Saturday, February 3, 2024

Did Prior Authorization Bill Get Prior Authorization?

 A scrum over prior-authorization is taking place in the Mississippi legislature thanks to one J. Walter Michel. Sarah Ulmer reported: 

Action began on Tuesday when Senate Insurance chairman Sen. Walter Michel (R) took up SB 2140 in committee. The bill passed on the Senate floor, with no dissenting votes, on Wednesday morning.

“Prior authorization” requires physicians to obtain approval before providing patients with certain non-emergency treatments. Insurance companies argue that prior authorization helps ensure ordered treatments are medically necessary and that more affordable alternatives have been considered. They contend the process is important to reducing healthcare and health insurance premium costs.....

Some requests of changes to the process include:

  • a requirement that insurance companies provide a list of all treatment requiring prior authorization;
  • an acceleration of the timeframe insurers have in which to respond to a prior authorization request;
  • the development of a web portal to standardize submission and consideration of requests.

In 2023, lawmakers passed similar legislation nearly unanimously to address what Sen. Michel said were concerns from both sides of the issue. Ultimately, the bill was vetoed by Governor Tate Reeves (R).....

 Governor Reeves’ Deputy Chief of Staff Corey Custer told Magnolia Tribune on Tuesday that the Governor’s office will have a piece of legislation to help reform prior authorization this session, but that Michel’s bill is not it.

“Governor Reeves believes prior authorization reform is needed to bring consistency and transparency to the process. On the day he vetoed Senate Bill 2622, he tasked his staff to work with all stakeholders to address the correctable flaws in the bill,” said Custer. “After months of work, Governor Reeves’ staff prepared legislation to address many of the concerns related to last year’s bill. The proposed legislation reflects a series of compromises by many of those stakeholders. Governor Reeves looks forward to working with the Legislature to move prior authorization reform through the legislative process.”

It is unclear at this time when that legislation will be filed.  Rest of article. 

 It appears the legislature and Governor might be on a collision course.  


Anonymous said...

"Governor Reeves’ staff prepared legislation to address many of the concerns related to last year’s bill."

Tate, that isn't your job. The legislature is supposed to write the laws, remember?

Anonymous said...

If you have private insurance and want to pay $1,000 per year in higher premiums, you are going to love J. Walter Michel’s bill.

Anonymous said...

The Blue Cross/Blue Shield and UMMC battle rages on...Michel is an Oxford acolyte attempting a stealthy approach to taming the Blues.

Ultimately as always: Those who have gold, make the rules - no matter how guilty you try to make them "feel".

Anonymous said...

Some commenters here are missing the reality of this proposed legislation. It has nothing to do with "decreasing healthcare costs", except that it decreases insurance company's expenses, increasing the time required to get treatment done, AND (most importantly), increasing insurance company profits. How dental think that BCBS of MS built up a billion dollar war chest??? How many of you guys are ok with your insurance company having veto power over what healthcare your doctor thinks you need?

Anonymous said...

Tater is bought and paid for by the insurance companies and the Medicaid MCOs. Don't believe me?? Check the campaign finance reports

Anonymous said...

"Insurance companies argue that prior authorization helps ensure ordered treatments are medically necessary..."

That's the doctor's job, not the insurance companies'. Insurance companies are practicing without a license, on patients that aren't theirs.

Anonymous said...

the insurance industry has the entire mississippi legislature on its didn't know that?

now you know.

Anonymous said...

""Governor Reeves’ staff prepared legislation to address many of the concerns related to last year’s bill."
Tate, that isn't your job. The legislature is supposed to write the laws, remember?"

Governors have always worked on legislation. The Governor will ask a member to drop (sponsor) the bill.

Civics class is great, but real-world experience is better.

Anonymous said...

Michel is bought and paid for.

Anonymous said...

The Legislature just guaranteed higher insurance rates. Ole' J. Walter and Dean Kirby.

Anonymous said...

12:23 you are right.

Governor Tate’s job is not to write the laws, but his job is to be a check and balance when the Democrats in the Senate start writing laws just like Democrats in states like California and New York.

Anonymous said...

What, during his tenure, has Michel done that was particularly noteworthy? He's sort of like a local level Roger Wicker.

Anonymous said...

To paraphrase 3:15:

Yeah, we know what the constitution says, but this is how we do it. We've been getting away with it for a while now, so we'll keep doing it our way until somebody stops us.

The governor gets to veto legislation. That is the beginning and end of his check on the legislature. He may telegraph his veto, in hopes the legislature will listen to him, but that's it.

His staff does not get to write the law. That is the legislature's check on the governor.


Anonymous said...

In re 3:19 - Did someone actually cite our system of checks and balances to argue for the executive's right to draft legislation? Holy sh*t

I guess having Democrats in the majority (who were elected) justifies throwing out the Constitutions, state and federal. So, we can either elect Republican majorities, or we'll have a Republican king (for the good of the country, of course). Is that it?

Anonymous said...

God forbid these wimps actually take a vote to override Tate's veto.

Anonymous said...

