The Wyoming House of Representatives voted Monday, Feb. 19, to send a bill that would streamline health care insurance processes to the Senate for approval.
The prior authorization process, the first step toward getting insurance companies to pay for specific services and medications, can take anywhere from 24 hours to 30 days. Insurance companies often use the process to delay, and even deny, care to patients.
While the amount of time the process takes can vary widely, depending upon the procedure and insurance company handling the claim, the Ensuring Transparency in Prior Authorization Act, which passed its third reading in the Wyoming House of Representatives on Monday, aims to change that.
Eric Boley, president of the Wyoming Hospital Association, said the process is convoluted and patients and hospitals suffer most when it goes awry.
"It takes a lot of time, a lot of man hours," Boley said. "The consumer, the patient, really doesn't understand the ins and outs of insurance companies and how to get that done."
When patients get hit with bills they can't afford, they can sometimes feel frustrated and hopeless. Many give up on the process, and their delinquent bills then go to collections.
When that happens, hospitals have to make up the difference. But many hospitals, especially those located in rural areas, like much of Wyoming, were on unstable financial ground before the COVID-19 pandemic exacerbated the problem across the board.
"Obviously, hospitals are there to care for people," said Boley. "We want to be able to do that quickly and efficiently. This bill is a big step in the right direction."
If the Senate approves the bill, it will speed up the prior authorization process by limiting the time that insurance companies may consider authorizing care from thirty days to ten.
Insurance companies will also be required to make in-person contact with health care providers to talk through claims before making a decision. And, the bill will create a gold card.
"Which means that, if you have a provider that gets prior authorization on a certain procedure enough times, and they're approved, then they don't have to go through that process anymore," Boley added.
The bill now has to pass three readings on the Senate floor.
This reporting was made possible by a grant from the Corporation For Public Broadcasting, supporting state government coverage in the state. Wyoming Public Media and Jackson Hole Community Radio are partnering to cover state issues both on air and online.
