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From YouTube: House Insurance Committee- April 20, 2021
Description
House Insurance Committee- April 20, 2021
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B
C
C
C
C
D
C
E
C
Thank
you,
representative
cochrane.
It's
a
difficult
issue
in
the
sense
that
medical
ethics
are
well
developed
in
in
within
the
field
of
transplantation,
definitely
come
across
very
difficult
situations
and
it's
a
balance
between
who
will
be
best
served
by
the
transplant,
and
I
think
the
medical
institutions
have
their
internal
policies
also
and
do
a
very
good
job.
Thank
you
for
adding
two
to
that
matter
in
the
sense
that
people
can
pay
more
attention
to
those
who
are
disabled,
that
they
are
not
discriminated
against
members.
D
E
C
D
Thank
you,
mr
chairman,
and
and
thank
you
sponsor
for
bringing
it
just
a
quick
question.
I
I
first
think
it
came
to
mind.
Are
people
are,
is
there
currently
being
discriminated
against?
I
mean
in
a
way
or
put
down
lowered
on
priority
list.
I
mean.
Is
that
general
practice
right
now
that
we're
trying
to
trying
to
correct
yeah.
E
And
I
I
do
not
feel
that
that
is
an
an
issue
currently
in
tennessee.
I
think
you
could
probably
throughout
the
nation,
maybe
perhaps
find
some
instances
and
truthfully.
I
do
not
think
it
is
a
huge
issue
in
this
state.
This
is
just
kind
of
one
of
those
things
getting
out
in
front
of
it
and
just
that
where
the
state
is
on
the
front
end
saying
look,
don't
don't
make
this
a
practice
that
all
all
life
is
created
equal
and
so
just
we
just
want
to
prevent
that
on
the
front
end,
all
right.
E
C
Thank
you
any
other
questions,
members,
seeing
none
without
objection.
We
are
voting
on
house
bill
1464.,
all
those
in
favor,
please
say:
aye
opposed
unanimous.
The
bill
moves
on
to
calendar
and
rules.
Thank
you,
chairman
and
committee.
Thank
you
item.
Two
on
our
agenda
is
house
bill
zero?
Six,
three,
five
by
chairman
smith:
do
we
have
a
motion
yep?
Second,
thank.
B
C
C
B
B
It
puts
a
a
definition
in
our
law
of
medical
necessity
that
re
that
restores
the
physician's
ability
to
define
medical
necessity
and
puts
the
burden
of
proof
on
denying
care
on
those
individuals
that
gain
the
profit
and
what
I
mean
by
that
is
currently
in
our
code.
The
burden
of
proof
for
medical
necessity
falls
on
physicians
and
or
or
a
nurse
practitioner
or
a
physician
assistant.
So
if
you
are
in
in
your
practitioner's
office,
he
or
she
makes
a
diagnosis,
believes
that
you
need
a
certain
level
of
care.
B
Clearly
they're,
going
to
look
at
your
plan
and
do
to
the
best
of
their
ability,
prescribe
and
treat
within
that
that
network
and
that
offering.
But
if
they're,
for
some
reason,
the
insurance
company
through
a
denial
makes
a
determination.
The
burden
of
proof
falls
on
the
physician
to
prove
the
insurance
company
wrong.
B
What
we
are
doing
with
this
definition
is
just
simply
saying
if
a
physician
or
a
practitioner
is
assessing,
the
patient
makes
a
determination
that
care
is
needed,
particularly
in
an
emergency
situation
that
it,
the
burden
of
proof,
now
goes
back
to
the
insurance
company
and
not
the
practicing
physician.
The
amendment
that
was
just
added
clarifies
some
language
so
that
the
department
of
health
will
not
have
onerous
obligations,
as
it
relates
to
a
a
disciplinary
matter
that
it
puts
the
word
of
the
physician
over
the
department.
B
So
we
we
make
sure
that
it's
not
onerous
in
this
case,
but
this
really
just
restores
to
the
practitioners
who
are
licensed
by
the
state
of
tennessee,
who
has
liability
insurance,
who
has
to
keep
their
knowledge
current
in
the
field
of
medicine
and
health
care.
It
allows
them
to
interact
with
the
insurance
companies
without
having
to
have
prior
authorization
actually
see
without
being
having
that
burden
of
proof.
It
does
not
eliminate
prior
authorization,
it
does
not
eliminate
pre-certification
or
peer-to-peer
review.
Instead.
B
C
You,
chairman
smith,
remember:
certainly
this
bill
is
thought
provoking.