This bill is incredible! The insurance companies want it so they can make even more profits. All it will do for the consumer is increase wait times for treatment when they aren’t outright denied. Insurance companies already audit doctors to see if they are billing for only medically necessary treatments. This is nothing but a slam to consumers. It is disgraceful.

Anonymous said...

I was faced with needing pre-approval in December 2023 after TWO doctors recommended the treatment. Only cost me an extra 1 1/2 hours of my life having to drive back to the doctor's office for a procedure that had to be pre-approved. And, of course a little fossil fault. I should have an e-car.

Anonymous said...

Built in to one's doctors' fees are several skilled "coding" staff to file claims for insurance payments. My doctors (about 6) know from daily experience what is an approved expense and it is part of the overall care one gets. Central MS is blessed to have Baptist, St Dominic's and exceptional physicians and surgeons inside of or independent of those health systems. Thank you Docs!

Anonymous said...

no 1223, the Governor is one part of the process. The old saying - the Governor proposes and the legislature disposes - explains that process.

Yes, the Governor proposes legislation just as every other executive branch officer proposes legislation (the Secretary of State, the Attorney General, the Auditor, the Ag Commish, etc).

Maybe you need to go back and review your sixth grade civics class before you interject your misunderstandings next time.

Anonymous said...

Damn there are some dumb folks allowed to have computer access and make comments on this site. What the hell do those that think the Governor doesn't have a position to propose legislation happens when an agency (lets say, Dept of Public Safety, or Medicaid, or Corrections - all Executive Branch agencies that the Governor appoints the leadership) proposes legislation that is filed by a legislator is happening. None of that is done without the Governor's staff having been involved, just as it has been on this issue.

What about the recent economic development projects - don't you understand that the Governor proposed those pieces of legislation? Of course, a legislator filed the actual bill, but it was written and approved 100% by the Governor before it was filed.

Get a grip folks. The Governor isn't just allowed to approve or veto legislation. Hell, I'm glad to see Tater getting involved a little more in the policy decisions being considered in this legislative session.

Anonymous said...

The insurance companies are death panels, pure and simple. They deny, delay, obfuscate, lie, and profit from it. Not much difference from them and ambulance chaser Dems, "self made" RINO Farmers on Farm Welfare, or RSJ pleading poverty and getting Restaurant Welfare. Except those farmer and restaurant owners don't deny or delay or affect life saving care.

BCBS is an abomination, and a curse on sick people.

Witness their arguments, endless, with UMC. Who would ever want to go into healthcare when doctors know what is needed but a bureaucrat denies your healthcare needs? The doctors hate life for the endless bureaucracy that health insurance creates.

The "medical directors" for insurance companies are simply craven corporate executives, who constantly decide that your kid, or your spouse, or your parents do not deserve to have the care that your doctors know they need, often to live, and always regardless of what is best for your family's suffering.

For profit and loss statements. FACT. If you deny that, you are a liar and deserve the fate you await at the end of your life.

We should be the best nation in the world on healthcare, but Godless LiberaLtarian money worshippers have allowed this.

Tax breaks for Amazon. Any vice you can make money off allowed. But no smoothing out the delays and denials of BCBS. Tater's road to Hell, as expected.

Anonymous said...

Damn 9:08 pm. Take a Zanax. Calm down. You can't take a rant like that against ---- well, everybody --- except of course yourself.

You started with what might be at least something to reasonably discuss about the conflict between health care providers and health care payers. OK. Don't necessarily agree totally with your rant, but it is at least focused.

But - Ambulance chasers (well, yes, they do impact the subject - much of what has to be practiced today in medical fields is due to the lawyers; including having to fill out the same form every time a patient crosses a threshold; moves from morning to afternoon; whatever, they have to cover their ass from the lawyers, just as the health care payers have to do) but to include in your rant regarding an issue in the legislature about pre-authorization the RINO Farmers (don't know why you limit it to "RINOs", although your use of the term speaks volumes about you and yours) because there are many farmers of all ilks that could be included; but then you go to RSJ - obviously a personal beef - and transfer over to both UMMC, Amazon, and Tate.

Take a break. Breathe. It will make you feel better. Focus. Pick one at a time. They ain't all connected. Enjoy your recently approved 'medical maryjo', forget that it is also connected to the government, the powers, the whoever and whatever you want to hate, and toke on it once more. Tomorrow will be better, and if its isn't you can go back to your licensed distributor and get you another bud.

Anonymous said...

But eh'body from all over the world comes to Murka to see our doctors 'cause we got the best healthcare in the world. I seen 'em say so on the TV news.

NOT Good to be Blue said...

