February 9, 2024

Legislative committee advances Pringle's bill to remove barriers to patient care

AUGUSTA – A majority of members of the Maine Legislature’s Health Coverage Insurance and Financial Services Committee (HCIFS) voted last week to advance legislation sponsored by State Rep. Jane Pringle, D-Windham, that would ease the administrative burden of prior authorization on healthcare providers. The vote was seven to five among committee members present.

As amended, the bill would also direct the Bureau of Insurance to collect data from insurers about their use of prior authorizations, including the percentage of claims denied, appealed, upheld, and overturned. The data would be collected from 2021 to 2023 and then be reported to the HCIFS Committee in early January 2025.

“LD 796 would keep insurance companies honest, revealing whether they are truly delivering benefits to their patients as promised,” said Pringle. “Often, an insurance company’s ruling to approve prior authorization is based on medical evidence, but sometimes their reasoning is arbitrary and aims at reducing expenditures, rather than prioritizing the patient’s best interest.”
The bill would seek to ease the administrative burden of prior authorization for medical professionals and, ultimately, reduce costs and improve quality of care for patients.

The prior authorization system was established as a cost-control plan for private and public insurance companies to ensure that patient care remains cost-effective for the companies. It is up to the discretion of the organization to approve or disapprove the medical provider’s course of treatment. 

If the insurance company decides to deny prior authorization, it is left to health care staff to take on the clerical burden of advocating for their patients by appealing the decision.

The bill faces further votes in the Maine House and Maine Senate in the coming weeks.

State Rep. Jane Pringle is serving her second non-consecutive term in the Maine House and represents part of Windham in the legislature. She is a member of the Joint Standing Committee on Health Coverage, Insurance and Financial Services. <

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