OKLAHOMA CITY (KFOR) – The Oklahoma State Medical Association wants to make Oklahomans aware of a law that could help you get your health insurance claims approved.
Senate Bill 550 was authored by Sen. Joe Newhouse and Rep. Daniel Pae, but one official from the OSMA also played a key role in its passage.
“Our goal here really is to level the playing field,” said Dr. Sam Dahr. “What we’re simply trying to do is enhance communication between the insurance company and [others] so it’s a level playing field.”
Dr. Dahr is a past president of the Oklahoma County Medical Society and an OSMA board member. He tells KFOR he has been working on this bill for three years, and that it addresses a transparency issue when it comes to insurance companies denying your claims.
“Right now when an insurer denies a healthcare claim, the appeals process tends to be very cumbersome,” he said. “What often happens is that the insurance company re-denies without explaining why they re-denied, and that is a tremendously frustrating experience for all involved.”
This law now requires health insurance providers to specifically detail their reasoning for a re-denial if they deny a claim a second time, and they have to provide a specific contact number for the appeals department.
“That will hopefully make it easier for people to call in and not have to navigate a difficult phone tree and wait on hold for ever and ever,” he said.
Dr. Dahr says he saw how difficult this process can be when a friend had a heart attack. Dahr says the man drove to the nearest hospital a mile away, but his insurance company denied his $25,000 claim, saying he should have driven to the in-network hospital farther away.
“He said, ‘Well I was having an emergency. I thought I was gonna die and so I went to the hospital that was right next to my house.’ And they argued that that was not an emergency,” he said. “Every time he would call in and talk to a different person, and every time that person would say, ‘Hey, you weren’t in an emergency.'”
Dahr says one of the reasons why this bill passed with little contention is because it is such a widespread issue.
“Every legislator we talked with had experienced this problem of a cumbersome appeals process with their health insurance,” he said. “We found that this concept had tremendous resonance.”
The bill passed the House 89-3 and no one voted against it in the Senate.
Dahr says the goal isn’t to ensure every appeal is successful. But they want to increase communication between all parties to make it an easier process on the patient.
“We’re hoping that one day this bill becomes a template for other states,” he said.