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Health Can’t Wait:  Patients and Providers Once Again Ask Legislature to Limit Health Care Delays and Insurance Company Red Tape

Health Can’t Wait: Patients and Providers Once Again Ask Legislature to Limit Health Care Delays and Insurance Company Red Tape

Wednesday, April 14, 2021

Hopes for reducing dangerous and unnecessary delays in the delivery of care and treatment to Michigan patients were renewed today with members of the Senate Health Policy and Human Services committee hearing testimony on SB 247—legislation that reforms the prior authorization practices insurance companies use to slow the delivery of life saving health care.

 

Sponsored by state Sen. Curt VanderWall, chairman of the Senate Health Policy and Human Services committee, SB 247 introduces new transparency and clinical validity requirements that would protect Michigan patients from costly and dangerous delays in access to health care. The legislation is the reintroduction of prior authorization reform, which previously took the form of SB 612 during the last legislative session.   

“With far too much regularity, insurance companies use these measures to delay—and sometimes flat out deny—patients from accessing treatments that have been prescribed by their physicians—treatments we know our patients need,” said Paul Bozyk, MD, board-certified pulmonologist, and current president of the Oakland County Medical Society, who offered testimony in support of SB 247. “Senate Bill 247 does not eliminate the ability for insurance companies to utilize prior authorization, but instead reforms the process to ensure that it is transparent, timely and that the doctor-patient relationship takes precedence over insurance company paperwork.”

 

SB 247 would achieve this aim by introducing new transparency, clinical validity and fairness requirements to prior authorization process. The bill would also require insurers to base their prior authorization requirements on clinical, evidence-based criteria established with input from practicing physicians.

The Health Can’t Wait Act would also establish:


  • Transparency – Insurance company prior authorization requirements will be published on the insurer’s website in detail and in easily understandable language, and that aggregated information about prior authorization approval and denials are made publicly available.
  • Clinical validity – Clinical review criteria is based on current peer-reviewed evidence and individuals with a financial stake in the outcome of prior authorization decisions are prohibited from the decision making process.
  • Fairness for patients – Urgent and non-urgent prior authorization requests must be acted upon in a timely manner and clinicians and patients are properly notified of new or amended prior authorization requirements.

“We’re very happy to see our state lawmakers taking the need for prior authorization reform seriously with the reintroduction of this critical legislation,” added said S. Bobby Mukkamala, MD, president of the Michigan State Medical Society.  “Today’s hearing was a great first step towards the kind of meaningful reform that will have a real positive on Michigan’s patients.”


Health Can’t Wait is a coalition of patients, health care providers, and patient-support groups working together to put Michigan patients first by ending dangerous delays in patients’ access to health care caused by insurance company bureaucracy, including prior authorization red tape and step therapy requirements.