Reducing Insurance Company Denials

When a healthcare provider recommends a treatment for a patient, the insurance company often reflexively denies payment. After substantial arguing the insurance company most of the time eventually approves the care. This delay creates pain and suffering for Nevadans, and sometimes causes permanent harm or death. I believe if people have paid a portion of every paycheck to get healthcare when they need it, then they should be able to get healthcare when they need it.

At the Nevada State Board of Medical Examiners we are seeking ways to punish physicians who enable the denial process, potentially by removal of their licenses. These are mostly physicians who live out of state and supplement their income by reading denial forms for the insurance companies when the physicians in our state contact them requesting approval for care Nevada patients need. Nevada currently has laws (NRS 630.310(8)) that clearly state the board has authority in this matter. To date, the board has not taken on any of these cases for fear of the tremendous cost of litigation expected to be brought by the insurance industry. Cases like this have the potential to bankrupt our board.

We have considered requesting assistance from the Division of Insurance at the Nevada Department of Business and Industry, but they seem understaffed and underfunded to handle thevolume of complaints they would receive should they start to pursue these claims. When a division of the executive branch of government cannot enforce the current laws on the books, making new regulations does not help and people then operate in an essentially lawless environment.

For this reason the best path forward seems to me to be to empower the trial attorneys. We should pass laws that make it very easy for them to successfully sue health insurance companies for vast sums of money when they inappropriately deny care. Eventually this should force the insurance companies to ease the denial process and to actually provide the care the patients need and for which they have already paid through their premiums.