Letter: Managed care needs regulation

The Clark County Medical Society is concerned by the statement made by Kara Kelley, senior vice president of the Chamber, that "Managed health care is being regulated to death."

Many individuals with managed care insurance are not protected by the new Nevada patient-protection law because their benefits are considered to be covered under the federal ERISA laws.

ERISA takes preeminence over the state law and does not hold all managed care organizations accountable for their actions.

There are no clear complaint mechanisms and you may only sue for the specific benefit denied, i.e., the cost of a mammogram, but not for damages caused by the denial of the benefit, i.e., advanced illness or death due to lack of treatment.

Physicians continue to try to gain further protection for their patients by eliminating these loopholes in the federal laws as well as expansion of state laws to include an impartial ombudsman.

We share the Chamber of Commerce concerns that Nevada's business environment should be healthy, but as physicians we are not prepared to purchase that with the health and safety of Nevada's patient population.

The reforms that came from the last legislative session were a good start, but do not go far enough. No one believes that managed care is being regulated to death.

Managed care, however, is a matter of life and death and more than the "bottom line" needs to be considered.

Kazem Fathie, Clark County Medical Society president

archive