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Michigan insurers that require health providers to get pre-approval to cover treatment would have to promptly respond to doctors’ requests or those requests would be automatically granted under a bill headed to Gov. Gretchen Whitmer for her expected signature.
The legislation received final, unanimous Senate approval on Thursday.
Advocates said the measure would speed delays in care and provide more transparency around the process known as prior authorization.
Starting in June 2023, a non-urgent request would be deemed as granted unless an insurance company acts to grant or deny it, or requires additional information within nine days. The time limit would drop to seven days beginning in June 2024.
Insurers would 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 as essential, can affect people living with a range of chronic conditions and diseases including heart disease, cancer and diabetes.
Insurance companies have said they are trying to ensure that the most clinically appropriate care is being provided amid medical advances and an explosion in drug costs that are driving up premiums.
Dr. Srikar Reddy, president of Michigan Academy of Family Physicians, called the changes “commonsense reforms” to what is now a “detrimental” process. He said they would help ensure that patients get the care and medications they need, when they need them, and alleviate some of the administrative burden for doctors. (AP)
