Who decides what is medically necessary?

Stephen Parrino
VIDEO CNN's Eileen O'Connor reports on one bereaved parent who is taking issue with how HMO's evaluate what treatments to pay for Windows Media 28K 80K

July 14, 1999
Web posted at: 10:25 a.m. EDT (1425 GMT)

(CNN) -- As the "patients' bill of rights" debate heads into its third day, the question of who should decide what medical procedures and treatments a patient needs remains unanswered.

Should the clerks in an accounting office decide, or should doctors have final say in what should be done?

Democrats insist doctors, not health plans, should decide patient care. Republicans want a better way to appeal decisions made by health maintenance organizations (HMOs).

Managed care groups say the authorization process involves a review by experts of all treatments available and insist it is not about watching the bottom line, but about saving the patient.

The insurance industry argues that leaving the question of care to doctors increases costs because physicians order unnecessary tests to defend their opinions.

Medical Correspondent Eileen O'Connor visited with Nick Parrino, whose son Stephen was denied care by his HMO after removal of a brain tumor. Parrino talked about his family's experience and the questions facing Congress.