BILL SUMMARY for SB09-061
SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES
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12:16 PM -- Senate Bill 09-061
Senator Carroll introduced Senate Bill 09-061. The bill specifies that, for the purposes of workers' compensation, property and casualty, and health insurance, any internal review of claims, independent medical examination, or utilization review must be conducted by a Colorado-licensed health care professional who is in good standing and has appropriate expertise to review the claim. Amendment L.006 (Attachment A) was distributed to the committee. Senator Carroll responded to questions from Senator Schultheis regarding the bill's fiscal note and its potential to increase insurance costs. She further responded to questions from Senator Mitchell.
12:22 PM -- Jill Tappert, representing herself and her family, testified in support of the bill and distributed a copy of her testimony to the committee (Attachment B). She described her family's experience going through an appeals process with an insurance company. She stated that if the bill had been the law at the time of her appeal, her lawsuit could have been avoided or the process could have at least been more efficient.
12:27 PM -- Dr. John Sbarbaro, University of Colorado and University Physicians Inc., testified in support of the bill, and in support of the provisions of Amendment L.006. He described the purpose of utilization review and how those decisions interact with medical care that is ordered by a physician. Dr. Sbarbaro described the use of medical literature in making decisions authorizing patient care. He stated that increases in health insurance premiums can only be controlled through utilization control techniques. He stated that physicians in other states should be permitted to make utilization review decisions if a Colorado-licensed physician is not available. He stated that procedures that lead to the denial of care are often fair.
12:35 PM -- Dr. Patrick Ray, Colorado Chiropractic Association, testified in support of the bill. He stated that utilization reviews are often conducted by people without appropriate expertise. He spoke to the time he spends writing to insurance companies trying to obtain care for his patients. He stated that lack of appropriate review by insurance companies can cause delays in care for the patient, which increases the need for health care services. Senator Mitchell commented on the bill's potential to increase insurance costs. Dr. Ray responded, stating that the bill allows for a dialogue between people of similar training regarding appropriate care. Senator Carroll commented on the administrative costs associated with the health insurance process, and stated that the bill will help prevent the escalation of certain appeals.
12:47 PM -- Emmy Conroy, representing herself, testified regarding her experiences attempting to receive approval for coverage of her child's care from her insurance company.
12:52 PM -- Christy Blakely, Family Voices, testified that Family Voices has a staff member to assist with denials of health insurance claims. She stated in her experience, claims are denied by individuals without specific expertise in the area of the claim. She stated that individuals reviewing insurance appeals should have the proper expertise.
12:56 PM -- Jacquelyn Kilmer, Colorado AIDS project and Colorado Organizations Responding to AIDS, spoke in support of the bill, and testified that denials of care can result in the loss of care that is critical to survival. She stated the bill provides common sense standards for the insurance appeals process. She stated the bill will increase the efficiency of the claim review process and ensure its integrity.
12:58 PM -- Betty Lehman, Colorado Division of Insurance Consumer Council, testified regarding her experience with the insurance appeals process. She stated that claims related to her son's care were not reviewed by doctors. She stated that it is a reasonable expectation of insured individuals that individuals with appropriate experience will review claims.
01:01 PM -- Heidi Loeffel, paralegal, testified that her law firm often represents consumers in claims against insurance companies. She gave examples of claims that have been denied by insurance companies. She stated that if insurance companies employ appropriate personnel to review claims, many appeals could be avoided.
01:05 PM -- Michael Rosenberg, Colorado Trial Lawyers Association, testified in support of the bill. He stated the bill is a matter of basic fairness. He stated that the expectation is that if treatment is denied, the person authorizing the denial has experience with that treatment.
01:08 PM -- Sheryle Hutter, Colorado Cross Disability Coalition, testified in support of the bill and regarding her experience with insurers denying claims. She stated requiring a Colorado-licensed doctor to make decisions will help level the playing field.
01:11 PM -- Robert Ferm, American Insurance Association, testified that the bill also impacts workers' compensation and property and casualty insurers, as well as health insurers. He stated that utilization review organizations are contracted with insurance companies, and that insurance companies are responsible for acts that are improper of utilization review organizations. He stated that utilization review organization are regulated, but indirectly. He stated that amendment L.006 attempts to address the issues raised by the bill regarding medical decision making. He stated that parties are continuing to work on the bill. He gave an example of unintended consequences that could be caused by the bill.
01:17 PM -- Steve Fitzsimmons, Anthem Blue Cross and Blue Shield, testified regarding his concerns with the bill, in its current form. He stated that the bill could have an impact on the regulatory framework of review of claims and appeals. He described the federal and state regulations that apply to claims review and appeals of denials. He stated that the regulations establish specific timelines and consistent procedures for claims review. He described the notice provisions that apply when claims are denied and the current regulations related to appeals of denials. He described the portion of the bill that requires a reviewing physician to consult with a peer, requesting that portion of the bill be modified, as the reviewing physician already must be a peer to the physician who originally ordered the treatment. He stated that the bill changes current procedures for second level appeals, stating that a panel is currently allowed to oversee the appeals and asked that the bill be modified to allow this to continue to occur. He testified that the bill's requirements related to review by physicians in similar specialties jeopardizes the plans' ability to meet claim review deadlines.
01:25 PM -- Jerry McElroy, Kaiser Permanente, testified regarding his concerns with the bill, and stated that his organization would like to pursue amendments to the bill. He stated that a number of claims are denied because coverage for the benefit is not provided through the insurance contract, and it wouldn't matter if the claim was reviewed by a member of a similar specialty, the claim would likely be denied because the person's plan doesn't provide coverage for the disputed benefit. He discussed the necessity of training for individuals who review insurance claims.
Senator Boyd announced that the bill be laid over and that it considered for action only at a later date. She invited witnesses in favor of the bill who didn't get a chance to testify to state their support for the bill briefly. Tom Russell, representing Health Care for All Colorado, Devorah Kappers, representing ADAPT and Colorado Cross Disability Coalition, Dr. Irene Aguilar, representing herself, Dede dePercin, representing Colorado Consumer Health Initiative, and Paula Rhodes, representing herself, voiced their support for the bill. The bill was laid over and the committee recessed.