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From YouTube: House Insurance Committee- April 13, 2021
Description
House Insurance Committee- April 13, 2021
A
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C
A
A
We
have
a
motion
and
a
second
on
the
amendment
chairman
smith.
Would
you
like
to
adopt
the
amendment
and
then
tell
us
about
the
amended
bill
that
would
be
favorably
received?
Thank
you,
sir.
Thank
you.
Without
objection,
members.
We
are
voting
on
adopting
amendment
6804
to
house
bill
0636,
all
those
in
favor,
please
say
aye.
I
opposed
the
amendment
goes
on
the
bill.
Chairman
smith,
you're
recognized.
C
C
What
what
this
bill
does
is
establishes
encode
a
process
through
the
department
of
commerce
and
insurance
to
ensure
that
networks
are
indeed
adequate,
we're
witnessing
on
a
growing
level
that
the
issue
of
surprise
or
balance
billing
is
an
issue,
while
indeed
there
is
a
federal
air
quote
fix
that's
in
order.
We
are
still
seeing
more
and
more
people
struggle,
and
if
the
chairman
would
indulge
me,
I
want
to
read
just
a
couple
of
letters
that
came
that
have
been
sent
to
me
from
individuals.
C
Bristol
anesthesia
services
sent
on
march,
the
14th
2020
a
letter
to
me
talking
about
their
status
as
the
sole
provider
of
anesthetic
and
peer
operative
services
to
bristol
regional
medical
center.
They
were
informed
by
a
healthcare
entity
that
their
reimbursement
would
be
cut
by
50
percent.
If
they
did
not
accept
that
cut,
they
would
be
out
of
network.
I
received
a
correspondence
on
may
the
8th
2020
of
from
the
anesthesia
medical
group
that
served
over
10
hospitals,
13,
ambulatory,
centers
and
included
500
anesthesia
providers.
C
They
were
told
to
take
a
similar
cut.
I
received
on
january
31st
of
this
year
a
notification
from
a
radiology
group
where
their
patients
had
been
informed,
summarily
that
that
that
they
would
no
longer
be
in
network.
I
received
on
january
the
eighth
of
this
year
from
middle
tennessee
respiratory
services
that
serves
one
two
three
four,
five:
six,
seven,
eight
rural
counties
around
the
bedford,
coffey
county
area
that
for
several
years,
they've
been
trying
to
get
in
network
for
to
be
a
provider
of
oxygen
and
respiratory
therapy.
C
What
we're
finding
is
it's
more
and
more
difficult
for
people
to
ensure
that
there
are
indeed
adequate
networks.
The
purpose
of
this
bill,
mr
chairman
and
committee,
is
to
have
access
plans
filed
on
an
annual
basis
to
the
department
of
commerce
and
insurance.
The
commissioner
will
promulgate
rules
and
ensure
that
there
is
not
a
a
hardship
place
on
patients
and
that
will
indeed
be
able
to
receive
their
care,
and
with
that,
mr
chairman
I'll
be
happy
to
take
questions,
but
I
do
ask
for
support
of
the
bill.
D
C
Please,
yes,
jim
and
smith.
Thank
you
thank
you,
chairman,
and
thank
you
from
my
colleague
chairman
powers.
The
the
department
of
ten,
the
bureau
of
tenncare
has
been
removed,
as
has
covered
tennessee
cover,
tennessee,
kids
I'll
get
out
in
a
minute,
and
the
reason
for
that
has
been
simply
that
the
center
for
medicare
and
medicaid
services
require
that
that
particular
care
be
under
the
jurisdiction
only
of
cms,
and
so
that's
why
the
fiscal
note
is
actually
nine
billion
dollars,
not
million,
and
so
we
we
remove
them
from
this
particular
bill.
C
D
A
C
You
chairman,
there
are
standards,
adequacy
standards
that
are
determined
by
the
bureau
of
tenncare,
and
I
think
it's
very
appropriate
for
this
body,
as
well
as
the
department,
our
health
committee,
to
engage
with
the
bureau
of
tenncare
to
ensure
that
there
are
indeed
adequate
networks
chairman.
So
I
share
your
your
commitment
to
making
sure
that
we
have
adequate
networks
in
both
the
bureau
of
tenncare,
as
well
as
in
our
commercial
pay,
but
this
bill
the
only
jurisdiction
as
far
as
this
bill
would
be
under
title
56,
which
is
the
commercially
insured.
E
Thank
you,
mr
chairman,
just
just
two
questions,
so
the
letters
you
talked
about
getting
the
insurance
company
notified
the
the
physicians
that
they
would
be
getting
a
50
reduction.
Wouldn't
that
be
good
for
the
consumer
if
they're
they're,
lowering
the
costs
and
then
I'll.
Just
ask
you
the
second
question
too,
in
here,
there's
there's
a
misdemeanor
for
for
changing
or
or
for
not
adhering
to
certain
things
in
the
the
the
bill.
E
E
If
a
doctor
was
to
get
get
orders,
her
husband
or
his
wife
was
to
get
orders
to
to
go
to
a
different
base,
get
transferred
and
and
that
that
physician
that
that
they're
married
to
also
has
to
obviously
leave
at
that
point
and
and
they
leave
in
60
days,
they
didn't
give
a
90
day
notification
that
they'll
no
longer
be.
You
know
accepting
blue
cross
blue
shield
of
tennessee,
because
wherever
they
move
doesn't
doesn't
have
that
insurance.
Would
they
be
in
violation
of
that
misdemeanor.
C
Chairman
smith,
thank
you
chairman
and
I'll.
Take
the
the
clearly
the
first
question.
First,
it's
interesting.
I
wish
that
there
was
a
a
free
market
pressure
point
already
that
reimbursement
rates
did
match
the
cost
of
care,
because
clearly
I
think
that
we
would.
