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Nevada State Medical Association to seek health insurance transparency


By Sean Whaley, Nevada News Bureau: The Nevada State Medical Association believes consumers should have access to clear and understandable information about the cost and coverage provided under health care insurance policies before they sign on the dotted line.

Executive Director Larry Matheis  said the association will pursue legislation next year to require companies offering health insurance policies to post such information on the Nevada state website to provide transparency for such critical health care decisions.

“It is essential that people have an understanding of what they’re getting with this package called health insurance,” he said.

There are many anecdotal examples of people purchasing health insurance policies only to find out that illnesses such as cancer were excluded, Matheis said.

“So all of those kinds of issues are what we want to see a much more open demonstration of the information that people need,” he said. “They (insurance companies) can make decisions about what they will and won’t cover, but it has to be then very clearly explained to people at the front end, not the back end. You don’t want to be shocked after you’ve had care to find out that the insurer has decided, not that you didn’t need it, but that they’re not going to pay for it.”

Making health insurance decisions more transparent by providing the information up front to consumers is even more important as the federal health care law begins to take effect, Matheis said.

Transparency efforts are moving forward in Nevada in the areas of reporting key hospital and physician data, he said. But the same cannot be said for the health insurance policies offered by the insurance industry.

“How does the health insurance industry deal with things like coverage,” Matheis said. “What does coverage mean? When do they exclude something. When do they exclude somebody. How much of the premium dollar goes for health care. How much goes for other things. Just a range of issues.

“People don’t need to have the unpleasant surprise when they or their family are going through serious illness and medical care decision making,” he said. “That is not the time to find out what your insurer does and doesn’t cover.”

The association plans to work with lawmakers to require such information to be posted by the state on its official website. Matheis says he hopes to win the support of the state Insurance Commissioner and Gov.-elect Brian Sandoval in the effort, which has no significant fiscal issues associated with it.

State Sen. Sheila Leslie, D-Reno, said she has not talked with Matheis about his proposal but that it is an idea she would support. Standardizing such information would be of great benefit to consumers, she said.

“Of course we should be educating ourselves but reading an insurance policy is like trying to find a needle in a haystack,” Leslie said. “You can never find the answer to the question you have without a lot of work.”

Assemblyman David Bobzien, D-Reno, proposed a similar measure in the 2009 session that would have required health insurance policies to identify certain medical conditions not covered by the policy. It also would have required posting on the state website. Assembly Bill 438 did not make it out of the Assembly Commerce and Labor Committee, however.

Las Vegas attorney Jim Wadhams, a lobbyist who represents Anthem Blue Cross and Blue Shield in the Nevada Legislature, said the industry would not likely have any issue with the idea of providing helpful health insurance information to consumers on the state’s official website.

But he did suggest that if the Legislature wants to move ahead with such an idea, it should include all health insurance providers, including those operated by private companies for their employees and those operated by such organizations as the Culinary Union.

“I don’t think the industry would have a particular problem with it,” he said. “But if we are going to have transparency let’s have it for all.”

Individuals seeking health insurance can already do some comparison shopping on the internet through a couple of different brokerages, ehealth.com and insuremonkey.com, Wadhams said.

“So the concept is not particularly radical,” he said.

 Matheis said the association agrees that all plans should be included. But he said the special need is going to be for those buying individual or small group plans, particularly if the health insurance exchanges are to function under the new Patient Protection and Affordable Care Act.

Matheis said that while some opposition could emerge to the idea from the health insurance industry, it will be hard to oppose the idea of providing more information and information people need when they make their critical health care choices.

The idea is not to create new regulation or mandates, but to provide more sunshine on the issue of health care insurance coverage, he said.

“More front end information makes for fewer unpleasant surprises at the back end,” Matheis said. “If we do it right, that is what transparency brings to the health care system.”

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