NASHVILLE — Legislation to help ensure that physicians and their patients have more information regarding what their health insurance covers and the protocols necessary to receive preauthorization approval was approved by the State Senate today. The bill, sponsored by Senator Mark Green (R-Clarksville), also requires insurance denials be made by a physician who is licensed to practice the procedure which has been requested to be performed.
“Dealing with an injury or illness is stressful for the patient as well as the family,” said Senator Green, who is a physician. “When an insurance carrier denies payment for a medical procedure or therapy that has been requested to be performed by the treating physician, it places additional stress and can even precipitate a crisis situation. This bill establishes a set of evidence-based rules based on nationally recognized protocol standards so everyone understands what is required when a procedure is recommended.”
Senate Bill 1142 amends the state’s “Utilization Review Act” by requiring that healthcare insurers, or third party payers, publish or post on the Internet at least the non-proprietary portion of the standards so physicians can know the rules of the game beforehand. In addition, it ensures that the utilization review is done by a physician knowledgeable about the procedure, rather than an insurance administrator who does not have medical training or expertise in the procedure that has been requested.
“In cases where there aren’t established standards, this legislation addresses who is allowed to make that medical decision when there is no consensus in the medical literature,” he added. “Based on the conversations that I’ve had with physicians, right now the appeals that go forward are happening not between physicians talking to a physician, they are happening between a physician talking to an insurance administrator who can make decisions, and in some cases about life and death procedures, without having the necessary medical training. This proposal requires that the person who makes that very important healthcare decision must be a licensed physician trained to do that particular procedure.”
The bill is sponsored by Representative Glen Casada (R-Franklin) in the House of Representatives where it is pending action in the House Finance, Ways and Means Subcommittee.