Honolulu (Hawaiinewsnow) – Physicians across Hawaii and across the country say the requirements for insurers to provide medical care, that they waste time, waste millions of dollars and sacrifice the lives of some people.
Currently, the Capitol has vehicles that can ultimately address this issue.
Molokai Dr. Kaohimanu Dang-Akiona leads Native Hawaiian doctors in a campaign to reduce the burden of pre-approval of insurance.
“It means the diagnosis is delayed because imaging is not approved quickly enough, because just seeing patients feel OK doesn't get the thing we know we should be able to get them,” she said.
Dang-Akiona says attractive denials take about 20 hours a week from patient care and demands full-time employees on paperwork.
Research shows that 80-90% of pre-approval requests are ultimately approved, leading reform proponents to wonder why the process exists.
Rep. Lisa Marten, D-Waimanalo, Keolu Hills, Lanikai, Kailua, House Bill 250 was introduced to reform pre-approval.
“It's been cultivated by third-party commercial companies to decide, and when they're rejected and they call, it's very frustrating for the doctors and they're talking to managers who don't have the medical expertise trying to make the patient's claim,” she said.
The reform movement has been accepted by physician Gov. Josh Greene, and former state health director, Dr. Jack Lewin, has been promoted to lead the state's health planning and development agency.
“If healthcare is medically necessary based on peer-reviewed national standards, you need to receive care and in fact should be automated,” Lewin said.
The bill requires Hawaiian health insurance companies to provide data on pre-approval policies and records, identify appropriate criteria for the 100 most common treatments, and form a working group to automate the approval process.
“In the doctor's office, you can know if you're qualified or not. It's black and white now. It's kind of a black box,” she said.
During a recent Senate hearing, wheelchair-bound James Revley with developmental disabilities complained about chronic delays and last-minute decisions for many of his needs.
“For people like me, it's very difficult to schedule an appointment,” he said.
Even Hawaii's health insurance giant HMSA is collaborating on the law, according to Dawn A. Kurisu, HMSA assistant vice president of regional and government relations.
“We want to thank everyone who worked so hard on this bill to make it viable and helping to advance approval,” she told the senator.
Lewin said pre-approval reforms are possible in Hawaii. He said if they could solve anything, it would be “cleaning the whole country.”
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