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From YouTube: House Insurance Committee- March 30, 2021
Description
House Insurance Committee- March 30, 2021
A
A
A
A
A
C
A
D
D
D
We
can
fund
critical
hack
access
hospitals,
there's
some
funding
for
graduate
medical
education
in
here
and
one
of
the
things
I
want
to
always
point
out
that
the
legislation
continues
to
specifically
prohibit
hospitals
from
increasing
charges
or
adding
a
surcharge
to
the
patients
as
a
result
from
the
assessment.
This
is
not
a
pass-through.
This
is
true
assessment
on
the
hospitals
themselves.
With
that,
mr
chairman,
I
would
stand
ready
for.
A
A
Questions
been
called
any
objections.
None,
we
will.
We
are
voting
on
house
bill
0181
as
amended.
This
may
be
one
of
the
largest
bills
we
have
and
we
will
vote
in
this
committee.
Thank
you
for
bringing
it
all
those
in
favor.
Please
say
I
oppose
the
house.
Bill
goes
to
your
own
finance
committee.
Thank
you,
mr.
B
Mr
chairman
and
committee
members,
I'm
bringing
you
administration
bill
today,
which
involves
cyber
security
for
insurance
companies.
What
we're
asking
you
to
approve
this
morning
is
a
bill
based
upon
the
national
association
of
insurance
commissioners
model
act,
and
there
is
an
amendment
traveling
with
it,
which
makes
the
bill
mister
chairman,
55-24,.
A
Yes,
this
is
5524
on
the
amendment.
We
have
a
motion
and
a
second
we
we
can
attach
the
amendment
to
the
bill
and
that
you
can
explain
to
us
any
further
that
you
need
to
without
objection
all
those
in
favor
of
attaching
amendment
5524
to
house
bill
zero.
Seven,
six
six,
please
say
aye
opposed.
The
amendment
goes
on
the
bill.
B
A
B
B
Can
you
talk
a
little
bit
about
why
that
that
number
of
250
is
important
and
and
how
many
cyber
security
breaches
do
we
have
I
mean
I,
I
guess
I
would
be
if,
if
I'm
impacted,
I'd
want
them
to
know,
if
you
were
impacted,
I'm
sure
you'd
want
them
to
know
and
do
some
research.
Why
250
and
and
how
big
of
a
problem
is
this?
B
Thank
you
well.
Thank
you,
representative,
freeman.
Unfortunately,
I'm
not
a
member
of
the
national
association
of
insurance
commissioners
who
brought
this
this
about,
but
I
can
tell
you
what
a
little
bit
about
what
the
concerns
are
and
primarily
what
the
issue
is
that,
particularly
our
department
is
concerned
about
number
one.
This
this
bill
applies
to
companies
that
are
have
25
employees
or
more
so
that
it's
not
really
going
to
affect
your
state
farm
or
nationwide
insurance
agents
situation.
B
What
they're
concerned
about
primarily
is
the
destabilization
of
the
financial
position
of
some
of
our
insurer
underwriters
that
are
affected
by
basically,
these
hacking
episodes
to
where
they
lock
up
their
system
and
they've
got
to
pay
basically
ransomware,
and
so
that's
what
this
is
modeled
towards
that
we're
really
looking
to
fight
great
that's
great
answer.
Thank
you.
A
A
A
B
A
This
is
amendment
5,
5,
8
6.
We
have
a
motion
and
a
second
on
the
amendment.
Without
objection
we
are
voting
to
attach
the
amendment
and
then
chairman
hicks
can
explain
the
bill
amended
bill
to
us
all,
those
in
favor
of
attaching
amendment
5586
to
hospitals,
one
zero
one.
Five,
please
say
I
oppose
the
amendment
goes
on
the
bill.
German
hicks.
You
are
recognized
on
the
amended
bill.
B
Thank
you,
mr
chairman,
amended
amendment.
5271
makes
the
bill.
The
intent
of
the
legislation
is
to
clarify
existing
laws
of
the
non-insurance
discount.
Dental
and
vision.
Programs
that
have
operated
here
in
the
state
can
continue
to
be
used
and
offered
to
tennessee
consumers.
