Good morning Chairman Micozzie, Chairman DeLuca, and members of the House Insurance Committee. Thank you for the opportunity to share with you why we support House Bill 1551, a measure that would help your constituents access physicians in a more timely manner when they are in need of medical attention.
Despite the complexities of our health care insurance system, my testimony will be brief as I believe you’ll find House Bill 1551 to be rather straightforward. Simply put, this legislation seeks to streamline credentialing, which is the process by which physicians are “approved” by health insurers by eliminating unnecessary delays. Why is this so important to physicians? All too often physicians, especially those who are entering medical practice for the first time, find themselves unable to treat privately insured patients until they have become fully credentialed. Let me explain.
After medical school and residency training has been completed, in most cases anywhere from 7 to 12 years of post-graduate education, physicians must get licensed by the state medical board, apply for hospital privileges, enroll in Medicare, and lastly, be credentialed by private health insurers. All of these processes involve an application, comprehensive documentation, and letters of reference. It is a process that has to start before a physician officially completes training due to the volume of information that must be collected, organized, and properly submitted.
With some exceptions, credentialing by private health insurers is the process that most frustrates physicians and can significantly delay a new physician’s ability to see patients. While we are certainly sensitive of the need to ensure that physicians are appropriately vetted before they begin providing direct patient care, lengthy delays are often the result of an insurer’s inability to reasonably communicate with physician applicants in a timely manner.
Take the case where a physician, after having submitted her application, contacts an insurer regarding the status of her application and learns that she had been approved 30 days before and was never notified. That is the best case scenario. In many cases, ascertaining the status of your application becomes a “cat and mouse” game of multiple telephone calls between the insurer and the physician and their staff.
Take the physician who mistakenly omitted the telephone number of his residency program director on his application. He’s never notified of the oversight. He assumes his application was completed properly, only to call the insurer two months later to learn of the missing information. It is like being sent back to “GO” and not collecting your $200….the process starts all over again.
Which brings me to the second most important element of House Bill 1551.
Under the scenarios mentioned above, physicians are not permitted to see patients whose insurer has not yet granted them credentials despite the fact that they have already been licensed and insured, and have been granted hospital privileges. In the meantime, you have patients in need of care. Needless delays. Especially in rural or underserved areas of the commonwealth where physicians are in such short supply.
Interestingly, a nurse or physician assistant can complete their education and training, join a medical practice, and immediately begin seeing patients and billing insurers…no credentialing required! Of course, if you pose that scenario to the insurers, their response will likely be that those providers are submitting claims “incident-to” the physician. “Incident-to” is a term used by Medicare that means the claim is being made by someone under the supervision of a physician credentialed by Medicare. Here’s the irony: Medicare, unlike private insurers, would allow this same physician to begin seeing Medicare patients immediately and retroactively pays physicians for that provided service up to 30 days after their enrollment application has been received.
House Bill 1551 would be of significant help to both physicians and your constituents. In short, it reasonably includes:
- Requiring insurers to notify physicians, within five days of receiving their application, if information is missing or additional documentation is needed.
- Requiring insurers to indicate their intent to continue processing the physician’s application.
- Requiring insurers to allow those physicians who have been notified that their credentialing process will continue to see patients 15 calendar days after their applications were received.
- Requiring insurers to provide physicians with the application receipt date and the meeting date of the health plan’s next credentialing review committee.
In essence, what we currently have is a private health insurance credentialing system or process that is at best inefficient, blind to the needs of patients residing in rural and underserved areas, and unfair to newly trained physicians who simply want to begin putting into practice the skills they have learned during nearly a decade of training. I should also point out that the system is no kinder to established physicians who change employers or relocate and who must similarly jump through and over an insurer’s hoops and hurdles while denying care to patients in need.
Thank you again for the opportunity to share with you the reasons why we support a commonsense approach to physician credentialing as set forth in House Bill 1551. To the best of my ability, I would be happy to answer any questions you may have.