We
would
see
a
different
health
care
market,
however,
for
a
provider
to
be
informed
that
they're
going
to
have
a
50
percent
cut
in
their
reimbursement
for
the
for
the
delivery
of
care
does
not
translate
into
a
lower
cost
for
the
patient.
C
C
Are
we
finding
that
that
you
know
the
the
management
of
utilization
is
used
and
you're
you're,
reducing
utilization
rather
than
the
cost
of
care,
and
then
on
the
specific
issue
and
and
you're
gonna?
I
may
have
to
ask
the
indulgence
of
the
chairman
in
the
case
that
that
are
you
talking
about
a
physician.
That's
on
a
an
army
base
delivering
care.
Would
this
be
within
the
va
system?
I
want
to
make
sure
that
I'm
I'm
not
misspeaking.
E
Thank
you,
no
just
just
a
a
dependent
or
a
spouse
of
an
active
duty
soldier.
You
know,
obviously
they
they
get
orders
to
pcs
fairly
quickly
at
times
and
and
so
if
they
get
orders
to
leave
fort
campbell
to
fort
hood,
texas
and-
and
you
know,
their
spouse
who's.
An
active
physician
in
clarksville
doesn't
have
time
to
give
a
90-day
notice
of
change
of
policy.
Is
that
is
that
going
to
be?
Are
they
going
to?
You
know,
be
be
in
violation
and
potentially
result
in
a
class,
a
misdemeanor.
C
Jim
and
smith-
and
I
appreciate
the
question
again-
that
that's
one
of
those
one-off
circumstances
that
I
don't
have
the
answer
to.
I
think
that
in
that
particular
case
in
in
contracting,
if
you
are
a
provider-
and
you
know
that
your
your
practice
is
going
to
be
influenced
by
you-
know
your
likelihood
for
deployment,
I
would
assume
and
appreciate
the
fact
that
providers
would
engage
in
contracting.
That
would
mirror
their
circumstances.
C
But
in
a
particular
case
like
that,
I
don't
have
the
answer
and
again
because
this
is
all
promulgated
under
the
department
of
commerce
and
insurance.
That
is
the
the
construct.
That's
permissible
for
the
commissioner
to
exert
that.
I
really
do
believe
that
commissioner
lawrence
and
his
staff
would
most
likely
engage
in
reasonable
accommodations
in
such
a
case
representative.
B
E
Yes,
so
so
does
that
individual
that
that
has
to
potentially
leave
in
a
hurry?
You
know
if
they're
accepting,
like
I
said,
blue
cross,
blue
shield
of
tennessee
or
aetna
or
whatever
they're
accepting,
and
they
they
get
relocated
or
assigned
to
to
a
different
location
that
doesn't
accept
that
insurance
and
they
have
to
leave
within
90
days.
Would
they
be
in
violation,
and
would
they
be
subject
to
that
class?
A
misdemeanor.
C
Thank
you
and
to
my
colleague
I
I
know
within
contracting
now
there
already
are
provisions
and
and
aspects
and
I'd,
be
happy
to
hear
from
a
colleague
who's
a
doctor
on
the,
but
as
as
I
understand
that
there
are
current
current
provisions
in
contracts.
Excuse
me
I'm
sorry.
There
are
current
provisions
and
contracts
that
discuss
terms
of
departure
and
leaving
a
network,
and
essentially
I
think
that
the
the
desire
here
is,
as
you
heard,
those
other
four
letters
and
there
were
others
that
were
sent.
C
A
Thank
you.
I
don't
really
know
whether
that
physician
is
employed.
If
they
are
unemployed
to
another
entity,
then
it
is
the
entity's
job
to
provide
alternative
coverage.
If
the
physicians
in
private
practice,
then
there
are
guidelines
from
the
board
of
medical
examiners
that
help
you
guide
through
properly
closing
your
practice
to
leave
and
one
they
would
just
have
to
check
with
those
guidelines
and
comply.
F
Thank
you
chairman,
and
to
follow
up
on
a
point
in
those
letters
and
to
the
representative
that
talked
about
the
from
a
patient's
standpoint.
Overhead
for
physicians
and
physicians
offices
has,
with
all
the
new
regulations
and
everything
that's
gone
on,
has
crept
up
significantly
and
it
may
be
65
75
cents
on
the
dollar.
That's
going
towards
overhead!
F
F
F
You
may
be
selling
your
practice,
you
may
be
moving,
and
so
access
and
rural
areas
is
is
a
problem
and
if
you
go
out
of
network,
know
that
right
now
you
know,
oftentimes
physicians
in
private
practice
will
sign
a
contract
that
is
90
cents
on
the
dollar
or
85
cents
on
dollar.
But
if
you're
kicked
out
a
network,
you're
probably
going
to
be
charging
100
cents
on,
you
know
the
the
entire
amount,
and
so
from
a
patient
standpoint.
You
may
be
getting
the
entire
bill
of
100
versus
90.
F
C
Physicians,
their
specialists,
their
emergency
care,
and
I
will
tell
you,
colleagues,
one
provision
in
this
bill
that
we
should
all
take
great
pride
in
is
we
have
added
to
the
definition
of
an
emergency
mental
health
services
and
and
those
type
of
services
that
would
be
considered
in
in
a
mental
health
crisis
or
an
emergency
which
have
not
otherwise
been
covered
in
health
care
coverage
and
adequacy
addresses.
So
I
think
that
that,
with
all
of
our
emphasis
and
and
attention
that
we've
been
given
in
recent
years
to
mental
health,
this
is
a
terrific
provision.
A
A
That's
a
relative
term
in
the
sense
that
a
physician
knows
that
10
care
for
this
particular
service
is
going
to
pay
me
a
hundred
dollars.
He
can
choose
in
his
billing
to
put
a
charge
of
thousand
dollars
or
500
on
it.