This
adds
a
new
chapter
to
title
56
to
preserve
the
status
quo
for
dealing
vision,
discount
programs,
while
also
strengthening
consumer
protections
and
streamlining
regulation.
A
Seeing
none
and
the
questions
been
called.
Thank
you
for
your
explanation,
chairman
hicks.
All
those
in
favor
of
house
bill
1015,
as
amended.
Please
say:
aye
opposed
the
bill
goes
on
to
calendar
and
rules.
Thank
you.
Thank
you.
Committee
item.
Five
moving
right
along
is
house
bill,
zero.
Four
one,
nine
chairman
speaking,
we
have
a
motion
in
a
second
mr.
A
C
You,
mr
chairman,
thank
you
committee
for
moving
this
forward
to
allow
us
to
get
us
in
this
position.
This
is
the
chiropractic
care
bill
that
I've
been
working
on
for
two
years.
This
amendment
we've
just
put
on,
allows
tenncare
to
cover
chiropractic
care.
They
will
promulgate
the
rules
to
to
you
for
usage
and
for
authorization
for
patients
to
use
this.
We
have
to
find
the
money
for
it
in
finance,
we're
working
with
the
governors
and
our
and
our
leadership
to
try
to
find
the
money
to
fund
this.
C
B
A
C
Speaker
you
recognize.
Thank
you.
It's
a
great
question.
The
bill
puts
it
in
a
position
where,
where
tenncare
will
make
that
decision,
whether
it's
going
to
be
the
first
treatment
or
referral
process
there,
just
like
they
do
with
all
their
other
physical
therapy
etc,
so
it
puts
it
in
line
with
all
the
things
that
tenncare
does
right.
Now,
it's
just
now
another
tool
in
the
toolbar
toolbelt
for
help
for
our
for
our
people
on
on
tenncare
and
the
department
can
administer
that.
C
Gentlemen
speaking
so
under
the
age
of
18
chiropractic
care
is
currently
covered
by
tenn
care.
It
is
not
covered
over
the
age
of
18,
it's
surgery
back
surgery
or
opioids.
This
is
hopefully
our
physical
therapy.
This
will
add
another
option
for
people
before
they
go
for
back
surgery
or
to
get
on
opioids,
which
we
have
problems
with
across
the
state
of
tennessee
as
another
option
to
prevent
them
from
having
to
go
on
opioids
or
back
surgery.
Possibly
chiropractic
care
can
help
them
stay
away
from
that.
A
E
B
E
A
A
A
F
A
A
A
A
So
do
we
need
to
consider
four
five
one?
Four,
we
do
not.
Thank
you,
sir.
So
the
amendment
that
we're
dealing
with
is
six
two
three
eight,
and
this
was
an
amendment
that
we
discussed.
That
was
about
eight
minutes
late
members.
My
inclination
was
that
it
is
acceptable,
but
I
would
need
the
will
of
the
committee.
A
A
F
Thank
you,
chairman
and
committee
for
your
indulgence.
The
amendment
was
accepted
by
ten
from
tenncare
and
to
to
exempt
tenncare
and
cover
tennessee
to
cover
kids
from
the
bill
to
remove
some
of
the
part
of
the
fiscal
note
reminding
the
committee
on
the
intent
of
this
bill
in
code.
There
is
conflicting
definitions
that
we're
trying
to
align
currently
in
tennessee
code,
annotated,
63-6-204
as
well
as
68-11-205.
F
There
is
a
specific
prohibition
that
physicians
or
providers
who
are
being
employed
by
an
entity
and
quote,
shall
not
be
restricted
or
interfered
with
for
medically
appropriate
diagnostic
or
treatment
decisions.
However,
throughout
the
tennessee
code,
chapter
56
and
throughout
the
entire
body
we're
finding
over
and
over
that
insurance
companies
have
the
ability
to
override
an
examining
physician
or
providers
clinical
judgment,
and
what
this
bill
does.
F
Is
it
puts
definitions
in
place
that,
if
you
are
seeing
a
physician
or
a
provider-
and
they
are
examining
you,
based
on
their
evidence-based
medicine,
based
on
their
clinical
judgment,
that
they
deem
a
treatment,
an
intervention,
a
surgery,
a
medication
as
medically
necessary
that
the
burden
of
proof
that
that
indeed
is
medical
is
not
medically
necessary-
is
shifted
to
the
insurance
company
rather
than
what
is
currently
in
code?
