HMO Appeals Program Hasn't Been Busy

Maryland lawmakers created a state appeals process for people who feel that their HMOs have denied them the coverage they deserve.

Although polls indicated that patients had lots of worries about adequate and fair coverage, five months after the appeals process went into effect, complaints are not pouring in.

In January, the first month of the appeals operation by the Maryland Department of Insurance, 13 complaints were filed. As the program has received more publicity, the number of complaints has increased most months -- the high thus far was 69, in March.

But that's not a lot, according to state Insurance Commissioner Steven B. Larsen, when compared with the 7,000 to 8,000 other health and life insurance complaints his agency receives annually.

"I'm encouraged that the numbers aren't higher," he said. "It indicates that things aren't as bad as people thought they were or that [HMOs] have taken steps to improve their internal reviews."

Indeed, state statistics show that most complaints are referred back to HMOs' internal review procedures because patients hadn't exhausted their chances there. But that's not to say those consumers aren't getting state help.

The same law that established the complaints procedure also said that the attorney general's office was to help and advise patients with their appeals to companies' internal reviews. It also required HMOs, when turning down a request for coverage, to inform patients that they could appeal. Doctors also can appeal HMO decisions under the new law.

The attorney general's Health Education and Advisory Unit is helping to shepherd many of the appeals through the HMOs now.

The law says that patients who are not satisfied with the results of a final internal HMO review can then appeal to the state, which has contracted with three independent medical review boards to examine cases and order HMOs to comply with their decisions. Only a few cases have gone that far.

Those seeking more information can call the Maryland Insurance Department toll free at 800-492-6116.

-- Daniel LeDuc

No More Money Available for `Kinship Care'

No More Sarah O'Neal, 60, is among thousands of aunts, grandmothers and others in the District who have opened their homes to abused or neglected children of relatives or friends in an arrangement known as "kinship care."

O'Neal, a great-grandmother, took in three little girls because their mother, her niece, was using crack and living on city streets. She received gifts and money donations after a story about her appeared three months ago in The Washington Post.

But the city's own effort to provide O'Neal and those like her with more money and benefits as "kinship care" providers never made any headway.

Such providers are seen by some child welfare advocates as the best hope for thousands of children mired in the city's overburdened foster care program. But O'Neal and others like her struggle to make ends meet. A monthly welfare check for each child -- and sometimes an additional Social Security check for the adult -- often are not enough to cover the costs of taking in several children.

In February, Earnestine F. Jones, the District's receiver for child and family services, proposed legislation to create a kinship care law, which she hoped would lead to more services and money for relatives and close family friends who take in abused or neglected children.

But the D.C. Council canceled a hearing on the bill, which would have provided for federal payments to providers, after Judge Eugene N. Hamilton wrote a scathing letter to city officials, saying the proposal was not well conceived and could actually cause more child abuse because it eliminated judicial oversight. Karen Kushner, spokeswoman for the Child and Family Services agency, said there has not been any movement since to write a new kinship care law.

-- Sari Horwitz