LEGISLATION WOULD REQUIRE GREATER EXPERTISE FOR HEALTH PLAN DENIALS

Legislation (A.723, Gottfried) passed the Assembly this week that would require a coverage denial decision made by a health plan to be made by a physician board-certified in the same or similar specialty as the physician who typically provides the recommended treatment. MSSNY strongly supports this legislation. Under current law, the only qualification required for a person who, on behalf of a health plan, may contradict the treatment recommendation of the patient’s treating physician is that such reviewer be a licensed physician. Therefore, the person reviewing the treatment request may not have the sufficient training or experience necessary to decide whether the treatment that has been requested is appropriate. As a result, care that may be needed for the patient may be unnecessarily delayed or denied while the patient has to resort to taking an External Appeal to attempt to receive the care that has been recommended.

Similar legislation (S.3450, Oppenheimer) is before the Senate Health Committee. Please call your Senator 518-455-2800 to express your support for this legislation.

This entry was posted on Tuesday, February 9th, 2010 at 3:23 pm and is filed under NEWS FROM THE NYS LEGISLATURE. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.

LEGISLATION WOULD REQUIRE GREATER EXPERTISE FOR HEALTH PLAN DENIALS

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