The Key Points Of The Access to Quality Care Act of 1999
Freedom of Choice
Every American should be able to choose their doctor and hospital.
Freedom to Change
Every American should be able to change their choice of doctor on a regular basis if they feel
No American should be forced to drive out of town to see a doctor or go to a hospital when
there is one available in their community to their liking.
Every American should be able to see a specialist if their doctor thinks they need one.
Gynecologists, and Pediatricians
Women should be able to see obstetricians and gynecologists, and children should be able to
see pediatricians, without any referral.
Patients should not be forced to change doctors and hospitals while in the middle of being
treated for a problem.
Patients should be able to go to the nearest emergency room when they think they have an
emergency, and should pay no more out-of-pocket than they would have at their health planís
designated hospital. If the problem reasonably appeared to be an emergency, but turned out
not to be, the insurance plan still has to pay.
When A Benefit Is Denied
Patients should be able to talk to health plan doctor, not just an insurance clerk, when a plan
denies coverage. If the plan still denies coverage, they should be able to have a third opinion
from medical specialists totally independent from the health plan, and that decision should be
binding on the plan. If the health plan incorrectly denies the third opinion on grounds that the
benefit in question is not included in the plan, the patient should be able to go to federal court,
and sue for not only the benefit, but attorneyís fees, court costs, and up to $250,000 in
penalties if the plan is found to be wrong.
For Injuries From Denied Benefits
If a patient is injured as a result of a covered benefit being denied or delayed, they should be
able to go to state court and sue for compensatory and punitive damages for medical
malpractice. Very importantly, employers cannot be held indirectly liable for the actions of a
No health plan may provide payment incentives for doctors or hospitals to deny care.
Reasonable flat rate payments and employment agreements are allowed, but only if they do
not indirectly provide incentives to ration care.
Every American should be able to clearly understand what benefits are and are not covered
by their health plan, before they agree to the coverage. Plans should provide specific
information in laymenís terms, in addition to information on the rights of patients to challenge
No medical information on a patient should be released to anyone without the patientís
Freedom Of Communication
Every doctor should be free to discuss anything relative to a patientís health with the patient,
even if the information may be negative towards the health plan. Health plans should not fire
or discipline doctors for talking freely with their patients.
All health plans should develop policies with the input of patients and doctors; should maintain
on-going programs to increase quality of care; should develop standardized participation rules
for doctors and hospitals; and should develop policies to ensure patient care if the company
runs out of money.
1707 LONGWORTH BUILDING
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