Senate Bill 34 "Patient Access Reform" (Any Willing Provider)
What is it> Senate Bill 34, "Patient Access Reform" (Any Willing Provider) is sponsored by State Senator Parley Hellewell. If enacted, it would enable HMO or PPO insureds to receive services from any provider hospital, physician, or other provider, whether participating on an insurance company's panel or not, and the provider could accept a 95% reimbursement or balance bill the patient.
Who Is For It> This would obviously provide more patient choice and help non-paneled providers. This bill has much support from physicians. It will enable them to seek reimbursement from insurance carriers irregardless if they are part of the carrier network or not. Patients have greater access to physicians. Physicians are mainly behind this bill as I observe whom attends various meetings.
Who Is Against It> This is obviously fought by the major health insurance carriers in Utah because they loose control of contractual discounts from "In-network providers". All of you have heard of "In-network" vs. "Out-of-network" providers. When you stay in network you pay a small office visit copay in the amount of $15. This bill would essentially smash pre-negotiated contractual pay rates designed and promoted by health insurance carriers. The carriers would not be able to discount or pay reduced fees that they are accustomed to. IHC Health Plans quotes "IHC Health Plans estimates the financial impact of this legislation will be over $75 million per year. These costs will be passed on in premium increases".
My Opinion> I think there are some merits with the bill but it doesn't surprise me that ongoing conflicts occur between Physicians wanting to get paid more vs. health insurance carriers wanting to pay less. I feel patients should have access to certain "specialist" physicians for disease treatment with out carrier intervention. But at what cost? After all it is the insurance carrier that has to determine actuarial premium rates to cover risk within a populace. They control costs and actually protect clients from over billing. That is probably my biggest concern is how many physicians would drop from a insurance carrier network because they could earn more and balance bill the patient. Good for them but I am not convinced "all" physicians would bill ethically. AS ALWAYS the "patient" is caught in the middle.