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For Immediate Release
February 6, 2001

Statement of The American Academy of Family Physicians

Regarding: New legislation on patients' rights

Attributed to:
Richard G. Roberts, M.D., J.D.

Members of the House and Senate have introduced bipartisan legislation on patients' rights. This is clearly a priority for the people of this country. We applaud these representatives and senators for stepping up to the plate early in this legislative session.

Family physicians know the tough choices many of our patients face when health plan accountants make medical decisions for them. That's why we think it is critical that America put patients and doctors back in charge of health care.

It is our hope that the spirit of bipartisanship will guide President George W. Bush and the 107th Congress to work together on this legislation. The members of the American Academy of Family Physicians offer our collective knowledge and help in achieving that goal.

The Academy recommends the following principles as a framework for effective patients' rights legislation:

Plan Information -- require that basic information about covered and excluded benefits, financial obligations, plan providers, experimental benefits and other important plan provisions be available to all plan enrollees.

Internal and External Appeals -- require that plans have an internal and external appeals process enabling meaningful and prompt access for patients and their physicians.

Prudent Layperson -- require that plans have a prudent layperson standard enabling patients to secure emergency care out of plan without prior authorization.

Gag Clauses -- require that plans honor the right of each physician and other health care providers to communicate freely with all patients.

Protections for Physicians -- require that plans have a policy protecting physicians who advocate on behalf of their patients for needed medical benefits.

Medical Necessity -- include an assurance that "medical necessity" decisions on clinically appropriate care will be made by physicians.

Plan Liability -- require that self-funded ERISA plans be held responsible for medical outcomes, as are other plans, within any given state.

Prescription Drugs -- require that plans have a process for ensuring that non-formulary drugs may be prescribed when most appropriate for the patient.

Choice of Provider -- retain language ensuring that children and women have access to family physicians, as well as other qualified children's and women's primary care providers.

If you wish to interview Roberts, please contact Maureen Maxwell at 1-888-794-7481.

Founded in 1947, the American Academy of Family Physicians represents more than 93,100 family physicians, family practice residents and medical students nationwide. It is the only medical specialty society devoted solely to primary care.

© 2001 The Washington Post Company


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