New ‘gold card’ law allows doctors to skip prior authorization and get patients treatment faster

Texas Politics

AUSTIN (Nexstar) — House Bill 3459 officially takes effect Sept. 1, and promises quicker care for Texas patients.

The bill aims to cut down the prior authorization process to get patients the treatment they need when speed matters.

“If I order things like a CAT scan to evaluate my patient’s breast cancer, to make sure it hasn’t spread somewhere else, frequently, I have to go through an insurance company to make sure that they think that’s okay,” Dr. Debra Patt, a breast oncologist and member of the Texas Medical Association, said.

Dr. Patt said the prior authorization process often delays her ability to treat and evaluate her patients.

“You can imagine that patients tremendous anxiety with their new cancer diagnosis if they have to wait a week or two to get information that they can get appropriate scans,” Dr. Patt said.

According to TMA, eight in 10 Texas physicians reported having to obtain prior authorization for medical procedures and common prescriptions. Of those doctors, 85% reported that process delayed patient care, ranging from days to months.

“That can change a child with a urinary tract infection from a local problem to a septic illness that could be potentially life-threatening,” Dr. Patt explained.

Now, House Bill 3459 gives doctors who have a 90% approval rating from an insurance company a ‘gold card,’ meaning they can skip the pre-approval process for that specific study.

“If you have prior authorizations that have been approved, and you have at least five of those in any six-month period, then it gives you a rolling approval when you order the same study,” Dr. Patt said.

But the Texas Association of Health Plans said these requirements are not enough.

“The way that it’s implemented, having just this very basic sampling, and a limited window of time, we can’t have a good assessment if physicians are really prescribing care and treatment in good faith. And it’s just an invitation for waste, fraud and abuse,” TAHP director of communications Alicia Pierce explained.

She said there are better ways to speed up the process, including avoiding using a fax machine and passing legislation that would make it easier to correct clerical mistakes.

Pierce also added that if a patient has multiple providers, who prescribe multiple drugs, the insurance company would be the only one with oversight to catch a potential bad interaction that could cause side effects.

“You have multiple providers who are providing different drugs and different prescriptions that may not show up for the doctor. And insurance companies are the only ones that have that 360 view of the patient’s health care,” Pierce said.

But Dr. Patt said health insurance companies are just trying to manage costs.

“They’re not in patient rooms, giving care to patients every day,” Dr. Patt said.

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