Insurance matters worry congressman: In a letter to Clark, Wise worries many will be unprotected

State law offers numerous protections regarding managed care, butmore than 670,000 West Virginians may be left out in the cold, U.S.Rep. Bob Wise cautioned.

The congressman sent a letter to state Insurance CommissionerHanley Clark, warning that when Clark told legislators of the statelaws, he may have given the impression that federal protectivelegislation is not needed.

"What the reports of your testimony failed to convey, however, isthat even in states with such patient protections in place, a largenumber of patients do not benefit," Wise stated."The federal Employee Retirement Income Act governs patient carefor 51 million Americans whose employer "self insures," exemptingthem from state managed care protection."Clark, who was not available for comment Friday or today, has saidWest Virginia already has laws regarding confidentiality of medicalrecords, credentials for health care providers, accessibility tophysician care and rules that allow physicians the freedom torecommend certain treatments.He noted that several legislators, not realizing the strides thestate has made, have introduced bills that would do what is alreadycovered by state law."We are not perfect by any means, but we are so much further aheadthan most other states," Clark said.Those are all areas Congress is considering including in a"patient bill of rights," which Wise supports.He cites information from the Employee Benefits Research Institutethat out of West Virginia's approximately 900,000 patients insuredthrough their employers, more than 670,000 are covered by thefederallaw that makes them exempt from state protection.That's "virtually three out of every four" insured employees, Wiseadds.The patients bill of rights would extend to those people, he said.According to Wise, the proposed federal legislation would alsorequire that managed care plans:- Refer out-of-network provi ders when the care offered isinsufficient.- Allow specialists to be primary care providers in certain cases.- Allow standing referrals to specialists for patients who havechronic or life-threatening illnesses.- Allow certain patients to continue to see a physician who hasleft the plan.- Have a process for obtaining drugs not included in a plan.- Create a "meaningful" process of reviewing appeals.- Not prohibit patient participation in clinical trials.- Be accountable for significant damage for wrongful denials ofcare."By taking a broader view of the patient protections that are, andare not, in place in West Virginia, the need for a federal approachwhich makes managed care plans accountable is readily apparent,"Wisestated in his letter to Clark. "I am encouraged that West Virginiahas several crucial consumer protections in place."I would encourage you to support a complete package thatcomprehensively protects all patients."Writer Stacey Ruckle can be reached at 348-5185.