House opens hearings on health insurance fix
The changes, which Pritzker first unveiled in his State of the State address in February, would limit the ability of companies to deny claims or steer patients toward cheaper, and possibly less effective, treatments. They are contained in an amendment to House Bill 5395.
They include banning prior authorization requirements for people to receive inpatient treatment at a psychiatric facility as well as all forms of so-called "step therapy" for prescription drug coverage. Step therapy refers to the practice of requiring a patient to try one or more cheaper, alternative medications before being allowed to access medications prescribed by their doctor.
Other changes in the plan include requiring insurance companies to publicly post the types of treatments and therapies that do require prior authorization; requiring them to maintain accurate lists of the providers who are in their networks; and banning the sale in
During the hearing, the committee heard personal stories from individual patients and their families, including some legislators, who spoke about their experiences having claims denied by their insurers.
Among them was state Sen.
"We had her stay four days in the hospital because we couldn't get a nausea medication that we knew worked after chemo (round) two," he said. "We couldn't get it authorized in chemo (round) three. Very frustrating. Four days in the hospital, and I'm not sure how that saves somebody money."
Dr.
"I've had multiple patients who destabilized because medicine they'd been doing well on was now denied, and the parents couldn't afford to pay for it out of pocket," she said. "The appropriate level of care is commonly denied."
But
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