There
is
no
limit
on
what
the
physician
charges
so
the
hundred
dollars
that
10k
is
going
to
pay
automatically
becomes
10
cents
on
the
dollar.
A
If
the
physician
chooses
to
charge
a
thousand
dollars
and
because
there
is
no
limit
on
what
a
physician
can
charge
so
that
can
be
a
bit
deceptive
and
as
true
that
10
care
compared
to
regular
market
insurance
pays
less.
But
to
quote
one
of
our
kindest
people,
10
care
is
doing
god's
work
and
that's
what
physicians
are
doing
when
they
do
take
10
care
patients
and
work
for
lesser
reimbursement
than
others
members.
Any
other
questions.
A
A
G
G
A
A
A
A
G
H
H
H
That
number
should
be
higher.
Considering
the
relatively
low
household
income
in
tennessee,
the
uninsured
rate
should
be
higher,
considering
the
relatively
low
health
status
in
tennessee.
That
number
should
be
higher.
Considering
that
tennessee's
not
expanded
medicaid,
that
number
should
be
higher.
My
point
is
by
all
measurable
metrics.
H
Any
state
with
comparable
demographics
to
tennessee
has
a
higher
uninsured
rate,
primarily
because
of
the
regulations
and
the
coverage
mandates.
They've
passed
of
that
10.2
percent,
almost
half
of
them,
make
over
50
000
a
year.
Think
about
that.
The
fastest
growing
percentage
of
the
uninsured
population
is
not
low
income
and
indigent
it's
the
working
middle
class.
That's
because
the
people
that
are
most
cost
sensitive
are
those
that
pay
out
of
pocket
for
their
individual
policies
and
those
small
businesses
that
have
to
offer
fully
insured
products
that
don't
have
the
luxury
of
being
self-insured.
H
This
bill
directly
affects
specifically
those
two
populations.
Now
someone
recently
accused
the
industry,
and
I
use
that
term
lightly
of
just
caring
about
a
healthy
profit
margin.
Consider
this
insurance
companies
operate
on
a
percentage
of
the
premium.
If
we
operate
on
a
margin,
companies
have
every
incentive
for
premiums
to
go
up,
because,
theoretically,
our
margin
would
go
up,
but
the
problem
with
that
I
apologize
for
getting
a
little
bit
peppery
on
this.
H
Individuals
and
businesses
decide
every
day
if
they
can
afford
their
insurance.
Now
the
difference
in
a
pure
coverage
mandate
and
some
of
the
what
I'll
call
the
healthy
disagreements
we
have
on
payer
provider
relationships
is
a
a
pure
coverage
mandate,
simply
adds
cost.
There's
no
discussion
of
excuse.
H
H
Now,
certainly
my
last
statement,
madam
chairman.
Certainly
this
legislation
will
help
people
that
can't
afford
this
coverage
and
that's
the
sponsor's
passion,
and
we
appreciate
that
there
are
also
people
out
there,
especially
in
that
range.
I
mentioned
that
want
to
start
a
family
and
they're
worried
about
losing
their
insurance
because
they
want
to
start
a
family.
There
are
people
out
there
whose
children
are
going
through
medical
treatments
and
they
lay
awake
at
night.
Thinking
what's
going
to
happen
if
they
lose
their
insurance.
E
H
That's
a
broad
question
representative:
there
was
a
study
done.
I
believe
it
was
in
2010
a
white
paper
by
an
actuarial
firm
on
the
effect
of
mandates
in
tennessee.
At
that
time
they
estimated
and
I'm
going
by
memory
here,
sir.
They
estimated
that
18.2
of
the
total
premium
dollar
in
tennessee
was
attributed
to
either
coverage
mandates
or
various
regulations
that
affect
how
we
do
business.
H
G
E
We've
we've
got,
we
can't
just
pick
on
on
one
party
right:
we've
got
to
start
calling
them
all
out
and
we've
got
to
have
a
maximum
of
of
what
what
people
are
allowed
to
bill
these
insurance
companies,
because
at
the
end
of
the
day,
if
we
keep
on
the
rate
we're
going
the
nobody's
going
to
be
able
to
afford
insurance
anymore
and
and
that
that'll
help.
Somebody
like
me
that
believes
in
a
single-payer
system,
but
but
I
don't
think
the
majority
of
people
sitting
in
this
committee
will
agree
with
me
on
that.
E
You
know
the
bottom
line
is
we
spend
a
whole
lot
of
money
on
health
care
every
year?
You
know,
as
a
country
we
spend
almost
twice
gdp
in
health
care
is,
is
our
european
counterparts
that
cover
a
hundred
percent
of
of
their
citizens
and
the
bottom
line?
Is
our
health
outcomes?
Are
far
worse
than
those
countries
in
a
study
on
on
11
countries,
health
care
outcomes,
we
rank
dead
last,
so
so
it's
not
quality
we're
just
paying
for
bad
service
and
and
so
at
some
point,
we've
we've
we've
got
to.
E
D
Thank
you,
madam
chair,
and
thank
you
for
your
testimony.
I'll
make
it
very
short,
but
we
heard
a
definition
of
insurance
a
few
minutes
ago
about
things
that
we
were
unable
to
cover.
I
want
to
give
you
webster's
dictionary
their
definition
of
insurance.
It's
a
coverage
by
contract
whereby
one
party
undertakes
to
indemnify
or
guarantee
another
against
laws
by
specified
contingency
or
pearl.
H
H
D
Yes,
thank
you,
and
I
have
been
in
this
situation
so
I'll
I'll
leave
that
my
questions
to
that
though,
but
I
just
I
just
wanted
to
make
sure
that,
under
that
definition,
I
was
trying
to
figure
out
how
that
would
be
to
find
you
know
when
we're
looking
at
this
type
of
service.
Okay-
and
thank
you,
madam
chair.
H
I
I
I
A
Thank
you
manager.
