Sen. Miller has introduced SB 30 which contains a proposal recommended by the interim study committee on public health, behavioral health, and human services.
It would require the Dept. of Insurance to post on the department’s website information concerning internal and external grievances for accident and sickness insurance policies and HMO contracts. The Insurers and HMOs would have to provide information about the DOI website and the policy grievance procedures to their insureds when the policy is issued or renewed and also along with each notice of denial.
Insurers and HMOS would also be required to file quarterly reports with the Commissioner of Insurance on the number of denied claims during the quarter. The quarterly reports are required to contain information about how many claims were denied because they were experimental, investigational, and/or not medically necessary.
Seems like a good idea to me. Part of the insurance game seems to involve discouraging claims with bureaucracy. My personal experience involved denial of a claim following a medically necessary C-Section for one of my kids. Because I’m a lawyer and one of my best friends is a doctor, I was able to read the policy, determine what types of C-sections were covered and what types were not, and articulate why our case was best regarded as being in the former category. Even though, economically, I was in a better position than a lot of the people receiving medical services, it was still a pretty scary situation for us. I can only imagine what it must be like for people with fewer resources, both in terms of navigating the bureaucracy, and paying for the amounts that eventually come due.
Hopefully this bill would be helpful in discouraging arbitrary denials by insurers.
This is an idea that I wish could be applied in a number of situations, where one side or the other takes advantage of assumed anonymity to lord it over people. If those events were publicly available, and potentially the source of public discussion, that could have quite an effect.
What immediately comes mind is the huge number of suits/hearings filed against school districts, demanding all kinds of silly things which if granted would force the district to basically “give away the store”. The district has to defend itself against every one of them, using significant resources–staff time as well as public money–in the process. Sometimes hundreds of thousands for nothing. The district cannot tell its side of the story in the media, but if people knew that these suits and/or hearings would be published anonymously, it could have a dampening effect. Just a listing of suits/hearings and the issue involved at the board meeting would do it. People would be stunned. Imagine if a school district could report that someone filed a Title IX complaint demanding that their daughter be part of the varsity pom pon squad. There must be a way….