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Thank you Washington City Paper for “HMOuch” (10/11) and shedding light on an issue of local concern that has received no attention in the “mainstream” press. Lack of attention may be one reason why John Ray’s office has heard no opposition to the Health Maintenance Organization (HMO) Act of 1995. Drafted by and for the industry, the HMO Act protects the financial interests of HMOs over consumers’ health. Specifically, under the bill, HMOs cannot be held accountable for damages resulting from utilization review decisions. This means that if your HMO fails to authorize medically necessary treatment and you get sick, suffer complications, or even die as a result, the HMO cannot be sued. The HMO Act also prohibits consumers from obtaining any information about treatment-authorization decisions from their own HMO. These provisions place consumers at risk, and leave doctors holding the bag when the HMO refuses to pay.
While regulation of the District’s HMOs is long overdue and desperately needed, enactment of Ray’s bill in its current form may be worse for consumers than no regulation at all. I am confident that as more District residents learn the particulars of this bill, they too will reach this conclusion and register their opposition.