I
would
like
to
point
out
that
on
amendment
666
there
is
a
fiscal
note
and
on
page
four
of
that
fiscal
note,
the
fourth
line
says
average
per
member
apartment
month.
Cost
is
90
cents.
So
we
don't
know.
This
is
calculated
by
our
fiscal
review
department
and
it's
really
a
very
thorough
calculation
of
what
the
percentage
of
people
who
have
infertility.
What
percentage
need
treatment?
How
many
of
them
will
have
you
know
the
exotic
or
the
most
expensive
forms
of
treatment,
including
ivf
and
calculating
all
that?
A
C
Smith,
thank
you,
madam
chairman,
and
for
the
guest
mr
sanders
currently.
Is
there
an
average?
Are
you
aware
of
what
the
average
benefit?
Let's
say
that
we
choose
to
move
forward
with
this
in
the
in
the
chairman's
bill.
There
is
a
cap
on
this
of
a
hundred
thousand
dollars
for
the
benefit
in
your
in
the
industry
of
insurance.
What
is
the
average?
You
know,
I
guess
of
a
covered
benefit.
Should
this
be
adopted,
because
a
hundred
thousand
dollars
is
a
lot
of
money.
H
Yes,
ma'am,
that's
correct.
There
was
some
discrepancy
last
week
or
some
confusion.
Excuse
me
whether
the
caps
that
we
have
seen
are
annual
or
lifetime,
and
that
certainly
makes
a
substantial
difference
and
it
may
be
clarified
in
the
amendment.
I'm
not
certain.
I
cannot
think
representative
of
any
other
covered
benefit
that
has
a
dollar
cap
on
it.
There
are
some
certain
and
there
may
be
some.
I
can't
think
of
any
off
the
top
of
my
head.
C
Thank
you,
mr
chairman,
and,
and
in
in
your
estimation,
is,
is
the
what
is
because
I
know
in
reading
some
information.
That's
available
online.
Some
states
do
put
a
cap
as
low
as
some
fifteen
thousand
dollars
in
your
industry.
Is
there
a
model
legislation?
Is
there
some
sort
of
information
that
would
give
us
some
a
a?
C
I
guess,
a
benchmark
to
understand
what
a
reasonable
benefit
coverage
would
be,
or
in
the
case
of
my
colleague,
mr
sapiki,
I
know
that
he
had
submitted
an
amendment
that
would
make
this
an
optional
writer,
where
the
the
premium
holder
could
indeed
apply
part
of
their
premium
toward
this
type
of
benefit.
If
you
could
speak
to
that,
thank
you,
madam
chairman.
H
A
Thank
you.
Thank
you,
madam
chair.
For
that
question.
I
can
clarify
that
one
we
did
check
with
legal
as
well
as
with
the
department
of
commerce
and
insurance,
to
say
that
yes,
caps
are
legal,
they
can
be
applied,
and
that's
also
true,
with
the
business
community
who
wanted
this
cap
of
100
000
is
relatively
high.
Yes,
it
is
a
lifetime
cap.
On
the
senate
side,
the
emphasis
is
on
a
50
000
cap
and
our
my
my
tennessee
fertility
association
are
good
with
that.
A
So
in
an
effort
to
decrease
the
fiscal
note
further,
you
know
adjustments
are
made
on
the
way
to
finance
committee
and
we
plan
to
do
that
to
make
it
better.
Once
again,
the
cost
already
per
member,
as
predicted
by
the
fiscal
review
committee,
is
90
cents
per
member,
and
I
think
we
can
even
make
it
better.
Thank
you.
Manager.
J
H
Thank
you,
madam
chairman.
There
was
a
study
done
in
the
late
2000s
representative
or
maybe
shortly
after
2010.
It
was
a
nationwide
study,
the
only
one
that
that
empirically
speaks
to
your
question
that
I'm
aware
of,
and
it
demonstrated
that
for
every
one
percent
nationwide
for
every
one
percent
increase
in
premium,
400
000
people
would
drop
coverage.
H
Now,
that's
a
very
broad
estimate.
I
can
tell
you
for
for
us.
I
have
polled
our
call
centers
before
because
I'm
curious
on
when
the
phones
start
ringing
when
premiums
go
up.
What
our
folks,
our
internal
folks
tell
me
is
that
when
premiums
go
up
ten
dollars,
they
start
getting
calls
on.
How
can
I
what
kind
of
coverage
can
I
drop?
What
kind
of
deductible
can
I
raise
when
increa
when
increases
are
twenty
dollars?
We
start
getting
calls?
I
can't
afford
the
coverage
anymore.
J
This
bill
is
very,
I
don't
think,
there's
anybody
up
here.
That
would
say
outwardly.
This
is
a
terrible
idea.
I
I
there's
not
anybody
up
here
with
that.
That
would
be
frankly
that
heartless,
but
what
we're
talking
about
even
small
moves
spread
out
over
millions
of
people
with
what
may
seem
to
us
in
this
room
to
be
small
cost.
J
K
K
Okay,
thank
you,
mr
sanders.
My
question
about
the
third
party
coverage
of
surrogates
is
from
the
insurance
perspective.
What
is
the
limit
of
coverage?
If
you
have
a
third
party
entering
two,
you
have
a
couple
who
has
the
insurance,
but
then
you
bring
in
a
third
party.
Do
you
have
enough?
Do
we
have
enough
protections
bill
that
the
medical
needs
of
this
third
party,
which
could
be
multiple,
that
you
may
not
know
about
how
how
much
coverage
healthcare
coverage
does
that
person
get
whether
it's
related
or
unrelated
to
the
pregnancy?
H
Yes,
sir,
madam
chairman,
thank
you
chairman.
Why
that
very
question
has
caused
a
good
deal
of
discussion
in
the
insurance
industry
and
the
short
answer
is
we
don't
know,
we've
never
had
a
situation
as
a
company
if
you
will
or
an
industry
where
legislation
has
required
us
to
do
business
with
a
third
party
with
whom
we
don't
have
a
contract.
