By: Maria- Paula

Sen. Stella Pekarsky D- 36th District, and Del. Michelle Maldonado, D- 20th District, have introduced companion legislation to address and reform insurance prior authorization requests in Virginia. 

In addition to insurance carriers’ prior authorization requirements, procedures, and forms to be made available in a central location of the carrier’s website with requirements for timely updates to the site, the proposed bills,SB 1215 and HB 2099, also aim to bring blanket turnaround times for prior authorizations to be approved, denied, or require supplementation. 

Pekarsky emphasized the importance of transparency in healthcare, stating that patients should focus on their health and not on navigating complex insurance policies. Delegate Maldonado joined his colleague in highlighting the need for clear communication and fair timelines to ensure quality care for Virginians

“I believe that when you and your family go into your doctor’s office and need care, you should know exactly what to expect from them and your insurance. You should be able to focus on your health and wellness, not on becoming an expert and self-advocate on opaque insurance policies. These requirements will bring much needed reform and transparency to a complex system that leaves too many families in limbo,” said Pekarsky.
 
Maldonado equally reiterated that timely, transparent prior authorization processes are essential to delivering the quality care that Virginians deserve. 

“This legislation ensures that patients and providers are receiving the transparency they need by requiring clear communication, fair timelines, and easy access to vital information about healthcare decisions,” said Maldonado.
 
Many a times, Virginians go to their trusted health care providers and find out they need lifesaving care as they are burdened with unknown timelines of approval. Instead of focusing on the care they need, many have to become their own self advocates to navigate a complicated insurance process. Requiring increased transparency ensures that patients can focus on their own health and have peace of mind. 
 
This legislation would require that carriers communicate with the provider or their designee within 72 hours of an authorization request for urgent health services whether it is denied, approved, or requires supplementation and seven calendar days for non-urgent requests.

It also prohibits retroactive denials, limitations, conditions, modifications, or restrictions of authorizations. 

Further, carrier’s websites would include prior authorization requirements, procedures, and forms available in a central location of their website, to be updated within seven days of any approved changes to those requirements.