May 10, 2010
Bill Required U.S. Licensure for Claims Denials
Thanks to all CDA members who wrote their legislators regarding HB 1234, the bill that would require denials of insurance claims be made by U.S. licensed healthcare practitioners who have expertise in the specialty or field involved in the claim. The CDA got involved with this bill after learning that a major insurer is planning to outsource the processing of dental claims to an office in India. HB 1234 would have provided some basic protections to ensure that claims processors are appropriately trained and that Coloradans receive quality care.
For reasons unrelated to our issue, HB 1234 met with opposition and was defeated on the second reading in the House.
The CDA continued to pursue a fix for the issue through another bill, SB 76 – a bill about unreasonable denials of insurance claims. We offered an amendment that would make a claim denial unreasonable if it was not performed by a U.S. licensed practitioner. While legislators claim to understand the problem and the need for a fix, they elected not to include this amendment with SB 76. However, there seems to be good support for addressing U.S. licensure for the denial of claims in the next legislative session.