Which
currently
is
that
it
requires
a
physician
to
provide
the
burden
of
proof
that
a
treatment
or
a
modality
is
necessary.
A
G
Health
good
morning,
patrick
powell,
from
department
of
health
as
drafted,
the
department
has
concerns
and
opposition
to
the
bill.
It
includes
titles,
63
and
68,
and
the
definitions
of
medical
necessity.
I
don't
believe
it
is
the
sponsor's
intent.
However,
it
would
cause
difficulties
with
the
department's
efforts
to
go
after
bad
actors.
G
Instead
of
a,
I
guess,
a
determination
of
medical
necessity
being
a
defense.
It
would
create
a
presumption
that
all
efforts
by
a
physician
or
facility
were
medically
necessary,
which
then
creates
a
burden
that
the
office
of
general
counsel
and
the
department
would
have
to
overcome.
So
in
over-prescribing
cases
things
of
that
sort,
we
would
have
to
actually
go
well
beyond
what
we
currently
do,
which
is
already
a
challenge
and
have
to
prove
that
it
was
not
medically
necessary
again.
F
G
And
represents
smith,
I
apologize.
The
insurance
world
is
not
my
forte.
I
I
can't
answer
that.
We're
we're
merely
looking
at
it
from
the
licensure
aspect
and
complaint
kind
of
side
of
things,
not
from
the
insurance
side
of
things,
so
any
of
the
language
say
in
56
or
in
that
realm,
not
our
department's
ball
game,
so
to
speak
just
in
63
and
68,
and
because
it
is
in
the
titles
for
health
practitioners
and
for
facilities.
A
A
G
G
A
G
So
we
we
are
a
complaint
driven
system,
we
would
get
a
complaint
on
a
provider
and
we
would
investigate
the
basis
of
the
complaint
so,
for
example,
over
prescribing.
We
would
then
look
at
kind
of
the
standards.
Standard
of
practice
have
expert
testimony
as
to
what
the
standard
practice
is
and
whether
or
not
that
violated
either
rule
or
law
or
professional
standards.
G
However,
this
language,
while
I
know
it's
intended
to
be
more
about
reimbursement,
creates
a
because
it
is
in
title.
63
creates
a
kind
of
barrier
where
we
would
have
to
be
looking
at.
Every
action
to
discipline
would
have
to
be
something
that
is
not
medically
necessary,
so
it
creates
a.
I
said,
a
higher
burden
that
we'd
have
to
overcome.
G
Yes,
sir,
that's
what
I
and
that,
in
fact,
that's
what
I
mean,
because
it
is.
It
is
all
actions
that
the
department
takes
on
on
behalf
of
complaints
on
bme,
boe,
board
of
nursing
and
so
on
and
so
forth,
including
healthcare
facilities
in
title
68..
So
it's
all
health-related
boards.
If
we
get
a
complaint
in
a
sense,
those
providers
are
because
of
the
way
the
statute's
drafted,
their
actions
are,
in
a
sense,
presumed
to
be
medically
necessary
and
we'd
have
to
overcome
that
on
any
kind
of
complaint
or
disciplinary
action.
Thank
you.
F
F
Of
63-6-248,
it
reads
in
in
section
11
subsection
b,
the
definition
of
medical
necessity
and
medically
necessary
within
this
section
does
not
affect
burden.
Excuse
me,
it
does
not
affect
proof
of
medical
necessity
or
medically
necessary,
as
it
relates
to
past
present
or
future
medical
treatment
or
medical
billing
and
personal
injury
actions,
health
care
liability
or
wrongful
death.
G
So,
at
least
from
the
sound
of
that
chairman
and
I
apologize-
I
don't
have
a
physical
copy
of
the
newest
amendment.
It
sounds
like
there
is
a
lot
of
language
in
there
that
would
protect
on
the
civil
action
side
of
things,
but
not
necessarily
the
administrative
law
side
of
things.
