To add insult to injury, the "right to sue" section of the House bill makes it much harder for patients to go to court if they lose the external appeal.

Congress should not back away from the commission's proposal, but it should take care to limit external appeals to large claims covered by contract and whose denial would truly jeopardize a patient's health.

That also includes an external appeal to an independent reviewer.

If this "external appeal" fails, the patient could go to court.

Along with the provision allowing the external appeals, the bill includes these provisions: *It bans "gag orders" that prevent doctors from telling patients about different treatment options.

Other states, like New York, New Jersey and Arkansas, have passed legislation with similar provisions, but the Connecticut law goes one step further in terms of external appeals.

The state-sponsored external appeal would cost most consumers $25, with the state paying the rest.

Many advocates for external appeal in Connecticut and nationally said that even if the number of appeals ended up being small, it is a vital check on managed-care companies.

The offender will have the right to an internal appeal, in addition to the right to an external appeal, and that appeal will have the effect of suspending the penalty.

His plan would offer an alternative appeals process if insurers deny coverage, providing people with the right to sue only after all internal and external appeals had been exhausted.