Copyright 1999 The Hartford Courant Company
THE
HARTFORD COURANT
September 11, 1999 Saturday, STATEWIDE
SECTION: EDITORIAL; Pg. A10
LENGTH: 318 words
HEADLINE:
PATIENTS' BILL OF RIGHTS DOESN'T PROTECT
BYLINE: Howard G. Iger, M.D.
Senior Consultant
The Institute of Living Medical Group P.C.
Hartford
BODY:
In the case of psychiatric patients, the
Connecticut patients' bill of rights legislation has little
value.
To cite one example, a patient covered by the bill was given a
thorough evaluation. I recommended a specific course of psychiatric treatment.
The managed- care company denied the "medical necessity" of the treatment plan.
The patient and I appealed. The managed-care company recommended a consultation
with a psychiatrist who had been medical director of a managed- care company.
The patient and I felt that a neutral expert would be more appropriate. The
patient was seen by an internationally renowned psychiatrist at an ivy league
medical school who fully supported the medical necessity of the proposed
treatment. The patient paid for that consultation.
For several weeks, we heard nothing from the
managed-care company despite
frequent calls. Eventually it was found that
the managed-care company had lost
the consultation; a second copy was sent.
The medical necessity of the proposed treatment was denied
again, and a
much less rigorous course was recommended. Treatment was,
nevertheless,
carried out by me, with the patient taking financial
responsibility.
The patient subsequently sued the
managed-care company. The company has
agreed to pay for the treatment. It is
now, however, months later.
Had the patient not been
capable of assuming responsibility for the cost
and had the patient and her
family not been educated and assertive, the
company would never have been
brought to its present position.
This is typical of the
problems we have in Connecticut despite the
patients' rights bill.
A contract with a managed-care company should be no
different from other
contracts. A failure to follow the contract should be
punished fully by civil
penalties and, when deliberate fraud has been
proven, criminal penalties.
LOAD-DATE:
September 13, 1999 
