Lawmakers side with doctors as they wade gingerly into the medical area of ‘prior authorizations’

April 5, 2013

A debate between Vermont health insurers and physicians over the need for prior medical authorizations is picking up steam in the Statehouse.

Insurers require this extra review before they’ll authorize coverage of certain treatments or medications.

Two parallel bills in the House (link) and Senate (link) seek to make the prior authorization process more transparent. The legislation proposes measures such as requiring insurers to publicly post data and clinical criteria for such decisions; to involve at least one physician in the review process; and give the state the power to penalize insurers $500 for failing to comply with the law….

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