For years, hospitals have sent patients’ medical information to insurers via mail or fax to get approved for payments. A state lawmaker is trying to digitize the process.
Assemblyman John McDonald, an Albany representative and pharmacist, introduced legislation last week to require hospitals to send patients’ entire electronic health records to insurance companies to help them decide whether to cover specific services. The bill aims to reduce the administrative burdens insurers face during the prior authorization process, when health plans review a patient’s medical history to decide whether specific treatments and procedures are necessary before they pay for them.
“I see patients waiting days on end for prior approval,” McDonald said. “This helps accelerate the process.”
The bill has the backing of insurance companies and local businesses that want to reduce their health care costs. But it also sets up another battle between health care payers and hospitals, who fear that a bill requiring them to hand off patients’ electronic medical records to health plans will result in more claims denials.
“The national, for-profit insurance companies that dominate the New York health insurance market have a demonstrated track record of abusive behavior,” said Brian Conway, a spokesman for the lobbying group Greater New York Hospital Association. State data shows that insurers denied more than 25% of inpatient claims in 2023, he said, adding that companies already fail to pay for necessary services at alarmingly high rates.
“GNYHA members are therefore extremely wary of these corporate behemoths, including when deciding whether to grant them access to patient data like EMRs,” Conway said.
Insurers have balked at criticism from the industry, saying that providing electronic medical records would not require hospitals to send more data than they would be sending via mail or fax, according to Lev Ginsburg, a member of the Local Business Relief Coalition, which is backing the bill. The hospital association denied this claim, stating that there are limits on the scope of medical record requests for insurance companies conducting reviews.
Ginsburg, who is also the executive director of the New York State Conference of Blue Cross Blue Shield Plans, which lobbies on behalf of health plans, maintained that the bill modernizes the payment system for providers and patients, which will result in fewer delays and improved care.
“It is, in my mind, very low-hanging fruit,” he said.
