MAG offers solutions in letter to insurance commissioner

The president of the Medical Association of Georgia (MAG) offered solutions for some of the state’s most pressing key health insurance challenges – including prior authorization, the assignment of benefits, network adequacy, and deselection/”take-it-or-leave-it” contracts – in a September 25 letter she sent to Georgia Insurance Commissioner John King.

Rutledge Forney, M.D., pointed out that practices spend an average of 20 uncompensated hours per week obtaining prior authorization. She stressed that, “Prior authorization places a heavy administrative burden on physicians and pharmacists and wastes a lot of time and resources. Each insurer has its own arbitrary requirements and standards of approval for prior authorization requests. [And] each insurer requires prior authorization for different drugs. Prior authorization often delays care, which can result in higher costs and poorer outcomes.”

Dr. Forney also emphasized that despite a state law requiring them to do so (OCGA 33-24-54), insurers in the state often do not honor assignments of benefits. She says that, “The insurers either tell the physician that the form [that was] used is not valid or the insurer issues payment to patients with no or inadequate explanation. The patient receives a check from his/her insurer and does not understand that the money is supposed to be used to pay the physician, especially when that check comes months after the care was provided.” Dr. Forney encouraged the commissioner’s office to explore ways to enforce the law.

Dr. Forney pointed out that one 2015 study found that more than 80 percent of Georgia’s health insurance networks were “small.” She explained that, “These narrow networks impact patient choice by restricting the physicians that the patient can see within their network. This can also lead to surprise bills when a hospital is in the narrow network but one of the physician groups that provide services at that hospital is not. Network adequacy is also especially important in light of the physician shortages that are occuring in these areas.”

Dr. Forney said that MAG would like to see Georgia bolster its network adequacy standards to “protect patients and to increase patient choice.”

She also explained that physicians now “often find themselves being removed from insurance networks with little notice and/or explanation. This leads to patients experiencing an interruption in their care, which can negatively impact the patient’s health. [And] This often happens during the middle of a patient’s contract year when the patient may have selected their insurer/insurance plan based on their physician being advertised as in-network. This leads to a bait and switch that leaves the patient with insurance that will not cover their physician of choice.”

And Dr. Forney reports that physicians in the state are being subjected to “take-it-or-leave-it” contracts that are “so low that the physician cannot financially accept the rates and then becomes (or remains) out-of-network.”

She adds that, “These low rates allow insurers to drive down the median in-network rate and the physicians that cannot or will not accept the reduction find themselves out-of-network. [This] harms the patient and exacerbates already-narrow networks.”

In terms of a solution, Dr. Forney suggests that the state use a/the “median in-network rate” to resolve payer/provider disputes related to out-of-network care to eliminate surprise medical bills.

MAG letter to Georgia Insurance Commission