|
Health insurance reform is TMA's main priority in the 2009 legislative session, and the association is taking bold steps to convince lawmakers to make insurers' business practices more transparent and accountable to physicians and patients. The way they do business now confuses and frustrates patients and makes them pay more money out of pocket for their care, hurts the physician-patient relationship, and drives up a physician's cost to run a practice.
TMA is working to make sure patients and physicians have access to pertinent health insurance information when the patient needs care. One of the obstacles in the delivery of health care is that only health plans know for sure a patient's health insurance coverage, copays, deductibles, and other expenses. Most patients don't understand or cannot easily access the information that describes what medical services their health plan covers. Nor do they understand the payment terms. It's just as difficult for physicians to access accurate patient insurance information.
That's why TMA developed the Health Insurance Code of Conduct Act of 2009. It ensures transparency and accountability and protects patients from questionable insurance tactics that cost them their coverage and increase their out-of-pocket costs. It would:
- Require health plans to use technology that provides pertinent patient information when health care is delivered and allows real-time adjudication of enrollee claims and payments.
- Require insurers to notify patients that rescission of their policy is being considered prior to the actual cancellation.
- Allow Texas' small businesses to challenge health insurance premium quotes and have insurers provide information to justify a premium increase. If a small business believes its premium increase is unwarranted, it can ask the Texas Department of Insurance to investigate the proposed rate.
- Require a consistent reporting formula for the term "medical loss ratio." The formula needs to specify exactly what insurers can include as a medical cost as opposed to profit or expenses for items such as marketing, administration, and recruitment.
- Regulate how a physician's contract information is sold, leased, or shared among health insurance plans and other companies.
- Require insurers to use scientifically valid criteria to evaluate physicians' performance and to disclose those criteria in advance.
- Codify a number of the antiracketeering lawsuit settlements' provisions, which are set to expire in the near future. This would continue to hold insurance companies accountable for how they process claims to ensure they are paying for the patient's care the way they should.
Several lawmakers have filed legislation in support of TMA's health insurance reform agenda. However, more work is needed to ensure this legislation gains support and passes both sides of the legislature. TMA believes an aggressive, grassroots campaign would help encourage legislators to pass these bills and stop the passage of dangerous, pro-insurance bills.
TMA members have identified payment and economic survival as the biggest challenges they face in practice. Ninety-three percent of the doctors surveyed said insurance companies take too much of their time and attention away from patient care. Ninety-seven percent said health plan hassles and prompt pay are "somewhat" or "very important" legislative, legal, and regulatory issues to them.
Future issues of Action will have more information on TMA's efforts. To read more about TMA's overall legislative agenda, check out Doctor's Orders: TMA's Prescription for a Healthy Texas.
Action, March 2, 2009
Last Published: 3/2/2009 Print this page
|