Notwithstanding the requirements of section 4321, the State shall establish an independent consumer assistance program through a contract with a nonprofit organization that operates independent of health plans and carriers.__The program must provide consumer assistance and advocacy to health plan enrollees in choosing among carriers or among coverage options offered by health plans and providing counseling and assistance to enrollees dissatisfied with their treatment by carriers in regard to health plan coverage and with respect to grievances and appeals regarding coverage determinations under those plans.

SUMMARY

This bill establishes a "Patients' Bill of Rights" for Maine residents enrolled in HMO's and other health plans. It will protect access to appropriate physicians and proper medical care and provide a means of recourse for patients who have been improperly denied such access. The bill will:

1. Ensure access to obstetrical and gynecological care;

2. Ensure access to specialty care for seriously ill patients;

3. Ensure continuity of care when a physician is dropped from a health plan;

4. Ensure access to prescription drugs;

5. Ensure access to clinical trials;

6. Provide patients with access to an independent external review of decisions regarding health care coverage and services;

7. Prohibit offering financial incentives to providers to limit necessary and appropriate medical care;

8. Establish an independent consumer assistance program to provide assistance and advocacy services to patients in selecting a health insurance plan, utilizing the plan and filing grievances and appeals of plan decisions;

9. Provide patients with the right to sue their health plan if the plan's failure to exercise ordinary care in making treatment decisions causes an injury to a patient; and