So
if,
for
instance,
I
was
your
physician
and
I
did
something
inappropriate,
you
might
be
able
to
sue
me
in
civil
court
for
monetary
damages,
and
it
sounds
like
that
language
is
intended
to
kind
of
not
create
a
new
burden
there.
F
F
So
to
that
end,
chairman,
I'm
happy
to
accept
the
mandatory
language,
but
it's
going
to
be
at
the
discretion
of
the
chairman,
because
this
bill
has
already
been
rolled
once
and
I
don't
want
to
put
this
committee
in
a
position
of
of
inconvenience.
But
again
my
office
is
at
6
44..
It's
been
there
for
three
years
and
I'm
happy
to
work
with
you.
If
you
also
provide
that
yes.
G
Apologies
obviously
I'm
short-handed
at
health.
Obviously
our
assistant
commissioner
has
recently
gone
to
the
governor's
office
and
my
other
liaison
is
in
quarantine.
So
my
apologies
representative
smith,
I'm
very
short-handed
this
week
and
my
understanding
is
that
I
was
under
the
belief
that
alexa
witcher
had
shared
some
of
our
concerns.
I
apologize
if
that
did
not
if
our
language
and
our
concerns
did
not
get
adequately
relayed,
but
I'm
happy
to
to
send
a
suggested
language
to
to
your
representative.
A
F
H
H
Notwithstanding
this
section,
nothing
shall
prohibit
a
renal
dialysis
clinic
licensed
under
this
chapter,
an
affiliate
of
a
renal
dialysis
clinic
from
employing
physicians
other
than
radiologists,
anesthesiologists,
pathologists
or
emergency
physicians
licensed
under
title
63,
chapter
6
or
9,
subject
to
the
following
conditions.
A
employing
entities
shall
not
restrict
or
interfere
with
medically
appropriate
diagnostic
or
treatment
decisions.
F
Anything
you
need
to
point
out.
I
would
thank
you,
mr
chairman,
simply
the
encode.
We
have
already
demonstrated
that
it
is
the
will
of
this
legislative
body
and
the
state
of
tennessee
to
allow
physicians
providers
to
practice
medicine
rather
than
having
financial
decisions
made
on
the
backs
of
patients,
and
if
the
committee
would
so
entertain
this,
I
will
ask
the
chairman
to
roll
this
to
next
week's
calendar
for
the
purpose
of
working
with
a
friendly
amendment
to
accommodate
the
department.
A
I
And
thank
you
chairman
and
of
the
committee
apology
coming
from
the
subcommittee,
mr
powell,
I
apologize
the
issue.
I
did
try
to
approach
the
issue
in
subcommittee
last
week
by
making
a
statement,
but
we
did
not
have
ms
whitcher
on
the
on
the
list
to
speak
to
us
about
this
particular
last
week.
So
I
I
accept
blame
and-
and
I
say
I
accept
accepted
life
for
that,
mr
chairman
and
members.
Thank
you
very
much.
A
Oh,
mr
hawk,
you're,
very
modest
and
generous,
it's
a
large
bill
with
a
lot
of
angles
to
it
and
a
lot
of
code
to
be
understood
what
exists
previously
and
what
we
are
trying
to
modify,
and
I
can
understand
that
really
all
of
this
could
not
be
covered
in
one
subcommittee
session,
or
it
appears
one
full
committee
session
for
that
matter.
Any
other
questions
from
mr
paul
seeing
none,
mr
paul,
thank
you
for
your
presence.
J
You,
mr
chairman,
scott
mackinlay
division
benefits
administration.
Thank
you
and
members
for
the
opportunity
to
discuss
house
bill
635
with
you
this
morning.
Benefits
administration
does
not
maintain
our
own
definition
of
medical
necessity
for
the
state
group
insurance
program.
We
defer
this
function
to
our
contracted
carriers,
specifically
in
our
planned
documents.
However,
we
have
seen
the
definition
of
medical
necessity
that
at
least
one
carrier
uses
in
their
provider
handbooks,
and
it
looks
the
same
as
the
existing
definition
of
medical
necessity
referenced
in
title
56.
