Thursday, March 13, 2008

HMO or PPO? Or PHP, PDP, PSO?

A Santa Monica based group is pushing to get ballot initiative for 2010 that would regulate health insurance companies the same way as other insurance.

Some kind of reform is needed, but copying the regulations in Prop 103 may not be the answer.

It would order HMOs and others to get their rates approved in advance by the state and force them to justify those rates; rates judged to be “arbitrary or capricious” would be thrown out. Rescinding coverage after an illness sets in would be outlawed. Extra costs for special services, the so-called “outof- pocket maximums” — would be capped, as would prescription drug costs. Patients would not be penalized for changing doctors or care plans. The HMOs and others would be required to submit detailed financial information to state regulators, who would have the authority to penalize companies for violations and seize and operate companies whose fiscal condition was suspect. There would be language making it easier to sue HMOs and others, and those who bring lawsuits in furtherance of the initiative would be compensated for their time — as in Proposition 103.

Actually, all those things sound good to me.

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