While most commenters on here want to argue political process and what Tate can/cannot do, the most important part of the equation is being ignored- the patients. And just to be clear, the main culprit in prelonged prior authorizations and denials is BCBS of MS! Most insurance companies already have a portal and process for getting timely prior authorizations and handling appeals. Not BCBS of MS. You have to call, wait on hold (sometimes for 30mins to an hour) just for one prior auth. NO medical office has the ability to have people sit on the phone and do business this way. This is by design as a delay tactic that the physician will say “screw it”, not get the approval, and the patient is left with inadequate treatment.
I have watched BCBS of MS head down this pathetic path for years. The most glaring juxtaposition in all of this is if you are a patient or physician that deals with BCBS in any of our neighboring states, guess what? You have portal access! You can actually get someone on the phone if needed!
But don’t worry, in MS our BCBS has plenty of money to fund marathons, cook offs, employee fitness initiatives, and the widespread marketing campaign touting “It’s Good to be Blue”… what a load of crap

Anonymous said...

Y'all still don't get it - who pays for something decides that something. You can whine all you want, but that's they way it's always been.

Legislators and governors can propose and pass laws all they want, but you can't make someone pay for something if they don't think it's required for them to do so... and if you sue, well - then the only thing that ends up happening is a long drawn out legal game of chicken - and the lawyers make out like bandits at the state level - but the ones with the money can take it federal and win because who pays dictates what's getting paid for.

Being a physician ain't got the prestige it once did because of inflation. Healthcare is not a right in the constitution, and most people can't afford it on their own. The scam is the same as higher education...70-80% of people were never meant to go to college, but federal financial aid is to college degree what insurance is to healthcare.

BIG business (and advocate lawyers) love trying to make the poor believe he/she is entitled to something when he/she is not, and never was.

Anonymous said...

I’m grateful for Sen. Michel paying attention to the issue of patients having their care delayed and denied by people other than their doctors.

Anonymous said...

Thank you Senator Michel. This bill SB 2140 adds timeframes and agreed upon expectations for patients. Many negative comments here are from people who are lobbying pro insurance and managed care. What y’all have missed is the actual Commissioner of Insurance for the state and the Dept of Insurance will make the rules and there are monetary penalties for not reacting in the 24 hours when it’s an emergency and within 5 days otherwise. Now, companies can delay indefinitely and then patients get caught in a never-ending process of no answers and delays. This forces doctors to veer off what they initially intended to try to find an alternative that may or may not be the best solution.

Last year, Gov Reeves vetoed similar legislation because it contained Medicaid. This bill covers everyone. Why treat people on Medicaid or the state health plan differently? All people in this state including Medicaid patients deserve treatment and to get the procedures they need; this bill helps facilitate that in a timely manner. Get all the facts about a subject before y’all start commenting on an issue. Have many of you actually read the bill? If you had, you would know it’s pro patient!

Anonymous said...

Senator Michel's bill actually helps Physicians. As it stands, BCBS has antiquated turn around times delaying patient care. This will force them to respond in a safe, timely manner.

Anonymous said...

@11:37am Nope. Won't happen. Tater won't sign off on it because BCBS gives him a lot of gravy as campaign contributions.

Elections do have consequences. Sorry folks, Michel is trying - but it's all wishful/magical thinking. No matter what angle UMMC attempts.

Anonymous said...

3:36 said, "What, during his tenure, has Michel done that was particularly noteworthy? He's sort of like a local level Roger Wicker."

Dang, I knew Walter Michel was bad but I had no idea Michel had reached the level of Roger Wicker. Ouch.

anonymous said...

As a physician with decades of experience with insurance companies, I assure you that the BCBS's of the world despise the idea of PA reform represented in this bill.
We have multiple employees dedicated to appealing denials of medically appropriate care. I once had to appeal denial of vitamin b12 shots for a patient with documented b12 deficiency because the uneducated script follower at the insurance company was not aware that cyanocobalamin is vitamin b12. Another time, my patient with clear cut testosterone deficiency was denied coverage clearly spelled out as covered in his policy, because I failed to document to their satisfaction the patients' symptoms before ordering the testosterone level. This oversight caused them to permanently deny coverage despite my personal call. Most recently, another patient suffering daily pain was denied the clearly indicated imaging study. A Peer to Peer review connected me with a "physician" who ignored the clear standard of care, causing an unnecessary referral to a specialist and 6-month delay before finally agreeing to the test which surprise surprise, revealed exactly what was expected and allowed him get the needed treatment. .

anonymous said...

Bingo 1137

Anonymous said...

Also a physician here and this legislation is desperately needed for patients and docs. The prior authorization process is broken and the insurance companies reap the benefits every day. I applaud the efforts of Senator Michel and others in reforming this nightmare. I can promise you the insurance companies are not behind this one. This bill’s for the patients.

Anonymous said...

Hey 6:54 Pm: Is that u Walter??

Anonymous said...


" I can promise you the insurance companies are not behind this one. This bill’s for the patients."

Yep, UMMC is. $$$$

Anonymous said...

As a long time pediatrician in Mississippi I appreciate what Sen Michel and the Senate approved in SB 2140. The legislation requires ALL insurance companies to expedite the prior approval process. My requests do not get DENIED by the current prior approval process, just DELAYED. This bill helps me and my patients.

Anonymous said...

I’d be real curious to know how much money BCBS has stockpiled ?? Also when did helping the patients become the wrong thing to do??

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