Before the Committee on Financial Services
The Mass Medical Society wishes to be recorded in support of H.960 and S.498, identical bills to prevent inappropriate denials for medically necessary services, filed by Representative David Nangle and Senator Daniel Wolf and many co-sponsors. This legislation codifies fairness and support for good clinical practice by requiring insurers to pay for medically necessary services which they have authorized. It prohibits plans from refusing to pay legitimate claims which have an administrative or technical defect.
The basic issue here is one of payment for value received by insurers. Individuals pay insurance premiums so that when they need medically necessary services, the insurer will provide payment to physicians, hospitals and other health care professionals who provide those services. Insurers should not be able to receive payments from their insureds, authorize the provision of services and then deny payment for such services. If the insurer approves the patient as one of its covered individuals and if the insurer approves the service as medically necessary then the individual or entity who provides this service, which has value to both the recipient and the insurer, should be paid for the service. The principles outlined in this legislation are so basic in fairness that it is unfortunate that this legislation is necessary.
Insurers may protest that the situations prohibited in this legislation do not occur. Anecdotal evidence from the physician community suggests otherwise. In every instance in which payments are denied for legitimate services delivered, insurers have received their premiums and denied payments to the providers who have given the medically necessary services for which patients paid their premiums. This should never happen.
The MMS encourages the Financial Services Committee to support H.960 and S.498 by reporting the bills out of committee favorably.
