Oklahoma bill would make medical care requiring prior authorization more transparent

OKLAHOMA CITY — A bill moving through the Oklahoma Legislature seeks to put more transparency into the prior authorization process used by health insurance companies.

House Bill 3190 would require insurance companies to post online prior authorization requirements for medical treatments.

The bill defines prior authorization as "the process by which utilization review entities determine the medical necessity and medical appropriateness of otherwise covered health care services prior to rendering" care.

The bill would require insurance companies to use licensed medical professionals to make determinations that deny care.

It would establish time frames and procedures for insurance companies to make authorization changes to previously approved treatments.

Dr. Diane Heaton is a radiation oncologist and Oklahoma State Medical Association president.

"There is not a week or month that goes by that we don't see patients have very adverse outcomes, including deaths from very major denials of care," Heaton said. "These patients are fighting cancer. Days can make a difference."

Insurance companies are routinely waiting weeks, she said, adding that eight weeks is not uncommon.

The delays aren't just an inconvenience, but a matter of life and death for patients, she said.

"This is the patient's money," she said.

Patients pay into a collective group of payments so they can use the funds later, she said.

She said it's critical that algorithms or artificial intelligence aren't used in the decision to deny care.

She said she went to medical school and has practiced a long time, but is now required to spend time "playing games" with insurance companies. Her time should be spent with patients, she said.

Pat McFerron, president of Cole Hargrave Snodgrass & Associates, said the results of a recent survey he did indicates 57% have an unfavorable opinion of the health insurance system.

The survey was paid for by the Oklahoma State Medical Association.

Another 84% believe that there should be a limit on health insurance companies requiring prior authorization, he said.

Oklahoma insurers worked with the Oklahoma Academy of Family Physicians and the provider community to create comprehensive changes to prior authorization to benefit patients and providers, said Haley Faulkenberry, Oklahoma Association of Health Plans executive director. The association is a coalition of health plans.

Rep. Carl Newton, R-Cherokee, and Sen. Jessica Garvin, R-Duncan, are the authors.

The measure was on the Senate Appropriations Committee agenda for its Wednesday meeting.

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