State lawmakers want to crack down on an insurance practice that requires people to wait for approval for medical treatments.
The practice is known as "prior authorization." Patients often have to wait days or weeks to find out if their insurance company will cover the treatment or medication their doctor recommends.
would restrict that practice. It calls for time limits for insurance companies to provide approvals, and it would require doctors working for the insurance companies to be licensed and regulated in North Carolina.
Rep. Grant Campbell, R-Cabarrus, who's also a doctor, said prior authorizations often lead to treatment delays and negative health outcomes.
"The parade of people that are trying to interfere with the relationship of the patient and their physician has got to stop, and this is one of the great first steps to do that," Campbell said.
Campbell is co-sponsoring the bill with Rep. Tim Reeder, who's also a doctor, and House Rules Chairman John Bell. Officials from the N.C. Medical Society, which represents doctors, and the N.C. Healthcare Association, which represents hospitals, joined the legislators at Tuesday's news conference.
Reeder says the system has gotten worse over time.
"Delays in care affect simple things like medication refills, even imaging studies, simple treatments and therapies," he said. "It is not just for those complex, expensive things that were envisioned many years ago."
Insurance companies argue the prior authorization system helps keep premium costs down by avoiding unnecessarily expensive treatments. But supporters of the bill say the system itself increases costs, as doctors and their staff spend hours filing prior authorization requests and insurance companies employ extra staff to review them.
"I don't think there's anybody in the room or anybody in the state that doesn't think that healthcare costs need to come down," Campbell said. "But the way to bring down healthcare costs is not to deny healthcare to people that need it."
Republicans in the Senate have also to reform the prior authorization process. They're proposing less drastic changes to the current system, which insurance companies say helps reduce premium costs.
That bill is scheduled for its first committee hearing on Wednesday, and it aims to speed up the prior authorization process and add more transparency.
"There is room for common sense reforms to help keep costs down and ensure patients can get timely, appropriate care," a news release from Senate Republicans said.
