Disputes between doctors and health insurance companies over covering procedures should become a bit more transparent in Tennessee. A new law that took effect Jan. 1 requires notifying the patient when there’s a hang-up with paying for care.
This is a law proposed out of personal exasperation for Rep. Johnny Garrett, R-Goodlettsville. He says he needed an MRI and had to take off work or schedule the imaging three different times. Each time, he discovered his doctor hadn’t provided his health insurance with requested information to prove the MRI was medically necessary. If he’d known what was up, he says he could have pestered his physician to provide the documentation.
“I didn’t get that opportunity when I tried to receive an MRI because I had no idea that my insurance company requested more information,” Garrett said during a committee hearing. “So it’s sort of to keep the patient kind of in the loop.”
Garrett’s law, which was HB1195, requires the health plan or the doctor to notify a patient within five days that there’s some conflict over paying for the care. It only applies to care that requires pre-approval by the health plan. The bipartisan legislation dovetails with a push nationwide to increase transparency related to what’s known as “prior authorization.”
Aside from keeping patients in the loop, the law is also intended to guard against a type of surprise medical bill. Patients could receive treatment only to find out afterward that insurance won’t pay because a pre-approval was required.
“We’re going to make darn sure that patients aren’t responsible for bills that they don’t know they’re going to have,” Sen. Rusty Crowe, R-Johnson City, said upon final passage in March. “[This bill] could take care of some of this on the front end, so the patient will know not to get into the situation in the first place.”
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