It
will
lead
to
better
understanding,
but
there
is
a
regular
tug
of
war
between
physicians
that
might
want
to
over
prescribe
and
among
insurance
companies
that
might
want
to
not
cover
all
services
that
a
physician
would
like.
So
it
there
needs
to
be
a
balance
in
life,
and
I
don't
know
where
that
balance
is.
C
B
Chairman
smith,
go
ahead,
thank
you,
mr
chairman,
and,
and
to
that,
to
the
to
the
chairman's
point
after
if
if
the
sentiment
today
is
to
move
this
out
of
committee,
there's
no
further
movement
I'll
wait
until
there
won't
be
any
effort
to
push
this
through
finance,
etc,
because
we'll
wait
until
next
year
to
put
this
back
on
notice,
but
again
for
the
purpose
of
getting
in
this
into
a
posture
of
reading
it
for
next
year.
I
do
request
a
consideration
today
by
the
committee.
F
B
No
thank
you.
It
does
not
strike
those
clauses.
The
amendment
actually
make
sure
that
we
don't
infringe
upon
the
department
of
health
being
able
to
use
the
control
substance
database,
as
well
as
their
ability
to
engage
in
what
would
be
considered
disciplinary
action
for
the
the
sake
of
patience
and
for
care.
F
Thank
you.
Thank
you
for
that
answer
that
that's
that's!
That's
where
I
really
have
a
problem
with
this.
The
reason
that
we
have
restricted
the
the
the
app
the
the
prescribing
ability
of
of
these
opioids
is
because
it
was
it
was
taken
advantage
of-
and
I
think
many
many
here
know
my
history
with
it.
F
I
lost
my
cousin
who
was
a
like
a
brother
to
me
because
of
a
doctor,
legally
prescribing
opioids
and
taking
advantage
of
that
ability
to
profit
off
of
this,
and
so
I
don't
think
I
could
support
something
that
that
gives
more
authority
back
to
the
doctors
to
prescribe
yet
again,
more
opioids
after
we've
fought
such
a
hard
battle
to
to
limit
their
ability.
So
thank
you.
C
Thank
you
represent
freeman,
I
think.
In
another
perspective,
we
do
have
legislation
in
place
at
this
time
that
restricts
the
amount
of
opioids
used
and
there
is
a
chain
that
they
move
along
when
they're
referred
to
pain,
clinics
and
so
on,
which
of
course
also
can
continue.
The
opioids
I
mean
the
battle
is
no
over,
but
we
made
some
good
faith
effort
towards
it.
G
B
Yes,
sir,
it
is
quite
a
bit
lower,
it's
still
substantial
and
we
are
working.
I
met
with
the
state
plan
scott
macanally
yesterday,
and
this
number
that
remains
of
just
over
six
million
dollars
is
based
on
their
anticipation
that
care
won't
be
denied,
and
I
find
that
fact
revealing
in
and
of
itself
because,
as
I
stated
and
have
stated,
there
is
a
healthy
tension
between
care
and
the
monitoring
of
care.
B
However,
if
someone
needs
something
and
they
have
paid
premiums,
it's
very
fascinating
and
it's
a
a
constant
process
and
a
state
where
we
have
to
have
a
balance
between
those
who
prescribe
and
those
who
monitor
through
a
bureaucratic
process,
and
so
the
the
the
proposed
fiscal
note
reflects
anticipated
care
that
would
be
delivered.
That
would
otherwise
have
been
denied.
G
B
G
H
H
C
B
I
mean
we're
we're
we
pull
up
the
wall
street
journal,
look
on
the
stock
dividend.
Postings
of
you
know
some
of
our
colleagues
and
what
you're
going
to
find
is.
You
know
we're
we're
seeing
profits
rise
in
the
the
sector
of
health
care
and
those
who
deliver
it.
But
are
we
seeing
the
quality
of
health
care
increase?
B
We
we
we
like
the
isms
in
the
the
center
right
of
socialism,
communism,
fascism,
we'll
beat
down
on
that.
Corporatism
is
an
equal
influence
where
we
assign
to
a
a
corporate
entity,
the
powers
of
government
and
they
profit
off
of
those
and
and
what
we're
not
seeing
in
this
corporatism
control
of
health
care
is
we're
not
seeing
the
costs
go
down.
B
C
A
Thank
you,
mr
chairman,
as
I've
said
in
in
previous
meetings,
when
we
were
discussing
this,
I
I've
always.
