Vermont providers, BCBS Vermont at odds over prior authorization bill

Vermont providers are pushing for the passage of a state bill that aims to reform the prior authorization process, while Blue Cross and Blue Shield of Vermont has raised concerns that the proposal could cause rates to rise. 

The bill would align prior authorization with Medicaid and claim edits with Medicare, the Burlington Free Press reported April 15. The legislation would also allow patients and providers to ask for exemptions to step therapy and would require health insurers to decide prior authorizations within 24 hours for urgent situations and two business days for nonurgent care. The bill also directs the state's Department of Financial Regulation to prohibit prior authorization requirements for certain medication and services and require insurers to collect cost-sharing amounts from patients. 

Burlington-based University of Vermont Health Care Network and the Vermont Association of Hospitals and Health Systems are among those calling for the Senate to pass the legislation, which was passed by the House in March, according to the report. 

UVM Health Network-Central Vermont Medical Center Chief Medical Officer Ryan Clouser, DO, said paperwork hassles are the leading cause of dissatisfaction for healthcare providers, according to an April 10 Vermont Association of Hospitals and Health Systems news release. 

"More importantly, I see what it does to patients when they can't get the right level of care in time and need to go to the hospital or are waiting in the hospital for a procedure," Dr. Clouser said. "This bill doesn't eliminate prior authorizations or other billing issues, but it's a step in the right direction."

BCBS of Vermont Public Policy Director Sara Teachout said the company is concerned that if the bill passes, insurance rates could rise between 5% and 7%, Vermont Public Radio reported April 11. She also said she is disappointed BCBS is being portrayed as a company that looks only at the bottom line. 

"Blue Cross and Blue Shield of Vermont does everything we can to improve patient safety, rein in costs and make sure that the care that's being provided is appropriate for the situation," Ms. Teachout said. "We never want to deny care for our members — that's not good for people and we know that."

Lori Houghton, chair of the House Health Care committee, disputed the company's projections and argued that the legislation will help reduce costs, according to Vermont Public Radio.

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