H
Now
I
presume
some
of
the
parameters
of
this
coverage
would
be
spelled
out
in
the
bill
or
the
amendments.
I'm
not
suggesting
it's
wide
open,
but
it
does
beg
some
of
those
questions.
First,
how
broad
that
coverage
would
be
what
is
related
to
the
maternity
benefits
of
that
third
party
and
then
how
far
do
those
extend
and,
frankly,
sir,
we're
not
sure
because
we've
never
been
in
that
situation
before.
K
Thank
you
and
that
that
does
give
me
concern
and
I
I'm
taking
what
we're
doing
very,
very
seriously.
It's
an
emotionless
in
many
ways
my
daughter's
oldest
son
went
through
ivf
also,
so
I
understand
the
procedure
and
and
what
it
does
for
a
couple,
but
the
surrogate
issue
of
health
care
coverage
when
you're
bringing
in
a
third
party,
which
we
don't
really
know
all
the
health
issues
that
that
person
may
have.
Thank
you.
A
Thank
you,
madam
chair
I'd,
like
to
clarify
that
third
party
coverage
does
exist
and
one
example
would
be
organ
donation.
If
I
want
to
give
a
kidney
to
my
sister,
my
sister's
plan
will
cover
it
because
she's
the
patient,
I
am
not,
I
may
not
even
have
insurance
coverage
or
I'm.
I
definitely
may
not
have
coverage
under
the
same
contract
that
my
sister
does
so
third-party
coverage
in
that
situations
exist.
It
applies
to
the
particular
condition.
A
It's
not
that
if
I
am
become
covered
by
the
insurance
company
for
donation
of
a
kidney
there
and
later
on,
I
develop
another
problem
that
they're
going
to
cover
that
so
that,
in
this
situation,
third
party
coverage
will
be
one
will
be
that
the
patient
or
a
woman
does
not
have
enough
eggs.
Eggs
need
to
be
donated
by
somebody
else,
and
the
eggs
are
harvested
and
the
insurance
coverage
will
be
limited
to
that.
Similarly,
for
obtaining
sperm
and
other
things
ensure
it
would
be
limited
to
that.
A
In
the
surrogate
situation
the
patient
has
has
eggs,
her
spouse
has
sperm
their
fertilized,
but
the
implantation
is
complicated
because
of
problems
with
the
uterus
with
the
patient,
so
a
surrogate
may
come
into
that
picture
and
the
pregnancy
would
be
covered
just
as
it
would
be
covered
for
the
patient
themselves.
So
it's
the
cost
to
the
insurance
will
be
the
same.
There
are
ethical
issues
I
understand
on
how
we
feel
about
surrogacy,
but
the
cost
to
the
insurance
company
will
remain
the
same
as
if
the
pregnancy
occurred
in
the
patient
themselves.
G
K
A
G
D
B
B
H
Chairman,
I
will
address
that.
I'm
not
sure
if
I
can
explain,
but
I
will
be
glad
to
address
that
to
your
first
question.
The
90
cents
presumably
would
be
per
per
member,
so
per
member
of
the
household
in
the
insurance
industry.
We
use
pmpm
per
member
per
month,
so
an
individual
would
be
one
family
of
four
would
be
multiplied
by
four,
a
family
of
ten,
and
we
have
some
families.
Ten
in
our
book
of
business
would
be
that
times.
H
Ten
to
your
second
point
about
the
disparity
of
the
cost,
I
confess
I
have
not
read
the
calculations
from
the
fiscal
note,
so
I
can't
speak
to
whether
they're,
accurate
or
not,
but
allow
me
to
tell
you
how
we
develop
numbers
insurance
companies
use
actuaries
and
I'm
going
to
go
I'll.
Be
I'll.
Try
to
be
brief,
madam
chairman,
but
I'm
going
to
go
around
the
barn.
For
just
a
moment.
H
H
Their
job
is
to
predict
the
cost
in
12
24
36
months
down
the
road
when
we
submit
our
insurance
rates
to
the
department
of
insurance,
who
has
to
approve
our
annual
premiums
every
year
we
have
to
use
by
law,
we
have
to
use
actuarial
data,
an
actuary
has
to
say
this
is
what
it's
going
to
cost
and
we
get
the
call
or
the
question
all
the
time.
Can
you
do
something
about
my
rates?
Well,
we
don't
develop
the
rates
our
actuaries
do
and
in
fact,
actuaries
actuarial
science
is
so
specific.
H
There's
19,
000
actuaries
in
the
whole
us
there
are
very
few
of
them
because
it's
such
a
specific
science.
So
a
lot
of
companies
actually
use
actuarial
firms
because
it's
such
a
specialized
science.
So,
with
that
being
said,
sir,
when
we
develop
cost
impact
of
legislation,
we
have
to
send
that
to
our
actuaries
and
they
calculate
it.
And
let
me
give
you
two
points
on
that:
in
calculating
a
cost.
H
There
is
the
in
the
in
the
rate
of
incidence,
how
many
people
would
use
a
benefit
and
then
there's
the
cost
of
the
benefit
on
the
rate
of
incidents.
That
can
be
a
tricky
number,
if
you
say,
there's
this
many
people
today
and
I'm
using
an
example
that
get
lasik
surgery.
So
if
we
pay
for
lasik
surgery,
is
that
same
number
going
to
get
it
tomorrow?
Well,
no
because
the
question
is
not
how
many
people
getting
it
today
will
get
it
tomorrow.
H
The
question
is
how
many
people
will
get
it
tomorrow
when
it's
paid
for,
and
that's
a
really
hard
number
to
estimate,
which
is
why
actuaries
are
so
good
at
what
they
do.
