A study released by the Oklahoma State Medical Association found 84% of Oklahoma voters support limits to prior authorization — where health insurers decide if a service is medically necessary and if they will cover it. A bill that passed the Senate Appropriations Committee last week could provide more transparency in the process.
House Bill 3190 by Rep. Carl Newton (R-Cherokee) and Sen. Jessica Garvin (R-Duncan) would require insurance companies to make prior authorization requirements for treatments accessible online and provide timely notice to providers and patients if they change them. A licensed physician or mental health professional would also need to weigh in if an insurer wants to deny care.
Utilization review entities perform prior authorization for an insurance company. Denial decisions would be made jointly with one of these group's medical directors, who also must be a licensed physician.
The licensed physician and mental health professional weighing in on the determination would be employed by the insurance company conducting the review, Newton said. He said he connected with hospitals, providers and insurers, and they agreed upon the bill’s language.
“(Insurance companies) gotta come back with an appeal process and explain why they denied it. I'm not minimizing it, because there's always concern there that they're gonna deny (care) because it's going to cost too much, but … care providers felt pretty comfortable with that language,” Newton said.
Dr. Diane Heaton, the executive director of the Oklahoma State Medical Association, said the study it worked on with Cole Hargrave Snodgrass & Associates found Oklahoma voters trust physicians to decide what care they need over insurance companies.
Eighty-eight percent of the over 500 Oklahoma voters surveyed from March 11-17 said they “support legislation to limit the ability of insurance companies to interfere in the doctor-patient relationship through denying coverage.”
Heaton said as a radiation oncologist, she’s familiar with insurance denials.
“There is not a week or month that goes by that we don't see patients have very adverse outcomes, including death, from very major denials of care,” Heaton said. “These patients are fighting cancer. Days can make a difference, and now we have insurance companies that are routinely waiting weeks. Six, eight weeks (for coverage delays) is not uncommon.”
Heaton said she spends 30% of her time dealing with insurance companies to ensure patients get the treatment they need. She said health care professionals shouldn't have to spend their day worrying about denials and prior authorizations.
“I probably see one new patient and three fewer follow-ups per day because of the time taken on this,” Heaton said. “And that, I think, is … what we're losing. To me, this is the patient's money. It should be used for patients’ benefit. And we need to keep that in the forefront.”
HB 3190 is headed to the Senate Floor after passing Senate Appropriations unanimously.
“I think we've got a workable product that'll make it better for our physicians to be able to spend less time doing paperwork and more time seeing patients and getting to see their families, and, yet, still provide the patients with the optimal care and an alternative to make sure they get what they need,” Newton said.
