Government Relations
Practice Directorate
July 1999
For more information: e-mail
Your Address
Date
The Honorable (Full Name)
United States Senate
Washington, DC 20510
Dear Senator (Last Name):
I am writing to urge you to vote for health plan legal accountability as part of
comprehensive managed care quality standards when the Senate debates the Patients’
Bill of Rights Act.
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,
