Carper Offers Centrist ‘Contract Compromise’ on Patients’ Bill of Rights

WASHINGTON, DC – Members of an independent medical review panel will not have the ability to override binding contracts between patients and their HMO provider under a bipartisan compromise amendment offered today by Senators Thomas R. Carper (D-DE), Evan Bayh (D-IN), and John McCain (R-AZ). The amendment clarifies the scope of health plans’ responsibility and provides greater certainty to patients before beginning the appeals process. HMOs will be held strictly accountable for providing patients every medically necessary procedure they have contracted to cover. Under the Carper-Bayh-McCain amendment, review boards may not mandate coverage that was not included in the original contract. “The Patients Bill of Rights as written leaves the door open to capricious actions by a medical review board. Unless amended, the bill gives reviewers the opportunity to void a contract between a patient and provider by demanding coverage explicitly denied within that contract,” Carper said. “Our amendment provides certainty for patients and health plans and eliminates the possibility of a reviewer abusing his or her discretion. I am pleased to stand with Senators Bayh and McCain to offer this amendment.”