San Bernardino, CA, March 23, 1999 -- Inland Empire Health Plan is one of the first HMOs in California to offer all its members access to external independent review (EIR) of any medical decision the member may dispute.
Last year, special interests stalled legislation requiring HMOs to give patients access to external review of their medical decisions by an independent third party. IEHP decided not to wait for Sacramento to try again.
"We saw no reason why our members should not have external independent review immediately available to them," said IEHP’s CEO Richard Bruno. "It is good for all concerned – the patient, the doctor, and the health plan – to have a third-party, medical expert review the case history to make sure appropriate care is given."
Equally important to IEHP was the reassurance EIR provides to members that the health plan is acting on their behalf.
"Whatever the ultimate decision may be following an EIR, our members know IEHP has voluntarily gone the ‘extra mile’ to see they get proper care and IEHP has voluntarily committed to abide by whatever the reviewer’s decision may be," said Bruno. "We feel our EIR program is very important to maintaining our members’ trust."
An EIR is conducted by an independent review organization that selects physicians based on their expertise related to the issue under review and their knowledge of evidence-based treatments. The independent review organization and its physician experts have no financial affiliation with either the health plan or the member. Neither the health plan, nor the member has any control over or influence upon the selection of the physician experts.
IEHP is among 16 of California’s largest health plans, which cover over 18 million of all managed care enrollees statewide, that announced in December they would implement EIR programs by the end of 1999. Some plans, however, opted to delay offering EIR programs in case state lawmakers successfully enact a new law.
"At the time of the announcement, IEHP had nearly finished preparing our EIR program," said Bruno. "So we had a bit of an advantage."
Anyone may review IEHP’s External Independent Review program on their web site at www.iehp.org (the 15th listing under ‘Viewpoints’) or contact Bob Sutton at (909) 890-2016 to obtain a written copy.
IEHP is the local initiative, non-profit health plan created by Riverside and San Bernardino counties to provide access to quality preventative and total health care services to Medi-Cal beneficiaries and children enrolled in the Healthy Families Program. IEHP’s present enrollment is 133,000 members.
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