Texas neurosurgeon's bill allows certain physicians to bypass prior authorization

Alan Condon -   Print  |
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Certain physicians in Texas no longer require approval from insurers for some medical procedures, treatments or drugs thanks to a new law that took effect Sept. 1, according to Houston Public Media.

Physicians who are approved 90 percent of the time for a service will receive "gold card" status and be exempt from the prior authorization process, which requires providers to get permission from insurers before delivering certain medical services.

State Sen. Greg Bonnen, MD, R-League City, a spinal neurosurgeon with Houston Physicians' Hospital, wrote the bill.

Many insurance plans require prior authorization for orthopedic procedures, imaging and medications, but it is becoming an increasing pain point for providers, who say the policy brings increased administrative burdens and takes away from time with patients.

Commercial payers opposing the law claim that it will put patients at risk, arguing that prior authorization is necessary to minimize costly procedures and act as a check on potentially unnecessary, inappropriate or unsafe medical treatments.

"A lot of time what goes on with patient safety isn't really just what happens with one physician," Jamie Dudensing, CEO of Texas Association of Health Plans, told Houston Public Media. "Health plans tend to be one of the few entities watching a patient's role in healthcare where you have a 360-degree view of what's happening."

Insurers in Texas will begin assessing which physicians qualify for "gold card" status, but some provisions in the law may be too challenging for insurers to implement, which could lead to prior authorization being eliminated across the state, not just a verified group of physicians, Ms. Dudensing said.

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