When a movie needs a group of villains, few are going to object if it turns out to be the Nazis. In non-movie life that role is often played by insurance companies.
Earlier this week NJ.com published a guest opinion by Josh Bengal, the director of government relations and staff counsel for the Medical Society of New Jersey. The point of the column was to encourage the passage of the “Ensuring Transparency in Prior Authorization Act, which — he says— “would remove barriers put up by health insurance companies, which use ‘prior authorization’ to deny coverage for care and treatment a physician deems medically necessary, but insurers consider ‘unnecessary.’”
I will get to the proposed statute in a minute, first I want to comment on something Bengal says in his opening paragraph about an ongoing review of our country’s healthcare system: “At the core of this review is an important question: How can we ensure patients have access to all the healthcare services they need exactly when they need them?” Absent a very strict interpretation of “need,” we can’t. In our society we have limited resources but unlimited wants. If you’re spending your own money, you make choices about what needs or wants take priority, but if someone else is paying, more wants have a way of becoming critical needs. Insurance policies are contracts, and patients should get the benefit of their bargain, which is not likely to be unlimited care.
As far as the prior authorization is concerned (and based solely on the description in the column — I have not read the actual bill), the proposal seems to involve only relatively modest, procedural requirements, such as prompt decisions, clear and concise requirements, and an opportunity to discuss denials with a physician. Who can argue with that? Exactly what makes me think that there are other features that may not be so benign. How to address limited resources and unlimited desires is a much more complex question.
Jay Bohn
March 9, 2023