Liability restored for HMSA delays
A key Senate committee restored language in a bill Friday that would make Hawaii Medical Service Association legally responsible for deaths or other harm as a result of undue delays in testing.
HMSA on Dec. 1 began requiring all physicians in its network to go through Arizona-based National Imaging Associates Inc. to approve diagnostic imaging exams, including MRIs, CT scans and other cardiac-related procedures. Before HMSA adopted the new policy, most doctors were given a waiver that allowed them to skip the pre-authorization step.
House Bill 2740 was amended Friday by the Senate Judiciary and Labor Committee. The committee reversed an earlier decision by the Senate Commerce, Consumer Protection and Health Committee that removed HMSA’s liability for civil damages caused by any holdups for pre-authorization. The HMSA liability language is now back in the bill.
Lawmakers introduced the bill following complaints by doctors and patients that HMSA’s new policy is delaying critically needed imaging tests, resulting in harmful consequences. HMSA, the state’s largest health insurer, contends that the policy is necessary because Hawaii’s imaging costs are about 9 percent higher than the national average in commercial markets for people who have insurance through their employers. An HMSA spokeswoman didn’t respond to calls for comment Friday.
“Not having any language that deals with some aspect of liability basically made the bill flawed, and it would’ve been subject to being in violation of the constitution,” said Gilbert Keith-Agaran (D, Waihee- Wailuku-Kahului), chairman of the Senate Judiciary and Labor Committee. “If there’s a delay in diagnosis because a test wasn’t performed, it’s a real problem for the patient. At the same time, I’m always a little leery of testing for the sake of testing. We all know that in the medical profession we have to rely on the good judgment of doctors, and any tools we can give them is worthwhile. There’s a lot of balancing of whether or not symptoms always require certain tests. We are caught in a geographic bind here because of where we’re located and where the contractor is that HMSA has picked.”
The amended bill requires preapproval requests and decisions for medical treatments or services be based on nationally accepted evidence- based guidelines and be made public to medical providers within a health insurer’s network.
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“If an insurer is inserting itself into the delivery of patient care, then it stands to reason that they should be responsible and accountable for their part if and when a patient is harmed,” said Dr. Lisa Ignacio, a Hilo interventional radiologist and president of the Hawaii Radiological Society. “As physicians we take that responsibility every day.”
20 responses to “Liability restored for HMSA delays”
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If a business entity influences the decision or the direction of patient care, through direct or indirect methods, then they do hold some responsibility for omission or misdiagnosis. Why has it taken so long for this to be realized?
Because Rep. Roslyn Baker, the committee chair, got paid off to remove HMSA’s liability from the bill if approval delays cause harm to patient. Senate committee has reinterpreted the penalty clause. Hope it stays in the bill.
Senate committee reinserted penalty clause in bill.
This should hold true for prescription medication. If an approved drug is withheld from being covered from the medical plan because of cost of the drug and not the effectiveness. My example deals with my prostate, where Cialis is approved for use to treat prostate problems, but not covered by because its also an ED drug and is expensive than other prostate drugs. I’ve used multiple prostate drugs with negative side effects with Cialis having no side effects. Because of its use to treat ED, its not covered for prostate treatment. Who are these Medical Coverage to say what’s good for me controlled by the cost of the treatment. If it works, cover it and monitor the doctors for abuse of medical coverage, not deny coverage.
my prostate is starting to hurt, too.
If we as subscribers pay for our health coverage, we should be able to receive the needed health care. It is sad that health care is driven by $$$$. Take a look at the salaries that the CEO’s at HMSA receives $1.3 million….It is all about the bottom line to be profitable.
Gold is taking home a lot more than $1.3 million.
Thank you Judiciary committee for putting back accountability that Sen Baker took out. It only makes sense that if HMSA policies cause harm that they are responsible. Can we have a sunshine law to have HMSA share with its customers how the NIA contracts work? NIA must earn their keep by denying procdures. If they cost more than they save then its not worth it. So there must be an intentional or unintentional quotas. IF HMSA wants to shed costs, they should look internally to their own bloated and ineffectual management and overhead programs.
agree but remember that the Roz, Hawaii’s worst legislator, is a recipient of much HMSA generosity. She was cheap to pay off IMO. I am glad that she was defeated in her outrageous attempt to damage the health of those insured.
agree…too many managers doing very little…there’s a reason they have a high turnover rate..
We had it and they took it away. The ones who voted to take it away needs to be voted out, they are clearly not for the people’s best interest but their own (pockets).
Senate Commerce, Consumer Protection and Health Committee, whoever was on this committee should be removed as they are clearly not in the best interest of the people. This Senate Commerce, Consumer Protection and Health Committee should have been looking out for the best interest of the consumer’s health and protecting it. Get rid of those who were on the committee.
So, patients who need these procedures will be forced to go to the Mainland and pay out of their pockets.
A victory for Hmsa subscribers
Now let’s make Our Representatives vote for Us Hmsa is paying our money to this mainland company. There is a local based approach
“If an insurer is inserting itself into the delivery of patient care…..”. Why the hell are we letting an insurer do this? Who’s running the show anyway?
This is only one small piece of the insanity. wait until your Dr. prescribes a medicine that HMSA has decided takes “pre-approval”. You don’t get the med unless you’re willing to pay the outrageous retail price. Obamacare. It’s what you all wanted, and now you’ve got it.
nothing to do with obamacare
You never heard of pre-approval issues before Obamacare. Not once. Don’t be so naive.
Premiums keep going up – patients pay more and get less.
Nurses & doctors keep getting paid less.
Get rid of the middleman (we don’t need a CEO making $1million/year) : costs go down, patients get the care they need, providers will get paid more.
We need to
1. go to single payor system
2. update the fee schedule to health care providers get paid a reasonable amount
3. get rid of the insurance companies whose profits are hurting everyone
HMSA is daring people to go elsewhere for care. There are other choices such as Kaiser Permanente. Not saying they’re better but from my experience from a knee injury, MRIs and CTs are done in a timely manner. I think a major reason is that Kaiser owns or lease their own equipment. No middle man to decide who gets a scan and no middle man to charge for the scans. It’s actually to their cost benefit to get the most usage out of the equipment before updating. I know of a friend with HMSA insurance who had to wait 2-3 months before being granted an MRI on his sore knee. HMSA insisted on physical therapy first. Turns out he had a torn ACL. That’s very poor care and a waste of a person’s time to go around for months on a knee that needed surgery. All HMSA has to do is lose 10-20% of their prescribers and they’ll start to go under.