MDN.ORG:
Missouri Digital News
MDN.ORG
Mo. Digital News
Missouri Digital News
MDN.ORG:
Mo. Digital News
MDN.ORG:
Missouri Digital News
MDN.ORG:
Missouri Digital News
MDN.ORG
Mo. Digital News
Missouri Digital News
MDN.ORG:
Mo. Digital News
MDN.ORG:
Missouri Digital News
JEFFERSON CITY - HMO consumers would have the option to skirt a primary care physician and go straight to a medical specialist if the Missouri House passes the managed care regulation package.
The House began hearing the bill, sponsored by Rep. Tim Harlan, D-Columbia, Wednesday and will continue today. The bill, which was drafted by a joint committee that met during the legislative intersession, would impose statewide regulations on managed care providers.
Under the original bill, patients would have had to get a referral from a "gatekeeper" to see a specialist besides dentists, eye care specialists, chiropractors and dermatologists. However, with the current wording, health maintenance organizations would be required to offer a "point of service" (POS) option.
With POS, consumers would pay a higher premium in order to have direct access to specialists within their HMO network.
"Basically what we're trying to do here is to give a little more option to the consumer," said Rep. James Foley, D-St. Ann, a sponsor of a similar amendment.
Harlan said the joint committee originally wanted POS in the bill, but insurance representatives were vehemently opposed to it. They changed their minds as additional specialists were added to the list of ones that could be accessed without a referral, Harlan said.
"We intentionally didn't cap the premium they can charge," Harlan said, referring to the fact that the bill doesn't limit the amount over the standard premium that HMOs can charge for direct access. "POS option is becoming something that people really want to have, so we believe it will be competitive."
Missouri's version of POS, allowing direct access only to specialists within the HMO network, is a new approach, Harlan said. Currently, some insurance providers offer options of direct access to any specialist, but those premiums are usually "quite a bit higher," Harlan said.
Besides the POS clause, the amendment also would allow people to see an obstetrician/gynecologist at least once a year without a referral.
"This is going to make the OB/GYN accessible to ladies so that they will get that important annual visit," said sponsor Rep. Mary Lou Sallee, R-Ava.
Hours before the House began debate on the issue, about 100 AARP members gathered in the Capitol Rotunda to voice their support of the measure. The American Association of Retired People's event just happened to coincide with the day the House took up the HMO bill.
The main priority of the AARP members is to regulate some of the practices of the insurance providers, such as requiring them to pay for emergency room visits in cases of false alarm.
"You can have the symptoms of a heart attach and it turns out to be a chest pain," said Betty Crim, of the Boone County AARP chapter. "It's hard for a lay person to diagnose their own problems."