Plans Should Inform Patients of Network Status When Requiring PA

TMA Testimony by Debra Patt, MD

House Insurance Committee
House Bill 2520 by Rep. Julie Johnson 

March 26, 2019

Thank you, Mr. Chairman and committee members, for allowing me to testify today. My name is Dr. Debra Patt, and I am an oncologist from Austin. Today I am testifying on behalf of the Texas Medical Association and its nearly 53,000 members across the state of Texas FOR House Bill 2520.  

The Texas Legislature took a great step in 2013 by creating a Texas Standardized Prior Authorization form. This was a useful initiative to begin streamlining what is still a complex and burdensome process for Texas patients and physicians.

I believe you were provided with this form. Representative Johnson did a great job of explaining what information is needed on the form when a health plan requires a physician to obtain prior authorization of care. TMA believes that if a plan requires a health care service to go through prior authorization review, the information submitted on the form could be put to good use in helping patients in ways beyond merely obtaining authorization for their medical care. 

When a patient is preauthorized to receive a health care service scheduled at a facility, the health plan should use the information submitted on the standardized prior authorization form to inform the patient of the network status of any physicians or health care providers who may be involved in the preauthorized health care. It also should be used to educate the patient on what level of coverage the health plan will provide and what the patient’s financial responsibility will be to all physicians and providers.

The information that we, as physicians, are providing to the health plan is more than enough to allow the plan to notify the patients of this valuable and necessary information. This financial and network information could prevent surprises in billing and allow the patient to better plan for his or her upcoming medical care.   

Prior authorization is burdensome. If health plans are allowed to create these burdens, then the information physicians must provide to health plans should be used more fully to benefit the patient, as is required by HB 2520.

Thank you for allowing me to testify today, and I am happy to answer any questions.  

Last Updated On

March 25, 2019