Year-End Wrap-Up : Health Care, Benefits, Insurance
Quixotic insurance reform now seems less so
By LYNN WOODS

State Assemblyman Adam Bradley, D-White Plains, has been a big advocate of health- care insurance reform. That has been a somewhat lonely and frustrating position, until business started getting involved. In the past two years ago, he and other reformers in Albany have finally had success in getting some “meaningful” legislation passed.

One bill required the insurance companies to adhere to a uniform coding system of procedures. Before, each had a different code for the same procedure, resulting in a bureaucratic nightmare for health-care providers, since billing departments had to keep track of hundreds of different codes.

Another bill passed by the legislature shortened the “look back” ­ the period of time in which an HMO can ask for money back from a provider because of overpayment by the HMO. The look-back period has been reduced from six years to 24 months, said Bradley. Yet another bill makes it more difficult for the health-care insurance companies to deny paying for a service that was pre-authorized by them.

Bradley said the legislation has “made a terrible situation just a bad situation. Tremendously more needs to be done.” The first step, he said, is to reinstate the rate regulatory authority of the state superintendent of insurance, which was in effect prior to deregulation of the HMOS in 1997.

 

 

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