STATEHOUSE (Jan. 30, 2018) — The House of Representatives today voted in support of a bill co-authored by State Rep. Martin Carbaugh (R-Fort Wayne) that would establish clear guidelines for health insurance plans requiring prior authorization for billable procedures or treatments.
Prior authorization is an insurance billing process where physicians must receive approval from the patient’s health coverage plan indicating the treatment is medically necessary. Without prior authorization, an insurance plan may not cover an individual’s treatment. The proposal would specify certain requirements to protect patients and facilitate the process between providers and insurers in a more transparent manner.
“Right now, prior authorization procedures differ among insurance providers in determining whether a treatment is medically necessary, and this can lead to confusion and delay,” Carbaugh said. “This bill would require a physician’s prior authorization request be submitted electronically and for health care providers to respond within a certain timeframe. Defined guidelines will help prevent insurance fraud, provide patients medical care in a timelier manner and provide reasoning for denial.”
According to Carbaugh, submitting requests electronically is more secure than by mail and can help prevent fraud.
State Rep. Martin Carbaugh (R-Fort Wayne) represents House District 81, which includes portions of Allen County.
A high-resolution photo of Carbaugh can be downloaded by clicking here.
State Rep. Martin Carbaugh (R-Fort Wayne) addresses Indiana House members about House Bill 1143 on Tuesday, Jan. 31, 2018, at the Statehouse in Indianapolis. Carbaugh co-authored HB 1143, a bill that would establish clear guidelines for health insurance plans requiring prior authorization for billable procedures or treatments.