Potential health insurance regulations pit providers, legislators against companies

For the first time, Wyoming lawmakers are trying to put rules in place that guide how health insurance companies can approve and deny medical care.

However, the second interim meeting of the Joint Labor, Health and Social Services Committee on Thursday in Evanston revealed the gap that exists between insurance companies and health professionals and lawmakers as the legislative group weighs the first draft of prior authorization regulations proposed by the committees working group.

Wyoming is the only state in the country without laws governing prior authorization, the process by which health insurance companies determine which treatments and drugs they will cover and pay for under a plan for patients.

Led by Sen. Dan Dockstader, R-Afton, and Congresswoman Sarah Penn, R-Lander, the committees working group met in May with medical groups and insurance companies to begin crafting prior authorization rules that would be acceptable to both groups ahead of next year’s legislative session.

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Doctors, other health care providers, and medical facilities have complained that prior authorization is an approval system gone astray, consuming ever more time and resources by delaying and blocking patient care. Insurance companies have said they serve as financial stewards for their members as they use the process to help control the quality of health care.

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At their April meeting in Casper, lawmakers on the committee voted unanimously to draft a bill that would curb the power of health insurance companies in Wyoming. The resulting 32-page bill met resistance from insurance companies at Thursday’s meeting, with the companies pointing to several issues they say needed to be addressed. They urged the panel to allow companies and medical groups to continue working alongside lawmakers to refine the law.

We’ve all worked very hard to reach consensus on things we could reach consensus on and there were some things we couldn’t and frankly we ran out of time, said Bruce Spencer, an attorney representing Mountain Health CO-OP, who covers approximately 18,000 Wyoming residents.

Among the concerns raised by representatives of Mountain Health CO-OP and Blue Cross Blue Shield of Wyoming were data reporting requirements that would force insurance companies to share information about when they deny medical services. The bill would also require companies to consult with doctors if they were considering withholding treatment because it wasn’t a medical necessity, an additional step the representatives said would lengthen the time it takes for treatment to be approved.

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As the bill is currently drafted, insurance companies would have five days to approve or deny non-urgent treatment requests and 72 hours for urgent requests.

It will lead to an increase in holding the line of just denying things because you have to meet those deadlines, said Ken Schaecher, a physician, medical director and administrator who works with the University of Utah and Mountain Health CO-OP.

The companies also opposed a gold card system that would allow doctors to skip prior authorization requests if their treatment plans were approved by an insurance company at least 80 percent of the time.

We don’t use prior authorizations as a mechanism for not paying for care, said Heather Roe Day, a lobbyist for Blue Cross Blue Shield of Wyoming. She added that prior authorization approvals ensure that insurance companies use limited resources effectively, that patients receive evidence-based and necessary care, and that health care providers are paid.

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Insurance companies have found some sympathy. Cheyenne Republican Representative Dan Zwonitzer, the committee’s co-chair, said the bill was not yet ready for the 2024 legislative session, acknowledging that lawmakers have listened to the company’s concerns. But others have expressed skepticism, aligning themselves with medical groups who have spoken out.

We still have a situation where we don’t provide enough follow-up care without all the confusion of waiting and delays, Dockstader said.

I hope you understand that we also want to protect other people’s money money and we want to protect them, but we also want to get to a point where people aren’t waiting for good healthcare, he added.

Sheila Bush, executive director of the Wyoming Medical Society, and Eric Boley, president of the Wyoming Hospital Association, have encouraged lawmakers to avoid insurance company rabbit holes. Both supported the bill as written, saying they thought it needed only minor changes.

It seems that much of the conversation this morning was resistance to prior authorization reform because insurance companies aggressively moved into the role of overseeing safe medical practice, Bush said. This is not an appropriate mechanism or use of insurance. It’s not their role.

Boley refuted the claim that prior authorization is to protect patients and healthcare professionals.

We’ve heard from insurance companies that this isn’t being done for cost containment, he said. This is an absolute mistake.

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During the first committee hearing in April, testimony from doctors, hospitals and medical groups swayed lawmakers as they spoke about the burden of prior authorization. Dr. Kevin Helling, a Casper-based general surgeon, expressed concern about what he said were essentially blanket denials by insurance companies that were hurting patients and doctors.

My expectation is that they will say, No, he testified. I’m not even sure if they read them.

Lawmakers once again gravitated towards medical groups on Thursday. When asked if they believed insurance companies should be required to have shorter turnaround times for approvals, the majority voted to update the bill so that companies have 24-hour deadlines for approvals. urgent care and 48-hour deadlines for non-urgent care.

Dockstader and Penn will once again lead a working group to find greater agreement between insurance companies and medical groups ahead of the next meeting of health care committees in Saratoga in September. But for now, lawmakers have the approval of at least one side.

As far as I’m concerned, we’re ready to go, Boley said, a statement to which Sen. Anthony Bouchard, R-Cheyenne, responded:

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