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Editorial - An advocate citizens need

November 24, 1997

Editorial - An advocate citizens need

Pennsylvania gubernatorial candidate Ivan Itkin may be thinking about more than citizens' health as he crusades for an independent advocate to help consumers deal with the state's insurance companies. But just because there may be some political motivation behind Itkin's proposal doesn't mean it's a bad idea.

The Pennsylvania Insurance Department says it doesn't need additional help in resolving consumer complaints. But critics note that last year doctors had to file suit against the department after it approved the merger of Pennsylvania Blue Shield and Blue Cross of Western Pennsylvania without requiring any formal public hearings. One of the new agency's first actions was to propose higher premiums for 193,000 "direct pay" customers not covered through employee plans or a managed-care arrangement.

More worrisome, however, is the evolving practice of dealing with insurers' rules on coverage through the legislature. In recent years, after some companies began restricting the number of days they would pay for hospital care after a woman had a mastectomy or gave birth, Pennsylvania lawmakers jumped into action, writing bills to mandate more humane time limits.

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The ranking Republican on the committee. Rep. Nicholas Micozzie, says legislative oversight is adequate to deal with those kinds of cases. However, it's not these highly public battles that worry us, but the insurance company judgments that affect just a few people.

If, for example, an insurance company, or more likely, a managed-care corporation, decides that a well-established treatment - a bone-marrow transplant, for example - is "experimental" and therefore not covered, a customer's only option is to sue, at great expense. For those without the means to afford the best legal talent, there ought be another way.

Itkin suggests the state model the new position after the advocate who now argues for consumers' rights in dealings with power companies. Is good medical care less important than making sure power customers aren't ripped off? Itkin may or may not have the right stuff to be governor, but the fact that he's a candidate shouldn't doom this good idea.

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