BELLEVILLE, Ill—Gov. J.B. Pritzker was in the Metro East Monday trying to grease the skids for Senate passage of a measure that would make Illinois the first state in the country to ban the practice of needed prior authorization for in-patient mental health admissions for the first 72 hours.
The Healthcare Protection Act also eliminates so-called “step therapy,” the process by which insurance companies can require first attempts at treatments that may or may not be a doctor’s first recommended option.
Dr. Jennifer Neville, a physician who treats osteoporosis patients at Memorial Hospital in Belleville, said her patients with a higher risk of fractures need a higher tier medication to start.
“This is the right decision for my patient, but often this prescription is initially denied by the insurer,” she said in joint news conference with Pritzker, state lawmakers, executives with the BJC hospital system and the Illinois Health and Hospital Association.
“It is only after an appeals process and the patient is referred to a specialist, adding cost and time delays that that medication I originally prescribed is ultimately approved. Unfortunately, this process is the norm.”
The measure would also require Illinois Department of Insurance approval before large group plans that aren’t self-funded can hike rates and require insurance companies to do a better job of maintaining their rosters of network doctors, so that patients aren’t further delayed in getting seen by a physician.
“Practices that allow an insurance company to override a physician’s judgement … These are cost-control strategies that benefit the insurance companies’ bottom line at the expense of the patient,” said A.J. Wilhelmi, president and CEO of the Illinois Health and Hospital Association.
The legislation passed the House last week with bipartisan support.
The bill was first read in the Senate on Friday but has not been heard in committee. Pritzker told reporters Monday that he expects the bill to pass before the end of the current session May 24.
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.