"There are dozens of ways to 'reform' health maintenance organizations in ways that would ultimately hurt patients or even kill HMOs. There are precious few ways to do it right, so that patients as well as HMOs are protected. The Arizona Legislature appears to have done it right."

"Power to Patients -€” Arizona HMO bill is the right mix of reform and caution," Scottsdale Tribune, 3/25/00

News Room

RETURNING HEALTH CARE DECISIONS TO YOU
AND YOUR DOCTOR*

Rep. Leff's landmark HMO Reform legislation (House Bill 2600) marks a sweeping change in how Arizona HMO's treat patients and health care decisions. Because of the magnitude of the changes made under Rep. Leff's leadership, the bill is considered a model for reform in other states and Congress. It becomes fully effective on January 1, 2001.

Here are what the important changes in Rep. Leff's HMO Reform bill mean for you:

• Health care decisions are returned to you and your doctor. If your HMO denies a treatment prescribed by your doctor, that decision must now be made by a medical director who is licensed to practice medicine in Arizona and must be documented in writing.

• Your doctor will be able to get approval for the prescription drug that has been determined to be the best for your particular condition.
  
  
• You will get two months of refills for a currently prescribed prescription drug when your insurance company changes the drugs on its “approved” list (formulary). This gives you and your doctor time to make a change or get permission to stay on the drug.
  
  
• Now there is a faster appeals process when your health could be affected by waiting for a decision that needs pre-authorization by the HMO.
  
  
• You will be able to see a specialist for an extended period of time with a single referral from your doctor.
  
  
• Doctors can fight for the rights of their patients without fear of retaliation from the insurance company.
  
  
• Health insurance plans are forbidden from offering financial incentives to delay, deny, or limit the treatment you need.
  
  
• You will be able to continue to see your current doctor for a transitional period when your health insurance has changed if you have a life-threatening condition or are in the third trimester of pregnancy.
  
  
• You can go to a chiropractor for the treatment of neck and back problems for a limited number of visits.
  
  
• Any group that assumes financial risk for the delivery of your health care must be financially solvent.
  
  
• All claims for providers must be paid in a timely manner or interest must be paid. By looking at patterns of late payments, this legislation provides a means to alert the AZ Department of Insurance of any possible financial problems of your health plan.
  
  
• Your doctor will have an added choice of drug therapies for the treatment of cancer.
  
  
• You will be able to sue your health care insurer for damages if that insurer has acted in bad faith.

  * This general summary is provided for informational purposes only.  For further information, see HB 2600, Chapter 37, Laws 2000.