I
understand
the
insurance
industry
not
wanting
to
just
have
a
cart,
a
blank
check
for
physicians
and
health
care
providers.
They
want
to
control
costs.
I
understand
the
provider,
the
doctor,
the
medical
facility
wanting
to
take
care
of
their
patients
plus
cover
themselves
against
liability
and
other
things,
and
it's
a
balance
with
a
patient.
A
A
The
only
two
groups
that
can
is
either
insurance
or
their
doctor
and
I
feel
sorry
for
the
patient,
because
this
isn't
just
about
forcing
insurance
companies
to
provide
coverage.
This
is
telling
a
doctor
that
someone
telling
a
doc
the
insurance
company
is
basically
telling
a
doctor
that
they
don't
know
what
they're
talking
about
and
the
patient
doesn't
need
this
service,
or
this
prescription
and
they've
never
seen.
The
patient
have
never
touched
the
patient
and
they're
making
decisions
that
could
affect
the
patient's
health
and
life.
A
A
It
isn't
and
I
want
somewhere
in
between,
but
I
don't
think
we're
going
to
get
in
between
unless
we
pass
this
out,
and
so
they
can
negotiate
over
the
summer
and
come
back
in
january
with
a
compromise,
because
if
we
kill
it
here
today,
we
have
to
start
all
over
again
next
year.
From
ground
one,
so
I
think
it's
important
for
us
to
keep
this
going
this
summer,
so
the
both
sides
can
can
negotiate
a
fair,
a
fair
deal.
That's
that's
best
for
the
patient,
not
for
themselves.
A
B
I
think
I
think
my
colleague
chairman
rudd,
for
his
comments,
but
chairman
kumar,
you,
you
really
hit
on
a
point
that
I
don't
think
is
publicly
known.
You
and
other
physicians
have
standards
of
care.
There
are
the
american
college
of
cardiology
standards
on
how
to
to
respond
to
certain
cardiac
conditions.
B
There's
the
american
college
of
oncology
and
cancer
that
you
know
produces
guidelines
that
are
standards
of
care
for
cancer
treatment
within
every
single
insurance
company's
plan.
There's
a
debt,
a
different
set
of
guidelines
that
they
use
to
place
over
a
pathway
of
care
that
determine
medical
necessity.
So
what
does
that
mean
in
reality
what
that
means
in
reality,
while
a
physician
has
evidence-based
medicine
that
he
or
she
is
studied
upon,
is
certified
to
enforce,
held
really
liable
to
through
medical
malpractice?
B
Insurance
companies
have
a
varying
set
of
guidelines
between
each
of
their
plans
that
determine
what
is
medically
necessary,
as
well
as
what
is
good
care,
and
so
physicians
have
to
navigate
and
health
care
providers
have
to
navigate
between
the
different
plans
and
the
different
guidelines,
while
overall
standing
making
sure
that
they
meet
that
evidence-based
level
of
care.
So
dr
kumar
makes
an
absolutely
accurate
point
that
there
are
evidence-based
medicine
guidelines
and
then
there
are
guidelines
that
vary
between
the
different
insurance
plans,
but
I
go
back
to
the
fact
that
all
this
bill
really
does.
B
Is
it
flips
the
burden
of
proof
from
medical
necessity
to
the
insurance
companies
rather
than
the
examining
health
care
provider,
puts
that
in
code?
But
it
does
not
end
the
practice
of
peer
review.
It
does
not
end
prior
authorization,
it
does
not
end
pre-certification
insurance
companies
still
have
mechanisms
through
which
they
will
continue
to
go
back
and
forth
over
levels
of
care.
It
just
puts
the
burden
of
proof
on
the
insurance
company.
That's
making
the
payment
rather
than
the
the
examining
health
care
providers.
C
Thank
you,
chairman
smith,
just
as
as
this
discussion
has
gone
deeper
than
I
thought
it
will.
I
do
want
to
invite
the
members
of
the
industry
or
the
provider
group
if
they
want
to
shed
light
or
they
want
to
air
out
their
feelings
about
it.
Kindly
let
us
know-
and
we
will
give
you
the
floor
next
on
our
list
is
chairman
terry.
I
Thank
you
chairman.
I
have
a
few
points,
a
couple
items
that
both
the
sponsor
and
actually
my
colleague
from
knoxville,
had
brought
up
about
potentially
driving
up
costs.