J
That
definition
holds
that
services
are
medically
necessary
if
they
are
in
accordance
with
generally
accepted
standards
of
medical
practice
if
they
are
clinically
appropriate,
not
primarily
for
patient
or
provider
convenience
and
not
more
costly
than
a
therapeutic
or
diagnostic
alternative
house
bill.
635's
definition
removes
the
standards
of
medical
practice
clinical
propriety
and
not
for
the
provider
or
patient
convenience
requirements
with
any
service
that
an
ordering
provider
determines
is
in
the
best
in
the
patient's
best
interest.
J
Rather,
the
definition
does
retain
the
not
more
costly
requirement,
but
only
if
the
alternative
treatment
is
suitable
for
the
patient's
best
interest,
as
determined
by
the
ordering
provider.
The
bill
also
creates
a
presumption
that
an
order
from
a
physician
that
has
physically
examined
a
patient
is
in
the
patient's
best
interest,
unless
substantial
evidence
can
be
produced
that
the
order
is
not
in
the
patient's
best
interest.
J
Changing
the
standard
for
medical
necessity
is
expected
to
have
an
impact
on
our
claims
in
2020.
According
to
our
carriers,
medically
medical
necessity,
reviews
resulted
in
40
million
dollars
worth
of
avoided
costs
through
denials
prior
authorizations,
free
certifications
and
other
utilization
management
utilization
review
functions
in
consultation
with
our
actuary
benefits
administration
projects
that
a
an
impact
of
about
26
to
28
million
dollars
of
those
claims
will
be
paid
under
the
amended
bill.
J
One
carrier
has
reported
an
average
of
27
claims
per
year
that
are
denied
on
grounds
of
medical
necessity
later
overturned
when
a
provider
is
able
to
furnish
appropriate
documentation
documentation,
rather
that
the
order
is
medically
necessary.
None
of
those
denials
and
appeals
resulted
in
a
delayed
date
of
service.
Our
other
carrier
said
they
have
to
manually
research
that
information,
so
they've
not
submitted
it
to
us
yet.
A
J
Summarize
your,
I
think,
the
the
high
level
summary
is:
we
defer
the
function
of
claims
utilization
to
our
carriers
and
they
adjudicate
medical
necessity
by
definition
that
they
come
up
with
they've
in
2020
avoided
costs
about
40
million
dollars
worth
of
claims
under
the
new
definition
of
medical
necessity,
both
how
it's
defined
and
how
it
will
be
implemented.
I
think
is
you
know
a
colleague
from
department
of
health
said
and
shifting
the
burden
of
proof
from
the
payer
to
the
provider.
We
would
anticipate
paying
on
about
26
to
28
million
dollars
worth
of
those
claims.
F
Thank
you,
mr
macanally,
and
I
appreciate
you
sticking
to
your
testimony
that
you
offered
in
the
council
on
pensions
and
insurance,
which
gave
this
a
favorable
recommendation
upon
the
exit
and
the
review
there
in
the
council
on
pensions
and
insurance.
One
thing
I
just
want
to
make
sure
to
revisit
is
in
in
your
statement
that
you
save
40
million
dollars
through
denial
and
utilization.
F
F
J
Do
pay
your
sorry,
the
chairman,
you
do
pay
your
premiums
on
a
monthly
basis
as
a
self-insured
plan.
When
we
avoid
costs,
we
don't
collect
any
compensation,
we're
just
paying
claims
that
are
reserved
so
to
the
extent
that
our
reserves
are
paying
out
less
the
need
to
increase.
Our
premiums
is
fewer.
When
we've
had
zero,
we
have
premium
holidays.
I
think
we
have
coming
up
this
year,
actually,
where
the
the
fund
was
over
balanced.
We've
also
had
instances
where
we
haven't
increased
premium
before
so
it.
The
claims
impact
does
have
a
direct
relationship.
F
J
A
Thank
you
well,
you
know
looking
at.
Is
this
an
absolute
if
you're
shifting
the
burden
of
proof,
either
from
provider
to
insurance
companies
or
vice
versa?
Is
there
not
a
middle
ground,
good
balance
where
prescribers
are
checked
upon
not
over
prescribing
services
and
insurance
companies
are
held
responsible
so
that
they
are
not
over
denying
care.
J
J
I
think
we
consider
our
current
medical
necessity
standards
to
be
working.
