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New HMO regulations give more protection to patients

December 2, 1997
By: Beejal Patel
State Capitol Bureau

New managed care regulations are designed to offer more protection for consumers who enter into an HMO plan.

From Jefferson City, Beejal Patel has the story.

Story:
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With today's HMOs, it is not uncommon for patients to be denied coverage after their HMO has approved the medical procedure.

That's according to state Insurance Department spokesman Randy McConnell.

He says the major cause in many of the denials is the procedure's high cost.

But, McConnell says, new regulations are designed prevent HMOs from backing out at the last minute, leaving consumers to pay the bill.

Actuality: McConnell
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Contents: "Whenever an HMO approves a procedure they must proceed with the medical aspect of it, but they must pay for it as well."

And, if HMOs refuse to offer medical coverage, the new rules give the insurance department the power to order the HMO to provide the care, after reviewing the patient's case.