Whether
it's
insurance
costs
understand
that
if
you
have
to
go
through
step
therapy
because
you
think
something
may
be
medically
necessary,
but
it
gets
denied
that
drives
up
costs
for
the
patients
as
well.
Also
when
you
are
and
for
that
provider,
and
when
you
are
a
you
know,
you
have
to
chase
down.
I
So
by
doing
that,
you're
decreasing
your
margin
unless
you're
able
to
contractually
get
better
rates,
and
particularly
in
rural
areas,
oftentimes,
you
don't
have
the
the
economy
of
scale
to
get
a
better
rate,
and
so
you
may
be
pushed
out
of
rural
tennessee.
And
so
that's
one
of
the
things
that
this
is
is
looking
to
do
is
to
decrease
that
overhead
and
and
bring
in
that
balance.
I
I
would
like
to
point
out
some
members
may
not
have
been
here
a
couple
years
ago
we
had
a
hearing
in
here
on
balanced
billing
dealing
with
imtal
and
emergency
medicine
or
emergency
treatment,
and
through
that
it
said
essentially,
95
of
the
balanced
billing
was
on
emergency
medicine
or
imtala
practices,
and
this
bill,
as
it
is
written,
actually
could
address
95
percent
of
the
balanced
billing
that
that
patients
deal
with
you
know
the
way
this
is
is
written.
Of
course,
it's
a
little
bit
more
broad
than
this.
I
I
I
You
know
back
when
I
was
in
medical
school
had
a
patient
that
came
through
and
again
the
physician,
based
in
their
judgment
at
that
time
felt
like
the
patient
had
to
have
a
certain
procedure
and
they
were
denied
and
the
the
the
patient
said
they
wanted
to
do
the
step
therapy.
Well,
while
they
were
waiting
to
get
that
step,
they
had
a
bad
outcome,
so
you
know
decreasing
overhead
and
saving
lives.
I
think
this
that's
the
goal
of
this.
Is
it
the
perfect
language?
C
What
you're
saying
is
95
percent
of
the
surprise.
Bills
were
related
to
amtala,
which
is
emergency,
medical
transport
and
active
labor
act.
So
if
somebody
is
being
transported
during
emergency
or
in
active
labor
at
that
time,
it's
no
longer
a
consideration
that
they
go
to
an
in-network
facility
or
physicians,
so
that
would
generate
billing
opportunity
I
well.
Fortunately
it
appears
that
the
federal
law,
of
course
has
covered
that
base
regarding
emergencies.
B
I
just
wanted
to
add
to
comments.
I
think,
dr
terry,
because
he
is
the
he
offered
a
very
substantial
amendment
between
subcommittee
and
full
that
we
did
include
the
amtala,
but
you
know
because
iris
and
I
are
representative
rudder
and
I
are
the
only
two
females
you
know-
I
can
say
this
very
specifically
as
far
as
membership.
You
know
over
about
15
years
ago,
my
father
confronted
a
diagnosis
that
he
never
expected,
which
was
breast
cancer.
B
B
He
was
within
this
window
of
time
of
gene
therapy,
different
things
that
were
on
the
verge
of
how
medicine
was
evolving
to
treat
breast
cancer,
but
because
he
was
a
man
and
it
was
a
very
unusual
situation.
Much
of
his
care
was
deemed
investigational
by
insurance
companies,
even
though
his
oncologist
was
showing
us
data
that
was
coming
from
stanford.
That
was
coming
from
md
anderson
that
was
coming
from
the
cleveland
clinic
that
showed.
If
we
do
this,
we
do
this
and
thank
god,
you
know
we.
B
Unfortunately,
he
met
his
demise
in
in
is
in
heaven
and
since
2016,
but
I
can
tell
you
we
lived
it
and
the
physicians
had
the
evidence-based
medicine.
The
physicians
had
the
data,
the
physicians
had
the
studies,
the
physicians
had
everything,
but
the
insurance
companies
had
put
the
burden
of
proof
on
the
examining
physicians
and
still
had
the
veto
power.
B
B
It
just
establishes
a
more
equal
balance
that
the
examining
practitioner
based
on
his
or
her
medical
knowledge,
access
to
research
and
accountability
of
malpractice
of
being
sued
and
licensed
by
the
state
of
tennessee
and
any
other
state
in
which
they
are
are
licensed
to
to
have
the
ability
to
deem
something
medically
necessary
and
the
insurance
companies
can
continue
to
push
back
and
negotiate
and
come
up,
but
again
making
always
sure
that
the
patient's
care
is
first.
