Div A, Tit 2, part 3: Consumer Protections (except 233)

This is slightly scrambled because 231 deserves a lot of looking. The remainder of the Consumer Protection section (subtitle D of Title 2) is darn near boilerplate. That is, it’s pretty much what you see all the time.

SecHHS will ensure that all the Qualified Health Benefits Plans (QHBP) remain above board in marketing practices by setting rules for what is and is not allowed.

QHBPs will have fair grievance and appeals mechanisms, and to ensure they do there will be a review done under the commissioner’s auspices of all denials (ie, if the internal says “no” to an appeal or grievance claim it automatically goes to this commission for review). This does NOT substitute for judicial review and legal action that states may allow or require.

Claims must be paid in a timely fashion. The Commissioner needs to get rules written asap regarding dealing with people who have multiple policies. Paperwork from QBHPs includes the Social Security requirements.

SecHHS will study whether physician prescriber information is being abused and if so make recommendations to protect the prescribers from “biased sales and marketing practices.” That’s actually kinda big, as right now the sales companies know who is prescribing how much of their and their competitors’ product. Allegedly (which is why the study is needed) they then apply some rather shaky pressures on the doctors who don’t prescribe enough of ‘theirs’ – allegations have included pricing penalties on other drugs, just for example. It’s a possible nasty mess that needs either exposed or shown to be a false accusation of ‘normal practice’.

Finally, Advance Care Planning – what got some people’s knickers in a twist over “death persuasion.” Exchange participating plans WILL require physicians to present information and directions to advisors for living wills, powers of attorney, and advanced directives regarding sustaining life, but WILL NOT recommend suicide, euthanasia, mercy killings, etc. The rest of this section (240, by the way) is response to all the fooferaw of the preceding months.

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