So
the
rate
of
incidence
is
the
first.
The
second
is
the
total
cost,
and
let
me
give
you
a
an
example
on
that.
I
read
about
a
medical
procedure.
H
If
you
were
looking
at
the
accounting
rate,
what
is
this
gonna
cost
an
accountant
would
say
a
thousand
dollars
per
person
times.
However
many
people,
but
the
actuary
would
say
no.
The
cost
is
the
cost
of
that
plus
the
25
of
people
that
spend
two
weeks
in
the
icu,
so
actuaries
look
at
the
total
cost
over
time.
H
I
believe
personally,
that
in
this
case-
and
that
was
a
long
explanation-
that
our
actuaries
look
at
the
total
cost
of
it,
fertility
treatments
usually
result
in
higher
pregnancy
costs,
for
example,
more
time
in
the
nicu
more
incidence
of
rate.
In
the
knee
cue,
I
believe
that's
where
the
cost
disparity
comes
from
they're,
including
the
total
cost
over
time.
G
F
F
My
colleague
from
knoxville
gave
a
pretty
good
summary
of
the
issue,
but
based
on
the
premiums,
currently,
you
said
with
one
percent
increase,
potentially
400
000
decrease
in
those
that
will
be
insured
and
with
potentially
from
a
four
to
twelve
dollar
per
member
per
month.
I
mean
that
may
be
anywhere
from
400
000
to
1.2
million.
F
Currently,
this
bill
shows
this
amendment
shows
a
state
expenditure
of
3.7
million
and
subsequently,
after
that,
4.7
million
that
would
cost
the
state,
in
addition,
federal
dollars
of
for
4
million
and
8
million.
So
obviously,
as
the
costs
go
up,
you
know
you're
going
to
lose
people
on
commercial
insurance.
It's
going
to
and
the
uninsured
goes
up.
F
So,
in
speaking
to
the
payer
mix
that
we
had
on
the
other
bill,
it's
going
to
make
it
much
more
difficult
in
rural
areas,
those
of
us
that
are
trying
to
without
expanding
medicaid,
to
get
those
uninsured
that
we
have
in
tennessee
ensured
this
bill
is
going
to
make
that
more
difficult
for
us
to
do.
In
fact,
that
may
it's
going
to
increase
those
other
roles
and
and
for
those
of
us
that
are
trying
to
get
commercial
insurance
to
the
uninsured,
it
makes
it
much
more
difficult.
So
I've
gone
from
a
quiet.
F
G
G
G
L
You
chairman,
kumar,
vice
chairman,
rudder
members
of
the
committee.
My
name
is
kara
garrett.
I
have
worked
at
the
national
fertility
center.
Oh
sorry,
I'm
an
rn.
I've
worked
at
the
national
fertility
center
for
15
years.
Part
of
this
bill
addresses
fertility
preservation
for
cancer
patients,
and
these
patients
are
my
passion.
L
These
are
patients
of
childbearing
age
who
have
just
recently
been
diagnosed
with
cancer,
and
they
must
move
quickly
for
women.
The
cycle
entails
a
couple
of
weeks
of
injectable
hormones,
a
routine
surgery
where
we
retrieve
the
eggs
under
anesthesia
and
then
freeze
those
eggs
for
future
use
in
an
ivf
cycle
soon,
after
sometimes
even
the
same
day
of
their
retrieval.
These
women
begin
chemotherapy
and
or
radiation,
and
cancer
treatment
has
come
a
long
way,
especially
in
younger
patients.
More
and
more
of
these
patients
are
surviving
their
diagnosis,
but
many
times
the
treatment
renders
them
infertile.
L
Hope
is
vital
for
patients
with
a
cancer
diagnosis,
but
there
are
many
times
when
a
patient
or
their
parent
tells
us.
They
can't
afford
to
do
the
procedure
because
it's
considered
elective
cancer
is
never
elective.
Just
last
week
we
saw
a
13
year
old
boy
with
cancer.
A
month
ago,
a
17
year
old
girl
with
cancer.
Three
months
ago,
a
32
year
old
woman
who
delivered
a
healthy
baby
and
weeks
later,
was
diagnosed
yesterday,
a
28
year
old
woman
with
cancer.
I
had
two
more
patients
coming
into
our
office
to
see
me
tomorrow.
L
L
M
Is
that
working
though,
okay
good
morning,
chairman
kumar,
vice
chairman,
rudder
and
committee,
my
name
is
candace,
william,
I'm
also
an
rn
at
nashville
fertility
center.
Although
my
journey
with
infertility
started
at
the
age
of
24,
when
I
needed
a
partial
hysterectomy
due
to
a
complication
associated
with
potential
deadly
clotting
disorder,
I
was
devastated
and
that
emotion
later
became
dread.
When
I
met
married,
my
husband,
I
was
afraid
we'd
never
have
the
opportunity
to
have
our
own
children
because
of
what
I'd
been
through,
but
he
loved
and
married
me
just
the
same.
M
Knowing
that
ivf
and
a
gestational
carrier
was
our
only
option
to
expand
our
family
at
the
beginning
we
were
young
and
just
starting
out.
We
knew
we
couldn't
afford
it
then
and
knew
what
it
would
take
fast
forward.
Seven
years
he
became
a
commissioned
officer
in
the
army
and
I
finished
my
degree
and
became
a
nurse
during
the
intervening
years
we
saved
and
planned
until
it
was
time
to
go
for
it.
M
We
rallied
our
friends
and
family
all
the
funds
we
had
and
even
took
out
loans
for
our
first
and
likely
only
attempt
and
had
a
successful
transfer.
However,
nine
weeks
later,
we
learned
that
we
had
lost
a
pregnancy.
We
were
washed
away
from
that
experience
in
a
river
of
grief
staring
at
a
mountain
of
debt.
It
almost
broke
us
emotionally
and
financially
still,
we
were
hopeful
that
we'd
be
able
to
try
again.
