Medical Review Board proposed

By John McPhaul

Rep. Joel Franqui Atiles announced on Tuesday that he has introduced legisla- tion to establish a review board with the power to initiate and execute remedies, actions or legal procedures that are necessary or appropriate to guarantee that the needs of patients and the medical class are met, in- cluding with regard to determinations made by insurers that affect the public interest.

House Bill 2567 amends the Insurance Code in order to eliminate the Advisory Com- mittee that currently exists under Law 77 and establishes a Review Board that will be made up of a health provider -- which can be a doctor, pharmacist, or medical technologist in Puerto Rico -- a consumer attorney and two representatives of the public interest.

“The legislative intention is to confer broad powers on a Review Board that is representative of the sectors most affected by the actions of insurers. With this measure it is possible to subordinate the criteria of the Insurance Commissioner to a representative Board of the people,” the legislator said in a written statement.

He noted that the review board, through the majority vote of its members, may declare the insurers that administer medical plans as a critical sector.

When declaring a critical sector, the review board will have the ability to review, revoke and modify the determinations of the insurance commissioner, as well as regulate or propose legislation aimed at avoiding cancellations of contracts with providers without just cause, and review the rates of medical plans, coverage, payments, con- tractual relationships with health providers, among other related purposes.

“Insurers have been free [of regulation]. The figure of the Insurance Commissioner must be complemented by the powers con- ferred on the Review Board,” Franqui Atiles said. “The Board will have representation of health providers and representatives of the public interest. In this way, decisions will be made by men and women who do not come from the insurance industry.”

“I am convinced that this Review Board will help us avoid cases such as that of the young Camuyan Alexis Joel, who has been denied payment by his insurer for the medical treatment he received after suffering burns all over his body when he was studying medicine in Mexico,” the legislator added. “Currently this situation prevents him from continuing with his therapies and receiving the treatments he needs for his recovery, which affects his physical and emotional health.”

The bill also establishes that the review board will have the power to confirm or revoke the resolutions that the insurance commissioner reports under his or her power to adjudicate disputes over violations of the Insurance Code.

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