Your insurance company could hold up or deny medical treatments

If you go to the doctor and need a medication or treatment for a serious problem, chances are you will have to wait for your insurance company to give a pre-approval for whatever your physician is recommending.

One New Jersey lawmaker is pushing a plan to change things.

Legislation sponsored by Assembly Minority Leader Jon Bramnick, R-Union, would prohibit health insurers, third-party administrators, pharmacy benefits managers and the State Health Benefits Program and the School Employees’ Health Benefits Program from requiring the pre-approval or pre-certification of medical tests, procedures or prescription drugs covered under an individual’s health benefits or prescription drug plan.

He said years ago if a doctor wanted a specific drug or test for a patient the physician would write a prescription and that would be that. But today, insurance companies are frequently slowing down or stopping the process.

“Why should an insurance company make a determination when your doctor already decided the issue? So now it’s become, in my judgment, obstruction by the insurance company to stop you from getting a treatment," he said.

He said insurance companies are now routinely making decisions about medical issues based on profit, not what is best for a patient with a serious problem.

Bramnick said this results in a "ridiculous" situation “where patients either get denied or they have to wait for months to get approval."

“What do we need pre-approval for? We’ve already got an approval from the doctor.”

He noted this issue came into sharp focus because his office manager had late stage cancer and then chemotherapy.

“Then she couldn’t get an MRI because of what she had to go through with her insurance company. Why should an insurance company decide whether you need an MRI after chemotherapy?" he said.

“The doctor went to medical school, not the insurance companies.”

He said a committee hearing has been held on the measure, A4613, but no vote was taken.

You can contact reporter David Matthau at David.Matthau@townsquaremedia.com