Thank
you,
mr
chairman,.
C
J
I
mean
insurance
companies
under
the
affordable
care
act
can
only
collect
20
administrative
fees,
so
really
they're
cut
to
20
profit,
so
it
actually
benefits
insurance
companies
to
see
doctors,
raise
prices,
not
lower
prices.
So,
theoretically,
under
that
that
argument,
this
would
benefit
insurance
companies,
because
if
a
doctor
charges
a
hundred
dollars
for
an
x-ray,
he
you
know
the
insurance
collects
twenty
dollars
if
they
charge
a
thousand
dollars
for
an
mri,
the
insurance
companies
getting
200.
So
they
probably
would
love
for
that
that
doctor
to
do
an
mri
every
time.
J
B
Smith,
yeah.
I
want
to
thank
my
colleague
for
going
on
record
to
say
that
the
insurance
where
we
are
in
health
care
is
just
just
we're.
You
know,
while
some
of
us
subscribe
to
the
goldilocks
principle,
where
we're
trying
to
get
it
just
right,
I
I
have
to
reject
the
the
principle
that
we're
we
have
it
just
where
it
needs
to
be,
because
I
can
tell
you
from
practicing
bedside
clinical
medicine
and
witnessing
that
people
are
having
to
go
through
bureaucratic
nightmares.
B
And-
and
maybe
you
don't
hear
that
in
your
district-
and
I
acknowledge
that,
but
I
would
just
simply
say
that
where
we
are
is
we
can
do
better?
We
really
can
do
better.
One
thing
I
would
also
say
is
you
know,
attributing
the
opioid
crisis,
to
a
few
doctors
if
you've
ever
heard
the
term,
the
fifth
vital
sign.
B
It
was
much
cheaper
for
someone
to
be
taking
opioids
than
to
go
to
physical
therapy
than
to
go
into
a
chiropractic
situation
to
then
to
go
into
some
other
alternative
type
of
care
and
so
the
again
back
to
this
healthy
tension
of
health
care.
The
fifth
vital
sign
is
the
root
of
where
the
opioid
crisis
began
and
it
began
began
when
we
institutionalized
and
and
put
this
narrative
in
place,
that
people
can
live
pain-free.
B
Guess
what
I'm
about?
To
be
58,
I
don't
live
pain-free.
I
have
age
things
deteriorate,
you
know
things
things,
I'm
not
pain-free,
but
that's,
okay,
I'm
not
going
to
subscribe
to.
You
know
that
that
whole
notion,
but
but
that
began
the
opioid
crisis,
not
just
a
few
bad
actors,
but
indeed
problems
beget
problems,
but
I
would
like
to
just
acknowledge
the
fact
that
this
bill
does
not
eliminate
utilization
review.
This
bill
does
not
eliminate
treatment
guidelines.
This
bill
does
not
eliminate
things
that
are
already
put
into
place.
J
J
I
blame
everybody
in
this
game,
making
a
whole
lot
of
money
while
the
patient
suffers
and
and
so
again
we
always
like
to
attack
the
insurance
companies,
but
we
never
attack
the
people
that
send
the
bill
to
the
insurance
companies
for
these
high
costs,
and
so
at
what
point
do
we
put
some
blame
on
the
the
hospitals
and
the
physicians
that
that
are
charging
these
prices?
I
mean
the
average
person
can't
have
surgery
even
with
insurance.
Half
the
time
these
days,
they've
got
to
make
a
decision
whether
they
can
afford
their
deductibles.
J
So
so
the
system
is
is
messed
up,
but
let's
not
just
throw
it
at
one
person
we've
already
got.
We
already
mandate
that
insurance
companies
can
only
make
a
20
profit.
Why
don't
we
put
that
mandate
on
the
rest
of
the
the
system?
Then
we
would
see
prices
lower,
so
yeah
just
just
insinuate.
That's
completely
wrong!
I'd,
be
happy
to
blow
up
the
whole
system
and
go
to
a
single
provider
system.
So
thank
you.
B
C
D
C
B
D
C
Members
do
we
have
any
other
business
if
you
will
kindly
give
me
a
moment's
attention,
this
is.
I
just
was
wanting
to
play
closing
music,
but
we
on
behalf
of
the
members
and
the
committee.
I
do
want
to
thank
our
clerks,
conor
linkovsky,
christine
dresser
alicia
downer,
as
well
as
our
sergeant-at-arms,
mr
rubin
sanders
and
members.
It's
been
an
honor
and
a
pleasure.