M
So
two
years
later,
after
nine
years
of
planning,
two
ivf
cycles,
hundreds
of
shots,
two
loans,
two
surgeries,
two
transfers,
one
miscarriage
and
about
a
hundred
thousand
dollars
our
trepidation
and
fear
of
the
unknown,
gave
way
to
joyful,
bliss
and
our
family
was
finally
complete,
welcoming
fraternal
twins,
my
son
leo,
and
my
daughter
sutton,
who
are
now
three.
This
was
a
long
journey
that
had
ups
and
downs
and
was
financially
draining,
but
holding
these
two
miracles
made
everything
worthwhile.
M
Sorry,
we
are
fortunate
that
we
were
able
to
make
our
desire
to
expand
our
family
a
reality,
but
everyone
is
not
always
as
fortunate.
So
I
know
this
bill
will
not
have
an
impact
on
me
personally,
as
my
family
is
complete,
but
for
so
many
in
our
state,
this
bill
would
prevent
this
unwanted
roller
coaster
of
stress
and
pain
and
give
them
at
least
the
potential
to
grow
a
beautiful
family
and,
as
is
often
the
case
with
policy
proposals
like
this.
M
C
You
know
I
don't
know
why
people
have
miscarriages,
I
don't
know
why
we
lose
family
members.
But
what
I
do
appreciate
is
my
concern
and
there
is
a
question:
that's
embedded
here:
are
we
picking
in
vitro
fertilization
through
management
of
insurance
policy
over
adoption,
because
there
are
a
lot
of
children
that
are
looking
for
homes,
even
as
we're
speaking
here?
C
I
do
know
in
other
states
that
this
policy
is
tethered
to
not
just
infertility,
but
the
money
can
be
paid
in
a
benefit
toward
an
adoption,
and
what
I'd
just
like
to
hear
you
articulate
is
in
in
both
of
your
cases
as
nurses,
a
what
is
the
average
age
of
patients
that
you
see
who
are
engaged
in
the
infertility
treatments
number
one
and
number
two,
how
many
treatments
typically
are
needed
for
a
successful
fertilization.
Thank
you,
madam
chairman,
for
your
indulgence.
L
L
There
are
lots
of
so
sorry,
so
it
depends
on
the
age
of
the
patient.
It
depends
on
the
diagnosis.
It
depends
on
the
sperm
quality.
You
know,
there's
there's
so
much.
You
know
that
you
can
say.
What's
the
you
know,
what's
the
average
success
rate
so
basically
candace
and
I
mostly
deal
with
ivf
patients
but
there's
also
in
this
bill.
I
believe
it
still
talks
about
iu.
You
know
intrauterine
insemination
and
other
things
that
aren't
quite
as
aggressive
as
ivf
average
age.
L
L
She
looks
so
much
like
him
and
I
just
think
that
that's
you
see
pieces
of
him
and
I
don't
know
it's
just
to
be
able
to
carry
your
own
child.
I
think
is
just
incredible
and
it's
this
technology
can
give
us
that
you
know
we've
had
up
to
70
success
rates
before
so
it
just
kind
of
depends.
That's
a
big
broad
question.
I
don't
think
I
answered
it
well,.
G
G
G
N
Yes,
ma'am.
Thank
you.
Thank
you,
chairman
kumar,
and
vice
chairman
rudder
committee
members.
My
name
is
cara
edwards
and
I
am
truly
honored
to
be
here
using
my
voice
as
most
of
you
here.
I
wear
many
hats.
I'm
a
wife,
a
mother,
a
jesus
follower,
I'm
a
court
appointed
special
advocate
for
foster
care.
I'm
a
small
business
owner,
I'm
the
founder
of
the
non-profit,
starfish
infertility
foundation
here
in
nashville,
and
I'm
also
the
middle
tennessee
lead
for
the
tennessee
fertility
advocates
and
a
miracle
believer.
N
N
I
was
diagnosed
with
a
disease
of
endometriosis
and
my
husband
with
male
factor
infertility
because
of
that
it
took
us
four
long
years
and
I
endured
603
injections
in
order
to
be
standing
here
and
celebrating
these
new
lives.
Even
after
finding
success
with
my
beautiful
family,
I
couldn't
simply
walk
away.
I
couldn't
turn
my
back,
knowing
that
so
many
were
still
walking
the
painful
path
I
had
been
down
and
I'm
asking
that
you
not
turn
your
back
on
them
either.
N
N
N
So
I
just
truly
believe
it
is
time
for
tennessee
to
be
the
leader
when
it
comes
to
pro-family
states.
You
know,
together
with
the
governor's,
foster
care
adoption.
You
know
I
I
love
adoption
and
together
with
that
initiative
and
this
legislation,
we
can
be
just
that
we
can
lead
this
country
in
pro-family
pro-family
states.
N
N
O
O
O
I
had
no
idea
growing
up
that
I
may
have
issues
conceiving,
and
here
I
am
with
this
awful
disease
due
to
something
that
I
experienced
as
a
child
to
save
my
life
after
marrying
roger
in
2015,
we
were
told
the
only
option
for
us
to
become
pregnant
would
be
through
ivf.
At
that
time.
I
was
also
diagnosed
with
polycystic
ovarian
syndrome.
O
We
have
had
many
failed
procedures,
along
with
countless
doctors,
appointments
and
multiple
surgeries.
These
processes
have
cost
us
over
thirty
thousand
dollars,
but
we
continue
fighting
because
we
desperately
want
to
build
our
family
with
each
failed
procedure.
The
emotional,
physical,
spiritual
and
financial
impact
takes
longer
and
longer
for
us
to
recover
from
with
each
failed
attempt.
We
are
reminded
as
a
couple
that
there
is
something
wrong
with
me
and
that
I
am
not
like
everyone
else.
