Tar Heels Now Covered By PBOR

October 22, 2001 (PLANSPONSOR.com) - A patients' bill of rights is now a reality in North Carolina.

North Carolina Gov. Mike Easley signed a PBOR law that includes a provision allowing patients to sue their managed care plans. The North Carolina House and Senate approved the measure last week.

In addition to the managed care suits, the new law also:

  • allows patients with chronic conditions to designate specialists as primary-care doctors
  • allows patients to appeal a health plan’s medical decision to an independent panel after two internal reviews. After the external review process, patients can sue health plans in state court.
  • permits patients who are being treated for chronic conditions and whose doctor has been dropped from a health plan’s network to continue treatment with that doctor for up to 90 days
  • prohibits insurers from giving doctors financial incentives to deny or limit care
  • permits parents to select a pediatrician as a primary-care provider for children.

New State Office to Help Patients

To help patients navigate the appeals process, the state will launch the Managed Care Patient Assistance Program. The office will also serve as a “catchall” for any questions or problems individuals may have with their managed care plans.

About 5.1 million North Carolina residents have employer-sponsored health insurance, but about 40% to 50% of these employees are enrolled in health plans regulated by ERISA which makes them exempt from state mandates.

However, the new law will apply to state government workers.

– Fred Schneyer                 editors@plansponsor.com

For the latest in the PBOR debate at the national level, see http://www.plansponsor.com/content/news/opinions/billofrights

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