‘The right thing to do’
Jon Ramsey of the Georgia Asthma Coalition said some patients with severe asthmatic conditions “have to jump through a lot of hoops’’ to get access to biologic drugs, which are produced from living organisms or contain components of living organisms and can be very expensive.
Ramsey talked of his own experience with asthma, and that of a Georgia girl who was stabilized on a drug that was approved by an insurer after she had already racked up more than $1 million in medical bills.
And state Rep. Kim Schofield, D-Atlanta, who has lupus, told the panel that the legislation “is the right thing to do. We’ve been fighting this battle for a long time.”
The bill would require a health plan to grant or deny an exception to its drug protocols within 24 hours in an urgent health care situation, and in 72 hours for a non-urgent case.
The legislation on surprise billing, also sponsored by Cooper, would require a hospital not in an ER patient’s network to contact the insurer once the patient had been medically stabilized. Then the insurer could order a transfer to an in-network facility or authorize further care at the hospital where the patient had been stabilized.
The measure, House Bill 799, is supported by Kaiser Permanente. A Kaiser vice president, Kirk McGhee, told the Insurance subcommittee that the legislation can reduce the surprise charges that ER patients often face.
He called it a “moral issue’’ for the problem to be resolved.
The legislation is opposed by the hospital industry.
Anna Adams of the Georgia Hospital Association said the bill would create delays in patient care. Rural hospitals don’t have sufficient staffs to comply with the proposal if it’s enacted, she said.