PENNSYLVANIA — On Wednesday, the Pennsylvania House of Representatives approved a bill to expand health insurance pre-authorization for patients to help deliver better care outcomes and give consumers more protection when disputing payment claims.
“This is one of the biggest pro-consumer and pro-doctor reforms in health insurance in decades, and it’s all about delivering better outcomes for patients and preventing future complications Insurance Committee Democratic acting Chair Austin Davis, D-Allegheny, said. “This bill was a true compromise between patients, doctors, hospitals and health insurance companies, and is a great example of how we can deliver true wins for the people when we work together.”
“Too many Pennsylvanians are denied coverage for the essential medical care that their doctors have ordered for them,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network. “With today’s bipartisan passage of S.B. 225, patients are one step closer to gaining critical protections that will ensure they are able to get appropriate care as prescribed by their doctors.”
Davis said some of the bill’s highlights include:
- Allowing doctors to bill insurance companies for “closely related procedures” – meaning if a patient is getting care for an already covered issue and the doctor identifies a condition that could lead to future complications, the doctor can address the condition immediately without having to get a second authorization for a service.
- Making sure patients get a simple, easy-to-understand explanation when payment for a procedure is denied, including outlining the patient’s rights and options.
- Giving patients who are denied payment the ability to appeal the denial to the Pennsylvania Insurance Department instead of just the insurance company itself.
- Requiring all denials to be reported to the department.
- Ending no-exceptions medication policies that require patients to “try and fail” an ineffective prescription before getting the medication that works.
- Ensuring patients going to out-of-insurance-network providers for coverage are reimbursed as quickly as a doctor’s office would be reimbursed to cut down on out-of-pocket expenses.
The bill now goes to the state Senate where it is expected to be quickly approved and signed into law by the governor.
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