Docs, health insurers battle at Statehouse

A log-rolling match between doctors and health insurance companies over how insurance payments are made has surfaced in
the General Assembly a fourth year in a row, and it’s difficult to predict whether two bills now before
lawmakers will founder again.

Both House and Senate versions of the legislation would force insurers to send benefit checks
directly to doctors, dentists or other providers rather than patients—even if the provider is outside
the insurer networks. In industry-speak, the practice of determining where checks are sent is called
"assignment of benefits."

Advocates say the measure would help providers stay independent of insurers and prevent confusion when patients receive insurance
checks and spend the money rather than reimbursing the provider. Last year, backers dubbed the legislation the "HHGregg
bill" for patients’ unwitting propensity to spend the money on flat-screen televisions and other
consumer goods at the Indianapolis-based retail chain.

Providers say the legislation not only would cut confusion over the intended use of reimbursements,
but also eliminate hassles of patients’ forwarding their payouts to providers.

On the other hand, insurers and their allies
are fighting to maintain the status quo, insisting health care costs would spiral out of control if providers
were allowed to charge what they wished without the restraint imposed by insurance plans.

Insurers wring out $3 billion in annual discounts for patients while guaranteeing the best possible
care, said Tony Felts, a spokesman for Anthem Inc., the state’s largest health insurer.

Mike Ripley, vice president of health care policy
at the Indiana Chamber of Commerce, which has joined insurers in opposing the legislation, said, "We
want to maintain the integrity of the networks, which were created to keep costs down."

Last year, a bill died in the Senate after failing to receive a vote.

Both sides agree the issue is contentious and can
confuse lawmakers.

"It’s
very involved legislation that normally requires spending a lot of time with legislators not coming from an insurance
background," said Doug Bush, executive director of the Indiana Dental Association, one group supporting Senate Bill 75
and House Bill 1299.

One thing is certain, said Ripley: The issue "is never going to go away."

Nineteen states have laws governing assignment of benefits. Of those, nine are limited to certain
types of providers, such as dentists and pharmacists.

In Indiana, assignment of benefits has become an issue only in recent years as more and more insurers
refuse to send checks to out-of-network providers. Delta Dental, the state’s largest dental insurer,
stopped honoring the requests in June. Since then, 285 dentists have joined Delta’s network.

The trend prompted dozens of dentists to converge
on the Statehouse Jan. 21 to persuade legislators to pass SB 75 and HB 1299.

While opposed to the overall legislation, the chamber
backs the Senate version, which would allow direct insurance payments to emergency room doctors.

The Senate and House bills were introduced by
Beverly Gard, R-Greenfield, and Peggy Welch, D-Bloomington, respectively.

The Senate’s Committee on Health and Providers Services
held a hearing on its bill Jan. 21, but took no action. As of IBJ press time, the committee
had not scheduled a vote.

A Senate task force looked at the issue last summer and made recommendations similar to the chamber’s stance. The Mandated
Benefits Task Force said the legislation should be limited to "medical situations where the consumer
may have no choice in the selection of provider, such as a hospital-based emergency room services, anesthesiology,
radiology or pathology."

The task force also recommended that when payments are made directly to the insured for out-of-network providers, the check
be accompanied by an explanation of benefits and a notice that the payment should be directed to the provider.