A recent KFF poll underscores the public’s persistent and growing frustration with how profit-driven insurance companies create barriers in accessing health care services. Now, as providers look to transform health care delivery to be more efficient following sweeping federal funding cuts, insurance companies, too, must find better ways to serve patients.
The number of Americans who see firsthand the impact of harmful insurance company practices is staggering. According to the poll, nearly three-quarters say that delays and denials of health care services by health insurance companies are “a major problem,” and more than half have personally been required to get prior authorization before receiving a treatment or service in the past two years.
In California, CHA is supporting a package of legislation that aims to curb these practices and help patients access the care they need with fewer hassles and red tape. Among the key bills continuing to advance this year are:
- AB 512 (Harabedian, D-Pasadena), which would shorten the timeline for prior authorization requests from within five business days to no more than 48 hours for standard requests or from 72 hours to 24 hours for urgent requests (our letter here). This passed the Senate Health Committee on July 9 and is headed for a hearing on Aug. 18 in the Senate Appropriations Committee.
- AB 682 (Ortega, D-Hayward), which would mandate that health plans collect and publicly report claims denial information, including the number of claims processed, adjudicated, denied, or partially denied (our letter here). This passed the Senate Health Committee on July 16 and is headed for a hearing on Aug. 18 in the Senate Appropriations Committee.
- SB 530 (Richardson, D-Inglewood), which would extend and expand time and distance requirements for Medi-Cal insurers to meet network adequacy standards — a change that puts the onus on health plans, not hospitals, to ensure the availability of specific health care services in a geographic area (our letter here). This passed the Assembly Health Committee on July 15 and is headed for a hearing in the Assembly Appropriations Committee.
- SB 306 (Becker, D-Menlo Park), which would require the state to instruct health care plans and insurers — excluding Medi-Cal managed care plans — to identify services most frequently approved via prior authorization and stop requiring prior authorization for those services (our letter here). This passed the Assembly Health Committee on July 15 and is headed to the Assembly Appropriations Committee.
At the federal level, insurers have voluntarily pledged to reform their prior authorization practices, but the effectiveness of this effort remains to be seen. As Centers for Medicare & Medicaid Services Administrator Mehmet Oz, MD, MBA, said during a news conference, “The pledge is not a mandate … This is an opportunity for the industry to show itself.” CHA has also supported the Improving Seniors’ Access to Timely Care Act to enhance access to care for Medicare Advantage enrollees.
In this new era of health care — where providers, payers, pharmaceutical companies, governments, and others are being asked to continue providing care with fewer resources — patients’ needs must come first. And based on this recent poll, it’s imperative that the for-profit health insurance industry be responsive to what Americans are demanding of their health care system.
