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Attorney general targets disputes in Pa. health care
"Some consumer advocates hail a new mediation unit. Critics said it
will only increase regulatory burdens."
By Karl Stark
INQUIRER STAFF WRITER
Pennsylvania Attorney General Mike Fisher has created a health-care unit to help mediate patients' disputes with insurers and take court action when necessary. Fisher said he was responding to growing confusion among patients. "My health-care unit will offer consumers a place to go to get straight answers on health-care coverage, services and costs," Fisher said in a statement. "These questions can be confusing to consumers, especially for older Pennsylvanians who remember a simpler health system." Fisher, who is running for reelection this year, envisions that the unit will help patients who are seeking treatments that insurers disallow, as well as those whose benefits are cut after they have joined a plan. The unit, which will be part of the Bureau of Consumer Protection, also could aid patients whose insurers delay bill payment, leading hospitals to turn over the debts to a collection agency. Fisher's effort, which yesterday received mixed reactions, is based on units that New York state began in 1997 and Illinois started last year. Other states with similar units include Maryland, Texas, Connecticut and Rhode Island, said Sean Connolly, spokesman for the attorney general. Some consumer advocates said they were thrilled to have the power of the Attorney General's Office to make commercial insurers, especially health-maintenance organizations, more responsive. "The Attorney General's Office is responding to a public outcry from citizens," said Joseph L. Romano, a Norristown-based lawyer who represents catastrophically ill children and adults. "Anything the attorney general can do more globally to put pressure on the HMOs to change their procedures and to be more consumer-oriented has to be a benefit to the people of Pennsylvania." Other observers said the new office would add another layer of regulation in an already closely watched industry. "Our members are already heavily regulated and answerable to the departments of Health and Insurance," said Kimberly J. Kockler, executive director of the Managed Care Association of Pennsylvania, which represents 12 HMOs in the state. "I worry about being regulated by another entity in state government." Alice G. Gosfield, a health-care lawyer in Philadelphia, said many issues that the attorney general is concerned about are already covered by Act 68, the state's managed-care-reform law passed two years ago. Health-care institutions and insurers have also come under increased scrutiny in recent years from the U.S. Attorney's Office. "A lot of people are paying attention these days," Gosfield said. "I don't quite understand what's different about this. . . . How much regulation can an industry stand?" Connolly responded that the new unit would reduce bureaucracy, not add to it. "This is a natural extension of our ongoing consumer-protection efforts," he said. "We can often mediate a resolution for consumers without litigation, without a heavy bureaucratic process." The unit, which has been getting established in the last few weeks, will have two lawyers and three investigators, and has already received about 35 calls without any publicity, Connolly said. "We anticipate that we'll receive a lot more." The unit will be headed by Lawrence Otter, a lawyer from Bucks County who transferred from the state Health Department, where he worked on managed care and long-term care. The unit's second attorney, Amy Freed, is a former deputy district attorney in Dauphin County who specialized in cases involving sexual assault and domestic violence.
Consumers can reach the new unit by calling toll-free, 1-877-888-4877.