Tag: prior authorization

VIDEO: House Endorses Bill to Speed Up Health Care, Limit ‘Prior Authorization’

      The House has voted for the second straight year to decrease wait times for Missourians seeking medical care, while increasing the quality of and access to that care and lowering costs. 

Representative Melanie Stinnett (Photo: Tim Bommel, Missouri House Communications)

      Representatives voted overwhelmingly last week to send to the Senate House Bill 618, dealing with prior authorization. 

      “‘Prior authorization’ is a term used to describe the process for requiring healthcare providers to request approval before providing a healthcare service,” explained bill sponsor Melanie Stinnett (R-Springfield). 

      She said it is a practice that is, “Getting in the way of health care for every day Missourians.”  

“I could go through all the components of prior authorization and all the pieces that are required but ultimately the process requires time, and it includes delays for patients.  We have data from different sources that says that healthcare providers, that physicians are spending sometimes 14 hours of their week doing prior authorization tasks, and that’s time that they could be spending with patients, that’s time that they could be providing care to Missourians.”

      Stinnett’s bill would free healthcare providers from having to seek prior authorization from insurance providers for a given procedure for six months, if at least 90 percent of its previous requests for authorization have been approved.  The bill also lays out how a provider could maintain that exemption status through ongoing evaluations. 

      Stinnett, who is a speech-language pathologist, said the current process is giving power and authority to insurance companies.  She recalled one case in which an insurer was denying care for one of her patients, based on the finding that the patient’s hearing loss was not congenital. 

      “Funny thing is, there’s not a diagnosis code for congenital hearing loss, and so there was no way for me to indicate that readily, and then going through the appeals trying to provide letters from the neonatologist and get that from the hospital and get that information from the ENT, and it was just a fight all along the way. I, as the provider, chose to go ahead and provide care uncompensated until I won that battle but it was months of a battle.”

      Other legislators who work in medical fields joined Stinnett in expressing why her legislation is needed. 

      Springfield Democrat Jeremy Dean worked in several healthcare clinics in his district.  He said legislators hear often that Missourians want more time from their physicians.

Representative Jeremy Dean (Photo: Tim Bommel, Missouri House Communications)

“We go and see our doctor hopefully one time a year if we’re healthy and it seems like we’re in and out, the doctor doesn’t have time to talk to us, and I think that this is one of the prime reasons that has caused doctors to feel like they are so stretched thin for time, is because they’re doing so many other things to please our insurance companies,” Dean told Stinnett during debate in the House. 

“Thank you so much for bringing this bill forward.  It’s absolutely going to help our constituents and the people of Missouri.”

      Representative Gregg Bush (D-Columbia) is a registered nurse.  He said there is a “crisis” in Missouri and the rest of the U.S., of individuals seeking care from medical professionals being impeded by insurance companies.

      “Right now in each one of our districts there is somebody who is sick and injured who’s going into a hospital, who’s going into a clinic, and instead of the clinician or a healthcare provider being able to treat our citizens who are sick and injured, [that provider is] on the phone with someone far away who’s never even laid eyes on the patient, who’s never even been around the person who is sick and injured, and is telling our health care providers what they can and can’t do.  Mr. Speaker I trust our education, being able to treat the patient in front of us, and that’s why I’m urging the whole body to vote ‘yes’ on this bill.”

VIDEO: An exchange between Representatives Gregg Bush (D-Columbia) and Melanie Stinnett (R-Springfield) illustrates why they believe her House Bill 618 should pass:

“Prior authorization is literally red tape in healthcare,” said Rolla Republican Tara Peters.  “When we’re sick and when we are trying to find out what’s wrong with us to try to get treatment we should not be waiting on insurance companies to make those decisions for us.”

      “We recently heard a story about a person under anesthesia that the insurance company would only pay so much, and they were actually under the anesthesia and had to get authorization to get more.  I mean, what kind of absurdity is that?” Peters asked.  “Let’s do away with barriers that are hindering our healthy outcomes for our Missourians and let’s pass House Bill 618.”

      Ozark Republican Jamie Gragg talked about his own experience as a patient with breathing issues related to allergies which used to result in him frequently being hospitalized for days at a time. 

