Should a patients’ bill of rights include the right to sue an HMO or other insurance company?
The U.S. Congress is again considering passage of a patients’ bill of rights to provide protection for people in managed care plans. The main point of contention between supporters and opponents of the bill is whether patients should have the right to sue their HMO or other insurance company.
Opponents argue that the courts will be flooded with lawsuits, driving up health insurance premiums and forcing employers to drop coverage. Supporters of the bill say this won’t happen because the internal and external appeals processes will address most patient grievances, thereby reducing lawsuits.
Eighty-four percent of readers said a patients’ bill of rights should include the right to sue.
The ADA has endorsed the proposed Bipartisan Patient Protection Act of 2001 (S 283 and HR 526). This legislation contains provisions to ensure that all Americans receive comprehensive information about their health plans’ restrictions and limitations and can see the doctor of their choice. Furthermore, it proposes requirements that health plans, including dental plans, establish valid internal grievance systems and binding and independent external appeal processes to ensure that patients can challenge plan denials and treatment decisions in a timely manner. And when a plan’s decision to deny or limit care results in injury or death, the plan can be held accountable for its actions in a court of law.
In response to the March Question of the Month, 84 percent of readers said a patients’ bill of rights should include the right to sue. Most of those in favor expressed the belief that insurance companies should be held accountable for their decisions. Said one respondent, "Companies and individuals must be held accountable for their actions. I’m tired of insurance companies taking decisions away from doctors and patients." Another reader said, "If insurance companies can dictate treatment, then they should be held responsible for the outcome." "Absolutely," said another respondent. "We as dentists are held accountable. Why shouldn’t insurance companies?"
A few readers expressed the need to avoid unnecessary lawsuits. Said one, "The right to sue should be tempered by the stipulation that if the patient loses, the patient pays all costs." Another respondent said, "No frivolous lawsuits—must prove cause. Put cap on judgments ($250,000?)." Another reader suggested that "arbitration would be the best method of settling, since it is less likely to increase costs." In that regard, one reader commented, "As far as driving up costs, those [insurance companies] with the fewest lawsuits will survive. Isn’t natural selection a wonderful thing?"
About 11 percent of readers do not believe patients should have the right to sue insurance companies. "Absolutely, positively no," commented one respondent. "Only arbitration by a panel of peer reviewers, whose impartial, objective evaluation is funded by both sides of a dispute, with no lawyers involved." Another reader said, "It would only be a welfare program for trial lawyers."
About 5 percent of respondents don’t know whether patients should be allowed to sue. "I don’t want insurance rates to increase," said one reader, "but insurance companies need to be held responsible for their actions."
More information on this topic can be found in the Government, Advocacy and Grassroots area of ADA.org.
