REFERENCE TITLE: insurer transparency

State of Arizona Senate Fiftieth Legislature First Regular Session 2011

SCR 1038

Introduced by Senators Lopez: Jackson; Representatives Farley, Heinz

 

A concurrent RESOLUTION

 

supporting transparency and clear disclosure of benefits by health insurers.

 

 

(TEXT OF BILL BEGINS ON NEXT PAGE)

 

Whereas, the core of the health care system is the physician-patient relationship, and the autonomy of physicians in concert with their patients to define medically necessary care should be held paramount; and

Whereas, medical care is deemed necessary when a prudent physician would provide it to a patient to screen, treat or prevent a medical condition in a manner that is in accordance with generally accepted standards of medical practice; and

Whereas, financial incentives must not corrupt benefit decisions, and all financial incentives potentially impacting benefit decisions must be fully disclosed; and

Whereas, decisions based on formularies or other benefit management tools must be consistent clinically with appropriate medical guidelines, and physicians must have a simple and expeditious way to get exceptions when warranted by their patients' medical needs; and

Whereas, Arizona patients and their physicians must have the right to appeal and to obtain free, timely, external review of any adverse benefit decision based on "medical necessity"; and

Whereas, medical care should not be denied on the grounds that it is not "medically necessary" unless a prudent, qualified, licensed physician makes that determination; and

Whereas, health care consumers in Arizona must be armed with full knowledge of the facts to make informed decisions concerning the health insurance coverage they purchase as well as where and from which providers they seek health care services; and

Whereas, insurers that offer or issue a policy of health insurance, a contract for health insurance or a health care plan providing coverage for the screening or treatment of a medical condition must be required to provide coverage information in language that is clear and easily understood; and

Whereas, insurers that offer or issue a policy, contract or health care plan should be required to file annual reports with the Director of the Department of Insurance making their rates of coverage and noncoverage publicly available via the internet.

Therefore

Be it resolved by the Senate of the State of Arizona, the House of Representatives concurring:

1.  That the Legislature supports the clear disclosure of the scope and limitations of benefits that health insurers purport to provide, in language that is meaningful to the average consumer, so that consumers can shop for health insurance and be able to access the benefits for which they pay.

2.  That the Legislature supports a uniform and automated process for overcoming prior authorization requirements by insurers in order for patients to access medications, specialists and other medically necessary interventions as quickly as possible.