We
constantly
ask
ourselves,
why
not
me
and
why
not
us
this
bill
would
change
thousands
of
lives
for
tennesseans.
P
The
disease
of
infertility
is
not
just
a
female
issue.
It's
a
family
issue
and
as
a
couple
there
are
things
that
we
can
relate
to
each
other
on,
and
there
are
some
things
that
tiffany
just
carries
on
our
own,
that
I
will
never
truly
understand
as
we
go
through
this
process
and
it's
a
helpless
feeling
as
a
couple
when
you
can't
explain
to
each
other
why
this
last
ivf
treatment
failed.
P
Q
Q
A
We
are
moving
at
this
time
the
best
amendment,
although,
as
I
said
on
the
way
to
finance
we,
we
probably
will
make
further
adjustment
basically
to
make
it
less
expensive
for
our
society.
But
then
again,
as
has
previously
been
said,
it's
a
very
good
cause.
It's
a
very
meaningful
legislation
and
I
think
we
need
to
support
these
tennessee
families.
R
R
R
Our
age,
our
testimony
from
farm
bureau-
and
I
realized
that
most
of
our
our
medical
coverage
is
covered
by
the
insurance
market
these
days,
so
otherwise
we
can
afford
medical
care
for
the
most
part
and
I'm
always
very,
very
leery-
about
adding
another
mandate
to
any
insurance
program,
but
sometimes
it's
it's
really
worth
doing
out
of
a.
I
believe
this
is
one
of
those
instances.
R
This
is
something
that
affects
families
everywhere.
This
is
not
the
1950s
where
most
women
start
childbearing
in
their
late,
teens
and
early
20s,
and
that
we
have
an
a
large
adoption
pool
out
there.
It
doesn't
exist
and
we
need
to
change
this
for
the
make
a
change
for
this
time
and
believe
this
is
a
warranted
bill
and
I
intend
to
vote
for
it.
D
D
So
I
I
empathize
with
with
what
you've
had
to
go
through,
and
I
I
understand
from
from
that
point
of
view
and
we
were
not
able
to
have
children,
but
we've
kind
of
adopted
four
little
ones
that
we
take
care
of
all
the
time
and
they're
a
handful.
But
anyway
that's
beside
the
point.
I
guess
the
question
is
and
one
thing
when
we're
looking
at
this
bill
too,
and
you
and
the
sponsor
I've
talked
about
this
before
but
anytime.
We
do
anything.
D
I'm
always
worried
about
fair
and
equal
treatment
for
everyone
that
we're
doing
it
for
and
if
we're
leaving
out
anyone
if
we're
passing
a
law
that
that
doesn't
provide
that
if
it's
good
policy,
it's
a
good
policy
for
all
seven
million
tennesseans
and
I'm
afraid,
when
we
start
doing
some
things
like
this,
that
we're
leaving
some
people
out.
So
can
you
assure
us,
dr
kumar,
that
that
everybody
in
the
state
would
be
treated
equally
under
this
law?.
A
Chairman
powers,
I
admire
your
commitment
to
family
and
what
you
have
done
and
the
caring
part
that
you
bring
to
our
legislature
about
covering
everything
everybody
possible
that
would
benefit
from
it,
and
I
share
your
values
very
much.
I
think
one
question
remains
about
10
care,
but
please
realize
that
in
10
years
they
discover
kids,
that
coverage
ends
at
age
18
and
they
are
not
eligible
for
this.
Also,
current
qualifications
for
10
care
are
women
who
have
limited
income,
are
in
poverty
and
are
either
pregnant
or
have
young
children.
A
So
they
are
not
candidates
for
fertility,
a
very
tiny
number
of
chil
of
members
who
are
caretakers
and
we
are
checking
into
that-
and
I
think
so
I
think
fear-
is
fair
and
again
with
our
commitment
to
doing
the
right
thing.
We
would
look
at
that,
but
then
again
10k,
let's
realize
I
don't
know
what
I'll
be
able
to
do
about
it,
because
it's
a
safety
net
program
and
if
the
certain
things
in
10k
are
different
than
they
are
in
current,
but
I
certainly
appreciate
your
concerns.
Okay,
thank
you.
Thank
you.
J
J
We
keep
coming
around
the
money.
I
want
to
say
it
again.
There
are
people
attached
to
those
dollars
very
real
people.
There
are
friends,
there
are
neighbors.
They
live
in
corners
of
this
state
that
I've
never
visited.
They
also
will
be
impacted.
There
will
be
cost
put
on
those
folks
that
may
be
already
on
the
margin
and
we
may
pull
more
people
toward
the
margin.
J
A
Chairman
kumar,
thank
you,
mr
representative.
Now
the
point
of
fact
is
that
we
have
not
issued
any
mandates
on
insurance
in
the
last
few
years
and
the
costs
have
gone
up
again.
So
really.
I
think
this
adds
very
little
to
it,
but
insurance
costs
going
up
are
a
routine
thing
and
all
I
can
say
to
you
is
those
calls
are
going
to
continue.
A
Let
us
do
what
we
can,
but
health
care
is
very
complex
with
the
federal
government
controlling
most
of
it,
which
really
leads
to
our
inability
to
control
costs,
because
federal
government
will
mandate
various
things
and
so
on.
So
I
I
mean
premiums
going
up
is
a
feature
every
year
we
all
talk
about
controlling
health
care
costs
and
we
will
always
continue
to
talk
about
it.
A
But
I
think
here
the
important
thing
is
doing
the
right
thing
for
these
families
that
deserve
our
help
and
care,
but
sincerely
insurance
costs
are
going
to
go
up
the
way,
the
industry
and
our
medical
industrial
complexes
at
this
time.
Regardless
of
what
we
do,
I
I
I
don't
mean
to
be
callous
about
it,
but
I
think
you
know
that
you
know
it
better
than
I
do.