State Sen. Donald DeWitte (R-St. Charles) is working to change a healthcare process that currently leaves many Illinois residents waiting for medical treatment because of insurance coverage requirements.
Illinois patients often have medical care delayed or denied because of their health plans’ use of a process called prior authorization. DeWitte joined a group of medical professionals and other lawmakers at a Capitol press conference Feb. 18 to discuss the Prior Authorization Reform Act (House Bill 5510 and Senate Bill 3822), a comprehensive bipartisan solution that will bring much-needed transparency and streamlining to prior authorization requirements.
Health insurance companies and pharmacy benefit managers use prior authorization to cut costs, requiring health professionals to do extra paperwork before the care they recommend for their patients is approved. Even when authorization is granted, too often insurance companies later deny payment for medical care they approved.
“When an insurance company approves medical care, they’re making a commitment to the patient and the care team,” said DeWitte, who is sponsoring Senate Bill 3822. “Under the Prior Authorization Reform Act, they’ll no longer be able leave the patient hanging.”
Prior authorization requirements are often not based on clinically valid criteria, and are administered by individuals who lack relevant qualifications. The Prior Authorization Reform Act will make sure prior authorization requirements are based on medical evidence and administered by qualified individuals.
“We surveyed over a thousand Illinois physicians on this issue, and they were almost unanimous that their patients are being harmed by prior authorization as it is currently used,” said Illinois State Medical Society (ISMS) President Paul E. Pedersen, MD. “We are seeing longer wait times, rising costs, and patient outcomes that are not as good they should be.”
Senate Bill 3822 has been introduced in the Senate and awaits assignment to a legislative committee where it will receive a public hearing.