Doctors Want New ‘Prior Authorization’ Rules

Oct. 28--A behind-the-scenes struggle over what Pennsylvania doctors can do to patients - specifically, the giving of final approval to what treatments are used - entered a new phase Monday morning.

Two bills that sponsors say would rein in insurance companies "excessive and unreasonable" use of prior authorizations on doctor-recommended procedures were introduced at a Capitol Rotunda press conference.

State law allows insurance companies to require that they be consulted for authorization before some treatments or procedures. But Dr. Jonathan Garino, a leader of the Pennsylvania Orthopaedic Society, said insurance companies' use of the process is out of control.

When doctors prescribe treatments for patients, insurance companies often are denying use of the treatment "for arbitrary reasons," Garino said in an interview before the start of the press conference.

Denials may lead the patients' doctor to seek a "peer review" by the insurance company, and the result can be a multi-step back-and-forth between insurance company and doctor that takes up time while the patient's health suffers.

Identical bills that are to be introduced in the House and Senate by Rep. Steven Mentzer of Lancaster County and Rep. Kristin Phillips-Hill of York County, both Republicans, would require that insurance companies use a standardized authorization approach.

The bills would, among other things, require that authorizations be done electronically and that if procedure is authorized, the insurance company must pay for it.

Asked to comment prior on a press release issued by the doctors' group before the press conference, Sam Marshall, CEO of the Insurance Federation of Pennsylvania, said he had not seen the proposed legislation.

However, he said he opposed draft versions he had seen previously.

"Anything that is excessive or unreasonable, whether it is medical care or prior authorizations, should stop," Marshall said.

Marshall said the whole point of preauthorization is to "ferret out -- and prevent it before it happens -- excessive and unreasonable care."

He noted that orthopedic doctors are among the highest-earning specialists in the medical field.

Morning Call reporter Ford Turner can be reached at 717-783-7305 or [email protected]

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