This is a follow-up post on my narrow network and natural disaster post.
On Saturday, the Texas Department of Insurance issued a number of bulletins regarding Harvey. One deals with network authorization and payment requirements:
Restrictions on insureds, enrollees, or certificate holders will result in many storm victims being without necessary health care or dental services. Insureds, enrollees, or certificate holders should not be left without their necessary health care or dental services during a disaster or threat of imminent disaster. Under these circumstances, it is the opinion of the Texas Department of Insurance that all health insurance companies and health maintenance organizations should waive penalties and restrictions on insureds, certificate holders, or enrollees when these insureds, enrollees, or certificate holders obtain necessary emergency and nonemergency health and dental services out-of-network as a result of the disaster through the duration of the governor’s proclamations. Additionally, health insurance companies and health maintenance organizations should not deny payment for necessary emergency and nonemergency health and dental services that are obtained out-of-network as a result of the threat of imminent disaster through the duration of the governor’s proclamations…..
In addition, the damage to infrastructure and the increased need for health care services may frustrate the ability of insureds, enrollees, or certificate holders to comply with health plan contractual provisions, which could result in many hurricane victims being without necessary health care or dental services. Insureds, enrollees, or certificate holders should not be left without their necessary health care or dental services during a catastrophic event. Under these circumstances, the Texas Department of Insurance is of the opinion that all insurance companies and health maintenance organizations should waive contractual restrictions that require insureds, certificate holders, or enrollees to obtain preauthorization, referrals, notification of hospital admissions, or medical necessity reviews for specified health care or dental services through the duration of the governor’s proclamations.
I am reading that to say that normal network management and utilization management restrictions are out the window for individuals in the flood zones.
This is a good response.
Major Major Major Major
A good response indeed. Is this something we could make national policy?
Tom
What – no book report?
BubbaDave
Is the “should” there in the sense of “it would be nice if…” or in the sense of “If you don’t do this voluntarily we’re gonna break out the regulators?”
(I have my suspicions it’s the former, because Texas, but…)
Greenergood
I am reading this living in the UK. The idea that people would have to worry about paying for injuries incurred during floods, fires, acts of terrorism – or washing your kitchen floor after midnight (Cole) – is not one that occurs to people living here, or in most ‘developed’ countries. We cannot comprehend that the country that calls itself the greatest, the richest, on earth would put its citizens through such worry and fear.
OzarkHillbilly
@Greenergood: Obviously you’ve never met a Republican.
David Anderson
@BubbaDave: I am reading this as “Charging OON cost sharing will lead to very pissed off regulators who will claim your scalp during the next election cycle…. so make my day and charge OON cost sharing….”
TomatoQueen
@OzarkHillbilly: They’ve got Tories tho. Always copying our worst behaviors. Save the NHS.
The Moar You Know
Suddenly Texas gives a shit about people who need health insurance. Almost like it’s important or something. Huh.
MikeifromArlington
Doesn’t “should” leave enough wiggle room for the insurers so say f’off customers, you didn’t contact our consultant hotline first therefore you violated Chapter 7, para 6 sub section 4 and will not be reimbursed for your operation?
Seth Owen
I’m reading ‘should’ as you WILL do this. We’d make it a rule if there was time but it’s an emergency so there isn’t, but if you don’t want trouble you’ll just do it for the limited time we are asking for.
randy khan
I’m glad to see this.
Barbara
Speaking as someone who has made telephone inquiries to every DOI in the country, the Texas Department of Insurance is, in my experience, an effective, mostly apolitical, regulatory agency. They have a very large professional staff.
Villago Delenda Est
@Greenergood: Your country is civilized. Ours, not so much.
p.a.
…time will tell…$$ vs. bad p.r…$$ vs. bad p.r…
Greenergood
@Villago Delenda Est: My adopted country – I’m originally from the US, which is why, maybe, the comparison is so acute. When I go back to NY and see the crazy paperwork that my 89-year-old mother has to deal with in terms of her (not cheap) health care, my mind it is boggled. There are many things in the National Health Service that need improvement (and meanwhile the Tories are doing their best to turn the NHS into a US-style privatised health care system), but for now I thank FSM every day for the NHS.