Jefferson City.

Story:Sarah Coleman
RunTime:
OutCue: SOC

Some HMO patients say the only thing they fully understand about their health care plan is their own expectations in a provider...success, cost, accessibility and now the prevention of HMO policy frustration.

Lynne Maritz, a St. Louis psychiatrist, says consumers may benefit from written policy concerning HMO procedures.

Actuality:Lynne Maritz
RunTime:
OutCue: ...a very necessary function.
Contents: This bill by providing a grievance bith within the Hmo and outside of it by a separate agent is a very necessary function.

A bill being considered by the Joint Interim Committee on Managing Care would regulate the changing benefits in policies and would stabilize patient expectations.

From Jefferson City, I'm Sarah Coleman.

A proposed bill would make it easier for HMO patients to see specialized doctors. Sarah Coleman has more from Jefferson City.

Story:Sarah Coleman
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OutCue: SOC

The bill being considered by the Joint Interim Committee on Managed Health Care, would allow Missouri HMO patients to go directly to a specialized doctor for treatment...instead of going through the red tape of having to see a primary physician first.

Missouri State Medical Association member, Tom Holloway...

Actuality: Tom Holloway


RunTime:
OutCue: ...medically appropriate care.

Contents: Patients ought to expect that there is not going to be unreasonable obstacles to getting the care they want to get and need to get...medically appropriate care.

Supporters of the bill say direct access to specialized doctors would make treatment more cost effective and avoid possible wrong diagnosis.

Opponents of the bill say giving patients direct access to specialized doctors would cause health care costs to increase.

From Jefferson City, I'm Sarah Coleman.