Tuesday, July 23, 2024

Lawmakers send to Gov. Scott bill to curb insurance companies’ influence on health care

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Vermont legislators passed a bill to streamline insurance requirements for health care and are urging Gov. Phil Scott to sign the bill into law.

The bill, H.766, will reduce administrative delays and remove barriers to care for Vermont patients, according to proponents. The University of Vermont Health Care Network, the state’s largest health care provider, has been pushing for the bill’s passage.

“We have reached a point where insurance companies can tell us what we can and can’t do, even in life-threatening emergencies, and the victims are always patients,” Dr. Katie Marvin, a family physician at Lamoille Health Partners, said in a statement.

Marvin took particular aim at the insurance company practice of requiring prior authorization for drugs and procedures, putting clinicians in the position of having to ask permission from insurance companies before a patient can receive services.

“(Prior authorizations) lead to delays in care, lapses in medications and apathy in providers,” Marvin said. “This bill may change this, which is why I have supported H.766 through the legislative process and spoke to the Governor about it last week.”

Pediatrician: Insurance practices leading to a crisis for kids with asthma

The House passed the bill unanimously on March 13, while the Senate voted 25-2 in favor of the bill on April 26. The Senate added an amendment, approved by the House, which requires insurance companies to give patients access to at least one type of available asthma inhaler without prior authorization.

“Insurance practices are leading to a crisis in caring for kids with asthma right now,” Dr. Kristen Connolly, a pediatrician, said in a statement. “We have had to order multiple types of inhalers to supplement for the one type of inhaler patients actually need. We have heard of rationing and increases in ER visits. This is our health system now − here in Vermont. We can do better.”

More: Vermont health care providers blame prior authorization for compromising patient care

The bill also ends a process where insurance companies could request patient records before paying for health care services that had been delivered.

“The increase in administrative burden required increasing our staffing to process the claims,” Dr. Julie Lin, an independent dermatologist in St. Albans, said in a statement. “There were also times that this policy meant we asked patients if they were willing to come back on two different days for certain services we could have delivered in one appointment so we could get timely payment by the insurance company. This added delays in care and inconvenience for patients. We know how long patients are waiting for dermatology services and this only made it worse.”

Legislators don’t buy insurance companies’ argument that costs will increase due to the bill

Rep. Alyssa Black, D-Essex, rejected the argument insurance companies have been making against the bill that it will drive up costs.

“Payers claim H.766 will lead to increased costs, but prior authorizations are almost always approved, serving only to delay care, and can drive up costs through incentivizing people to go to emergency departments when care is not approved, which is the most expensive location,” Black said in a statement. “Primary care spends less, orders fewer tests, fewer unnecessary labs, and provides the most economic, best bang for your buck.”

Sen. Ginny Lyons, D-Chittenden Southeast, said the bill is a first step in decreasing the administrative burdens on practitioners.

“We all benefit when health care providers can get back to caring for patients, not paperwork,” Lyons said in a statement.

Contact Dan D’Ambrosio at 660-1841 or ddambrosi@gannett.com. Follow him on X @DanDambrosioVT.

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