A bipartisan patient-protection measure drafted by the Senate Finance Committee last week would favor physicians' medical judgment when external review panels hear appeals of coverage denials, sources said.
Although it was unclear when the committee would act on the measure, the committee staff was drafting the bill as part of an effort to achieve a compromise between Democrats and moderate Republicans on legislation aimed at passing tax breaks for individuals buying health insurance coverage.
Democrats, along with Republican John Chafee of Rhode Island, won't vote for a tax bill without an accompanying patient-protection measure. Republicans hold an 11-9 majority on the committee but can't pass the tax measure without Chafee.
The committee had tentatively scheduled a hearing this week to revise and approve the patient-protection measure, but by the end of last week nothing had been formally scheduled.
Health plans opposed the medical-judgment provision, which the plans said would give enrollees more issues to appeal than they had with "medical necessity" provisions in other bills under consideration. Such provisions would define medical necessity as being "consistent with generally accepted principles of professional medical practice."
The bill includes such commonplace provisions as banning health plans from restricting what physicians can tell enrollees about treatment options and requiring plans to cover emergency services.
The tax measure, meanwhile, would follow through on the Senate GOP leadership's pledge to expand healthcare coverage by tinkering with the tax code.
Senate Majority Leader Trent Lott (R-Miss.) is sponsoring legislation that would allow self-employed individuals to deduct 100% of their premium payments from their gross income reported to the Internal Revenue Service.
It also would drop limitations on the number of "medical savings account" plans that an insurance company can sell.