Once he was diagnosed, doctors were able to put him on medication that kept him out of the hospital “however, every year I have to go through a preauthorization, and there are times where I am off the medication for a couple of months because the preauthorization is such a headache.  It’s a pain, because there are times when I’m off the medication for a couple of months that I have issues with breathing again.”

“I’m not unique,” Gragg told his colleagues.  “This is what people go through, and it’s even more detrimental with some other medications they have to wait for, so this is a very much needed bill.”

      Though much of the sentiment expressed during debate suggested that this legislation would benefit patients over insurers, Stinnett said she believes both sides will win if it becomes law.

Representative Gregg Bush (Photo: Tim Bommel, Missouri House Communications)

      “When providers know that their prior auth status is based on a 90 percent approval rating, they’ll be less likely to test the waters and see what they can get approved.  There’ll be streamlining of what services are provided, and the motivating factors mentioned previously will be neutralized.”   

“Ultimately,” Stinnett continued, “what will win out is the best interest of patients, and every Missourian will be positively impacted.”

      The House voted 148-4 to send that proposal to the Senate.  Similar legislation last year was voted out of the House 146-6, but it did not receive a committee hearing in that chamber.

House Approves Plan to Reduce Wait Times, Costs for Healthcare

      House lawmakers have voted to decrease the time Missourians must wait for some medical procedures, increase quality of and access to healthcare, and decrease costs.

      Insurance entities require health care providers to seek prior authorization before performing some procedures before they will agree to cover those procedures.  If House Bill 1976 becomes law, health care providers who reach a 90 percent approval rate for a given procedure over a six month period will then not have to seek prior authorization for the following six months.

Representative Melanie Stinnett (Photo: Tim Bommel, Missouri House Communications)

      “Insurance companies and their prior authorization standards are getting in the way of health care for everyday Missourians,” said bill sponsor Melanie Stinnett (R-Springfield).

      She said the passage of HB 1976 would mean “better access to care for patients and, potentially, decreased cost for patients, because the prior authorization process, itself, increases costs within the healthcare system.”

      Stinnett said without knowing it, many patients have likely had a negative experience that involved prior authorization.

      “Often, [patients] feel like it is something that the doctor hasn’t done or needs to do, but in reality it’s something that the health insurers lay over on top of what the health care provider has to do,” said Stinnett.  “It’s a challenge that the health care provider has to deal with, but often the patient doesn’t realize who’s imposing it or where that’s coming from.”

      “As someone who has spent hours and hours and hours trying to get preauthorization for patients that need physical therapy, I cannot support this enough,” St. Louis Representative Jo Doll (D), who has worked as a physical therapist, told her colleagues.  “The process is burdensome, it takes hours and hours of – people that are there to provide patient care – takes them away from patients and makes them calling, writing, submitting countless forms to get visits approved.”

Representative Jo Doll (Photo: Tim Bommel, Missouri House Communications)

      Health care industry workers and those patients who know of the prior authorization process view it as little more than “red tape” that drives up costs and slows care, and Representative Patty Lewis (D-Kansas City) agrees, and said some doctors report that the delays it causes lead to worse outcomes and even deaths.

      “Some of the witnesses who came through committee talked about the additional [workers that must be hired to do prior authorization paperwork].  We know we have a workforce shortage in the State of Missouri, so putting additional workforce just to go through red tape when they end up providing the care that’s needed … this is the right thing to do to increases access to care,” Lewis said.  

      The legislation made its way to the House after being approved by the Committee on Healthcare Reform.  Chairman Kent Haden (R-Mexico) noted that panel gave it a bipartisan, unanimous vote.

      “The only people that testified against it were the insurance people and [pharmacy benefit managers],” Haden said.  “It is really good for all of our clients, all of our constituents.  Not many bills we see effect everybody in the House and all their constituents.  This bill will effect virtually everyone and their constituents immediately.  It’s a great bill.” 

      Stinnett told her fellows the prior authorization process gives power to insurance companies and leaves providers fighting to get the best care and outcomes for their patients.  Her legislation aims to change that, and to allow providers to focus more on patients’ needs rather than what insurers will allow.

      “I think that this bill really puts a highlight on prioritizing the physician and patient relationship, and allowing the physician or the other health care provider and that patient to make their health care decisions.”

      The House voted 146-6 to send that legislation to the Senate.