MONTPELIER, Vt. (WCAX) – A bill that gives health care providers more flexibility to order tests and procedures for patients without insurance prior authorization is in the hands of Governor Phil Scott.
Paperwork — it takes up an entire nurse practitioner’s job at the Little Rivers Health Care in Wells River. And amidst a provider shortage, doctors say prior authorization from insurance companies results in fewer patients served.
“It is demoralizing and contributes to the burnout that a lot of people in primary care feel,” said the clinic’s Dr. Fay Homan. “We could do better, more comprehensive care with a little more employee time freed up.”
A bill before the governor would allow primary care doctors to administer tests without a patient’s insurance carrier’s permission. Right now, primary care doctors are required to ask insurance companies if they will cover the care they provide to their patients before they do it, resulting in what Homan says can be harmful to patients and more costs to the system.
“We have had to send patients to the emergency room to get CAT scans or MRIs because we couldn’t get a prior authorization in a timely fashion, and those are people who didn’t need the charge of an emergency room, but it was the only way we could get the test,” Homan said.
Rep. Alyssa Black, D-Essex, introduced the bill in response to a provider burden report that specifically referenced the challenges prior authorization poses to doctors and patients. “When a primary care physician is spending two to four hours a day not seeing patients, that’s intolerable,” she said. Black says insurance companies use prior authorization as a way to deny care. “They are making clinical decisions on patients that are not their patients, and they use it as a cost-saving measure.”
In a statement, Blue Cross Blue Shield Vermont says if the governor signs the bill into law, it will end up costing Vermonters more. “While Blue Cross VT supported some of the provisions in H. 766, overall the legislation would contribute to increasing premiums that are already unaffordable for many Vermonters,” they said.
A spokesperson for the governor on Wednesday said that while he has some concerns about the uncertainties around cost, he also understands there could be benefits, creating efficiencies and improving patient experiences.
At least nine states and the District of Columbia have passed legislation that reforms the prior authorization process, according to the American Medical Association.
