Michigan insurers that require health providers to get pre-approval to cover treatment will have to promptly respond to doctors’ requests or those requests will be automatically granted under legislation signed by Gov. Gretchen Whitmer on Thursday.
Supporters said the law will speed delays in care and provide more transparency around the process known as prior authorization.
Starting in June 2023, a non-urgent request will be deemed as granted unless an insurance company acts to grant or deny it, or requires additional information within nine days. The time limit will drop to seven days beginning in June 2024.
Insurers will have to post their prior authorization requirements and restrictions, including clinical review criteria, on their websites.
Doctors and health advocates have complained that the pre-approval process delays care, frustrates patients, and creates unnecessary red tape and expense for providers. The cost controls, which insurers have defended, can affect people living with a range of chronic conditions and diseases including heart disease, cancer and diabetes.
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“This law will help improve the process and ultimately benefit patients,” said the bill sponsor, Republican Sen. Curt VanderWall of Ludington.
The insurance industry opposed the legislation when it was introduced, but changes were made.
Dominick Pallone, executive director of the Michigan Association of Health Plans, said last month the bill “came a long way” and will improve the prior authorization process for both health plan enrollees and network providers.
“It strikes a good balance to modernize the process while also preserving tools used by health plans to protect patients from unnecessary or even potentially harmful services,” he said. (AP)