Oct. 21, 2020

By Rep. Steven Mentzer
I have partnered with State Sen. Kristin Phillips-Hill (R-York) to craft legislation that would reform insurance tactics that are delaying care and increasingly undermining decisions made between physicians and patients.

Senate Bill 920 and House Bill 1194 would address inefficiencies within an insurance processs called prior authorization (also called pre-authorization).

Prior authorization requires physicians to obtain approval from insurers before prescribing medication, conducting tests, or moving forward with a specific treatment. It is often applied to patients living with a wide range of diseases and chronic conditions, including cancer, diabetes, heart disease, arthritis, and multiple sclerosis.

While insurance plans claim to use these processes to control costs, patients and medical professionals often experience delays in care as a result. More than one out of four physicians reported that delays from prior authorization have led to serious adverse events for their patients, according to a February 2019 nationwide survey from the American Medical Association.

“Senate Bill 920 will improve transparency, accessibility and consistent application of prior authorization by including a standard definition and will streamline the process by requiring insurers to make an electronic communications network for providers to access,” said Sen. Phillips-Hill. “At the end of the day, what this really means is physicians will be able to provide better, more timely care to their patients.”

When you are sick or in pain, time is of the essence. And yet many Pennsylvanians are not currently receiving the timely care they need because of prior authorization. The solutions presented in House Bill 1194 will ensure patients receive more timely care, allow insurers to be more transparent, and reduce administrative burdens for physicians and their office staff.

Senate Bill 920 and House Bill 1194 do the following:

•Ensures physicians and other prescribers have access to more efficient electronic prior authorization systems (“ePA”)
•Establishes a basic framework for when it is medically appropriate to exempt patients from fail first, as well as an exceptions process that is transparent and accessible to patients and health care professionals
•Provides deadlines for insurers to render decisions on prior authorization requests

“We need to restore the bonds among patients and physicians and return insurers to their place as the payer of services, not the provider of health care services,” said Jonathan Garino, MD, first vice president of the Pennsylvania Orthopaedic Society. “For far too long, health care insurers have had a free hand in delaying or denying medically necessary health care services.”