Government Relations
Practice Directorate
July 1999
For more information: e-mail
Your Address
Date
The Honorable (Full Name)
United States House of Representatives
Washington, DC 20515
Dear Representative:
I am writing to urge you to vote for the Norwood amendment on health plan legal
accountability as part of comprehensive managed care quality standards when the Education
and the Workforce Committee debates managed care reform legislation.
As a result of a loophole in the Employee Retirement Income Security Act, most
individuals and families enrolled in managed care plans are prohibited from bringing legal
actions when they are injured as a result of negligent decisions by these plans to delay
or deny treatment. The ERISA loophole allows plans to make negligent cost-containment
decisions, including denials of covered benefits, without any accountability to the
patient.
An external appeal, even when legally binding, will not protect patients from
inappropriate cost-containment decisions. Health plans must be held accountable when they
deny or delay a promised benefit and the patient is harmed as a result. Legal
accountability will improve the care delivered in health plans and help patients to access
necessary psychological services.
Thank you for consideration of my views.
Sincerely,
