Relative to external reviews and patient protection
If passed, H1132 would notably amend existing regulations under Chapter 176O of Massachusetts General Laws, aiming to streamline the external review process while elevating the standards for medical professionals involved in such reviews. By mandating malpractice insurance for physicians conducting these reviews, the bill introduces a layer of protection for patients. Furthermore, it allows patients to appeal the outcomes of external reviews in superior court, thereby reinforcing their rights to challenge decisions made by insurance providers.
House Bill H1132, titled 'An Act relative to external reviews and patient protection,' seeks to enhance the process surrounding external medical reviews. The legislation stipulates that these reviews must be conducted by licensed physicians who are certified in the relevant medical specialty tied to the claim. This aims to ensure that patients receive highly qualified opinions regarding their medical situations, ultimately striving for fairness and accountability in the health insurance process. The bill emphasizes patient rights by requiring that the reviewing physician provides a comprehensive written report to the patient, backing all conclusions with citations from peer-reviewed materials.
While the bill is designed to bolster patient rights and improve the integrity of external medical reviews, it is likely to face scrutiny from insurance entities concerned about increased operational costs and liability implications. Critics may argue that the additional requirements could complicate the review process and may burden healthcare providers. Proponents, on the other hand, believe that these changes are necessary to improve outcomes for patients facing insurance disputes.