It’s almost as if the health insurance industry has run amok in recent months.
Earlier this month, Anthem Blue Cross Blue Shield wanted to tighten the reins on the use of anesthesia for surgery. New York Governor Kathy Hochul and Assemblyman David Weprin (D – Hollis, Queens), chairman of the Assembly Insurance Committee, strongly pushed back on this move.
“Last night, I shared my outrage at a plan from Anthem to strip away coverage from New Yorkers who had to go under anesthesia for surgery,” Hochul said via a written statement on December 5. “We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy.”
“Don’t mess with the health and well-being of New Yorkers – not on my watch,” she added.
Weprin was equally incensed. “Can you imagine a situation where you’re in the middle of an operation and then all of a sudden somebody wakes up and says, ‘Ouch!’ ‘Sorry, your time is up on anesthesia.’ It’s just outrageous,” Weprin told The Jewish Press. “If you have an extensive course of treatment for a condition and you get pre-approval, you shouldn’t have to go back on every little procedure in that approval. That’s a big deal.”
“I’m sponsoring a bill to prohibit insurance companies from imposing arbitrary time limits for the use of anesthesia during an operation on patients under anesthesia,” he continued. “Anesthesia is obviously expensive, but no patient wants to be under anesthesia any longer than they have to be. That should be a medical decision and not an insurance decision.”
Many insurance carriers use the frustrating practice of “deny, delay, and depose.” Such words were found on shell casings from the gun used when Luigi Mangione shot and killed UnitedHealthcare CEO Brian Thompson on December 4. The killing became a symbol of a resurgent widespread anger toward America’s health insurance industry.
Mangione pleaded not guilty to the charges in court on Monday, December 23. The Manhattan District Attorney charged Mangione, 26, with multiple counts of murder, including murder as an act of terrorism. Mangione’s initial appearance in New York state’s trial court was preempted by federal prosecutors bringing their own charges over the shooting. The federal charges could carry the possibility of the death penalty, while the maximum sentence for the state charges is life in prison without parole. Prosecutors have said the two cases will proceed on parallel tracks, with the state charges expected to go to trial first.
Weprin pointed to the practice of “deny, delay, and depose” as a problem with the insurance industry. “Traditionally, what they have done in the past was to automatically deny. Then you can appeal it and you usually win on appeal. If time is of the essence, you don’t have time for that and that’s part of the problem,” he said. “These decisions should be made by healthcare medical professionals, not by insurance companies. They should just approve a general authorization. That makes authorizations for treatment or medication valid for the duration of all procedures relating to the condition, so you don’t have to keep going back every time. That’s something the doctors have been pushing for for a long time.”
Weprin has also cracked down on insurance companies through another groundbreaking legislative measure.
“We are the first state in the nation to eliminate co-pays for insulin, which is obviously an emergency medication [for those that need it]. The cost of drugs has gone up so much that’s why we’re mandating some of these things,” he said.
Last week Hochul vetoed one of Weprin’s bills that he had high hopes of being signed into law. It was a bill capping co-payments on physical therapy, which is usually prescribed post-surgery and generally not covered by insurance, Weprin said.
The insurance lobby won the day on this measure. On Friday, December 13, the day after Weprin’s interview with The Jewish Press, Hochul handed down her decision. Her veto message read as follows:
This bill would prohibit a health plan from imposing on an insured a copayment or coinsurance amount for services rendered by a physical therapist or occupational therapist that is greater than the copayment or coinsurance amount imposed on an insured for an office visit to a primary care physician or osteopath. While I support the goal of protecting consumers from high cost-sharing for physician and occupational therapy, this bill would prevent health plans from designing their plans in a way that encourages insureds to seek care first from their primary care provider or osteopath. This bill also has technical issues that would make implementation challenging and could have the unintended effect of raising costs for consumers visiting their primary care provider or osteopath.
Weprin countered with the following statement:
I am very disappointed with the Governor’s veto. This bill was a top priority for me last session. The bill would have expanded access to physical and occupational therapy services for New Yorkers by limiting co-payments to the cost for an office visit to a primary care physician. In some instances, insurers have begun to shift the majority of the cost for these services to the patient by imposing high copayments. This is problematic as physical therapy and occupation therapy generally require multiple visits over an extended period of time. A high copay can be cost prohibitive and result in New Yorkers forgoing these medically necessary services and risk worsening their condition or injury. I stand behind this legislation and plan to reintroduce it.
The chairman of the Senate Insurance Committee, who sponsored the measure in the upper house, Neil Breslin (D – Delmar, Albany County) is retiring. There will be a new chairman of that committee beginning in January. It is unclear who Weprin will partner with in the state Senate on this measure next year.
