Independent external reviews

External review of coverage and contractual issues is fast becoming available to all insured health care consumers. The Patients Rights Bill would allow consumers to appeal claims denials to indepenent third parties. Many states already allow this right by state law. Insurors and other health care providers (managed care organizations, physicians, third party payors and state run health care plans) are adding independent external claims reviews to their benefits package. Michael Cardillo, president of Aetna, spoke of this issue in the following article:

"Aetna U.S. Healthcare is committed to raising the quality of healthcare in America and a significant part of that commitment is making sure that members receive access to the care that they need, when they need it," said Michael J. Cardillo, President of Aetna U.S. Healthcare. "We believe it's important to have the input of independent experts to review our coverage decisions. While statistics show that few members will ever need to use this process, we want our members to have the added layer of security provided by external review should that rare instance occur," Cardillo said. (Aetna U.S. Health care in Action, August 5, 1999)

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