The two bills aim to reduce the financial burden of keeping high deductibles and annual maximums, which have become more common in recent years, by allowing patients to make payments outside their insurance plan. However, at a hearing on the bills during a meeting of the Committee on Commerce and Labor of the Assembly on Friday, health insurers expressed concern that the requirements set out in the written version could be technically difficult to achieve and would be excessively burdensome.
One of the bills that Spiegel introduced AB185For example, if patients choose to pay the cash price of a medicine at the pharmacy, they may pay for the prescription drug or the entire deductible and the annual deductible for the insured sum. Spiegel argued that the change would save money, both for patients who might be able to get a cheaper cash price for the drug than they would for their insurance, and for insurance companies that would not be responsible for paying part of the price regulations ,
Spiegel provided an example to legislators of a prescription for the drug levothyroxine, used to treat hypothyroidism, costing patients a $ 15 co-pay and insurers another $ 20.99 at a pharmacy While the cash price for patients in another pharmacy is only $ 10, additional payment would be required by the insurance company.
"Here the patient saves money, the insurance company saves money, and this bill simply asks the insurance company to give the patient a loan for the money spent and the savings they have collected for the insurance company, and this loan consists in the Form of being something that is important for their deductible, "said Spiegel. "It's not about cash, I'm just saying that the patient gets credit for what he spends on his own."
Heidi Englund, a patient with multiple sclerosis and a retired public servant, charged the lawmakers with the cost of their treatment: $ 23,000 a month for their main disease-modifying treatment and two more medicines, each costing $ 1,000 and $ 200, respectively.
"Irrespective of my diagnosis of MS, I must have insurance cover, but secondly, I can not afford to pay higher deductibles, premiums, and duties," Englund said. "It is necessary for me to incur all the expenses that arise out of my own pocket when I understand the high cost of these medicines."
However, some proponents of the patient expressed concern that the bill did not go far enough by not prohibiting Copay accumulators or accumulator accumulators. A practice where insurance companies do not seek support from patients from drug manufacturers or foundations to cover drug costs – maximum and deductibles.
"Although AB185 is a good start to understanding some of the costs that patients face, it barely scrapes the surface of our affordable drug barriers that we worry about," said Betsy VanDeusen, Executive Director of the Nevada Chapter, National Hemophilia Foundation. "I hope the bill, with a few changes, can be very effective in protecting the ability of patients to afford their medication."
VanDeusen told legislators that copay accumulators are not yet widely available in Nevada, but neglect the charitable resources that patients would be provided by drug manufacturers and foundations to meet their deductibles and maximums, and patients would need to spend thousands of dollars pay personal attention.
Spiegel said, however, that the ability to provide patients with financial support for their deductibles and maximum amounts could lead to increased insurance premiums in the long term.
"What happens is that they work faster through the deductible, and then the insurance company will be more financially engaged in a shorter period of time, which ultimately has the potential to increase the premiums," said Spiegel. "I feel for the patients who are going through this and really need the relief, they need the help. I do not give it up at all. However, I have tried to develop a methodology that will provide some relief to consumers and patients without overburdening the insurance companies. "
Health insurers expressed their support for the overall intention of the bill, but expressed concern that some provisions sound simple but would be difficult to achieve in practice. For example, it requires insurance companies to manually process the applications submitted by patients for each paid cash order.
"That's easy in itself, but how can we achieve that goal mechanically within the insurance industry?" Said Tom Clark, lobbyist of the Nevada Association of Health Plans. "To make the insured aware that if he submits a receivable with receipts for the cash he has paid and wants the deductible to be claimed, he will only apply to the deductible and this cash payment will not be received. "
Given some concerns of insurers at the hearing, giving patients the opportunity to apply the value of drug manufacturer coupons to their deductibles and maximum limits, SPIEGEL clarified that the deductible credit applies only on the basis of which the patient pays actually and would not contain any discounts.
Spiegel also introduced an amendment to the bill requiring insurers to apply the value that patients have to pay for the cash regulations on deductibles or maximum limits that are optional for public insurers, including districts, school districts, municipalities and the state government. The Public Employee Benefits Program, which monitors public health insurance and other local government agencies, issued tax assessments expressing concern that legislation would drive up costs.
"To remove the budget comments, I want to change the" should "for these companies into a" can, "and if they realize that they will save money, it will be better for their patients and better for their bottom line than they will be for them can, "said Spiegel to the legislature.
A second bill that Spiegel submitted to Friday AB225would require insurers to calculate the cost of emergencies in the emergency department outside the network based on the annual maximum amounts of patients. However, the Health Services Coalition, which represents several self-funded employers and union health care funds, expressed concern at the hearing that the legislation would be overly burdensome in addition to the requirements already set by the Affordable Care Act.
"The ACA already requires that all plans cover real-life emergencies outside the network as a cost share in the network," said Chelsea Capurro, lobbyist of the Health Services Coalition. "This bill is trying to do something different. This includes payments outside the network in annual maximum amounts that patients must pay. This is not part of the ACA, so we have a bit of heartburn when we add additional mandates to what we already have to comply with at ACA. "
Insurers also raised concerns about the provisions of the legislation prohibiting the withdrawal of payment entitlements after granting prior authorization for the service, by requiring the prior authorization for one year and the payment prohibit reclaim payments to suppliers for services provided more than a year ago. The insurers said that they want to continue working with Spiegel on the legislation.