From WisPolitics.com/WisBusiness.com …
— Gov. Tony Evers in his budget address slammed the health insurance industry and said he wants Wisconsin to be the first state to audit insurers for denying too many health claims.
“I hear from folks all the time who feel like they’re getting ripped off by the health care industry and insurers,” the Dem governor said last night during his address to the state Legislature. “Folks can’t get a straight answer on what’s covered by insurance and what’s not.”
He ticked off a number of complaints about health insurance and health care more broadly. Included: insurers refusing to cover the cost of certain medical care, surprise charges in medical bills, health insurers deciding whether treatments are medically necessary and others.
“If an insurance company is going to deny your health care claim, they should have a darn good reason for it,” Evers said. “It’s frustrating when your claim gets denied and it doesn’t seem like anyone can give you a good reason why … under my plan, if an insurance company is denying Wisconsinites’ claims too often, we’re going to audit them. Pretty simple. It’s very simple.”
In response to the guv’s remarks, Wisconsin Association of Health Plans CEO and former GOP lawmaker John Nygren said the group is disappointed that Evers didn’t engage with health plans and cooperatives in the state “to discuss the solutions we’re already implementing” ahead of the address.
Nygren points to insurers’ efforts to lower costs, protect access and “deliver high-value care” to state residents.
“Instead, the plan unveiled last night would, in fact, have the opposite effect, and serve only to increase costs for patients across the state and continue to drive healthcare inflation for consumers and businesses alike,” he said.
Along with his proposal to audit certain health insurers, Evers also called for: creating a new office tasked with helping state residents whose claims are denied; establishing new standards to expand what insurers are required to cover; requiring greater transparency from insurers about prior approval; and banning insurers from requiring pre-approval for inpatient mental health services.
He also proposed: creating statewide standards for maximum wait times for scheduling health care appointments; requiring health insurance companies to make sure the services they cover are available nearby; making insurers give state residents notice of unpaid medical bills; and banning health care providers from reporting unpaid bills to consumer reporting agencies during a six-month grace period.
“Folks have to wait to get care until doctors get permission or may end up forgoing treatment altogether because of all the hassles with insurance,” Evers said. “That can cause health conditions to get even worse — even dangerous and even life-threatening.”
Nygren argued Evers’ comments are “particularly unhelpful in spurring meaningful dialogue given the current heightened tensions following the murder of an executive of a national health plan,” referencing the killing of health insurance executive Brian Thompson in New York City.
“The speech not only painted a distorted picture of health care economics, but could be construed to feed the negative and dangerous rhetoric that fueled that horrific act,” Nygren said.
See more on Evers’ health care-related budget proposals in the release below, and find more coverage at WisPolitics.
Watch the speech here.
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