Editorial: Helping navigate HMO maze

The legislation pushed by Buckley outlawed physician payment incentives for denying medical care, mandated emergency room care if the patient and physician believe it is justified, and prohibits insurance companies from deciding what doctors can say to patients. Considering that Nevada hasn't had a great track record in passing tough consumer protection legislation -- and that HMO lobbyists carried considerable clout with legislators -- it seemed a miracle that Buckley's bill actually became law.

But Buckley's persistence and public outrage resulted in passage of these reforms, which have been praised nationally as setting a standard for other states to follow. Even with these protections, however, people still need assistance. As the Sun's Art Nadler reported last week, Buckley said she's been getting hundreds of calls from people who are trying to navigate the health care system.

Buckley and the Nevada Health Care Reform Project believe the state should create an ombudsman's office that would give HMO patients a voice. Under the proposal, the ombudsman would explain consumers' rights when dealing with HMOs, investigate and try to resolve consumer complaints, and explain laws and regulations that govern health care.

It can be incredibly intimidating to contest a decision by a managed care company, whether it is an authorization for a treatment or getting the health plan to pay for a service provided by a physician. Often the attitude on the other end of the phone line is contemptuous and condescending, something no health care consumer should have to endure.

The 1997 Legislature demonstrated its progressive leadership in health care, but it needs to build on these reforms. The 1999 Nevada Legislature should pass a law giving patients a voice, helping them effectively make their way through the managed care maze.

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