Withdrawn Utah Bill Makes Case for Single Source

Yesterday I posted about Oklahoma taking the risk of exploring (again) a single source medical payment system.

Today in WorkCompCentral is a news story about why a single source system makes sense.

Utah State Sen. Karen Mayne, D-West Valley City, withdrew Senate Bill 130, which would have required a private health insurer to pay hospital and doctor bills when a workers' compensation carrier is disputing a claim and has not made payments within 46 days of an employee reporting a work injury. The bill would require the health insurer to reimburse services at the rate set in the Utah Medical Fee Guidelines and seek reimbursement from the workers' compensation carrier if the claim is determined to be work-related.

Mayne dropped the bill from consideration after it met stiff opposition from Republican lawmakers, but is assembling a working group to draft a similar bill for 2013.

Mayne testified before the Senate Workforce Services and Community and Economic Development Committee that some health insurers refuse to pay for medical treatment when there is a potential workers' compensation claim. Insurers continue to deny payment during the appeal process, forcing injured workers to pay for treatment out of their own pockets.

"There are all kinds of issues with bill paying," she said. "These injured workers, for no fault of their own, are losing everything because there's no money coming in."

Maine and Oregon are two states that already have similar laws.

In Maine a health insurer is required to pay medical bills when the denial of a workers' compensation claim is being appealed.

In Oregon, a claim that is denied and on appeal must be processed by a health insurance company if a claimant has coverage. If there is a balance remaining, the health care provider can bill the workers' compensation carrier, which must pay up to the fee schedule.

Casey Hill, director of government relations for the Utah Medical Association, testified in support of the bill, saying doctors are now in an uncomfortable position of having to tell injured workers that they can't provide service because they don't know if they'll get paid.

Richard Burke, an attorney with the Utah Association for Justice, testified before the committee that, "The real issue here is where there are two policies and one will pay eventually, who should bear the brunt of the delay? Should it be the injured worker who has to wait years for the claim to be adjudicated, or should one (carrier) pay and then get reimbursed if it wasn't their responsibility?"

Kelly Atkinson, executive director of the Utah Health Insurance Association, said in testimony opposed to the proposition that health insurers would have to recalculate premiums to factor in possible payment for workers' compensation claims.

If that's the only argument against Mayne's proposal, it's a weak one. It seems to me, with all the computing power available to Big Insurance, that recalculating premiums is not that big of a deal.

Mayne was granted permission from the committee to form a working group of stakeholders that would report back to the committee twice during the interim and try to reach a consensus on legislation that would be introduced in the 2013 legislative session.

Meanwhile, in another publication, Dr. Rob Stone makes a compelling argument for a single source medical payment system, stating, "the insurance industry is the single greatest barrier to achieving an efficient and affordable system to cover all Americans".

Mayne's legislation (and the laws in Maine and Oregon) would be unnecessary if a single source system were in place, but there are huge obstacles in the way of such a system. Dr. Stone says the biggest obstacle is the health insurance industry itself.

I've heard all the arguments in the past about why Americans can't have a single source system. Perhaps from a present day practical standpoint those arguments have merit. Dismantling the present private health insurance system would disrupt tens of billions of dollars.

But, as Dr. Stone puts it, "There is no business case, no health care case, no moral case to support their ongoing existence. They make their profits by avoiding taking care of sick people — by refusing to issue policies, canceling policies, or denying payment."workers compensation, work comp, injured worker