We
have
an
appeals
process.
We
believe
our
appeals
process
is
adequate
if
it's
adjudicated
not
be
adequate.
We'd
certainly
be
happy
to
look
at
that
in
terms
of
how
those
denials
are
reviewed
again,
we've
asked
of
the
carriers
and
it
appeals
that
it
appears
that
appeals
has
been
their
answer
for
how
those
are
reviewed.
A
F
And
thank
you,
mr
chairman,
and
I
appreciate
the
committee's
indulgence
and
I
and
I
hope
that
others
find
this
a
thoughtful
discussion,
because
here's
where
we
are
in
the
state
of
health
care
in
in
the
1960s,
the
average
patient
consumed
just
over
a
hundred
and
twenty
something
thousand
twenty
hundred
and
twenty
something
dollars
a
year
of
health
care.
Now
it's
almost
twelve
thousand
dollars
per
year
out
of
pocket,
and
so
while
we
have
constructed
these
extreme
bureaucracies,
some
government
controlled
some
private
sector
control.
Many
are
a
combination
thereof.
F
We're
not
seeing
health
care
costs,
go
down,
we're
seeing
them
go
up.
We're
not
seeing
the
quality
of
care
necessarily
go
up,
we're
just
seeing
the
consumption
of
a
lot
more
care.
That's
not
necessarily
yielding
very
good
outcomes
in
some
cases,
and
so
the
purpose
of
any
bill
that
I
have
ever
carried
in
my
two
and
a
half
year.
Tenure
for
patients
is
simply
because
we're
hiding
prices
in
the
in
the
sector
of
health
care.
We
hide
prices.
F
We
rely
on
third
party
administrators
to
contract
things
out,
negotiate
some
prices
leverage.
Some
prices
we've
seen
the
the
vertical
alignment
of
health
care
insurance
companies
now
on
pbms,
which
now
own
specialty
infusion
pharmacies,
which
now
own
doctor's
practices
and
we're
seeing
costs,
go
up
and
so
to
the
degree
that
our
chairman
here
practices
or
did
practice
medicine
and
that
people
are
relying
more
and
more
heavily
on
health
care.
F
We
need
to
understand
what
health
care
is,
and
my
goal
here
is
to
absolutely
address
the
bad
actors.
In
both
cases,
most
legislation
is
to
dictate
the
tales
of
of
a
bell
curve,
those
that
practice
on
this
side
and
those
who
practice
on
this
side
and,
unfortunately,
we're
witnessing
the
corporate
practice
of
medicine
in
the
state
of
tennessee,
where
we're
watching
the
reimbursement
cms
has
already
broadcast.
For
the
last
three
years.
Medicare
reimbursement
is
going
to
go
down
10
10
within
the
next
five
years.
F
Is
blue
cross
blue
shield's
definition
of
medical
necessary
the
same
as
united
health
care,
which
is
the
same
as
united
as
aetna,
which
is
the
same
as
cigna,
because
while
we
are
working
hard
to
have
a
uniform
statement
in
code,
I
would
submit
to
you
that
the
men
and
women
who
are
practicing
healthcare,
don't
have
a
uniform
definition
and
all
they're
having
to
do
is
fly
by
the
seat
of
their
pants
waiting
for
an
approval
here.
A
utilization
review
there
and
I'll
sit
and
listen.
But
thank
you,
mr
chairman,
for
your
indulgence.
A
However,
certain
statements
that
the
cost
of
health
care
has
gone
up
and,
of
course,
we
know
the
reasons
it
has
gone
up.
Utilization
is
one
part
of
it,
but
also
the
various
medical
advances
are
a
major
part
of
it
and
the
fact
that
quality
of
health
care
has
not
improved.
I
would
submit
to
you,
it
has
improved
tremendously.
We
are
living
longer
than
ever,
and
the
treatments
for
various
common
diseases,
including
heart
disease,
have
really
taken
major
leaps
and
leaps
in
progress.
A
I
So
it's
taken
70
million
out
of
the
cost,
but
there
is
still
a
cost
to
the
state
of
tennessee
in
the
state
insurance
plan.
That's
that's
what
we're
talking
about
now
with
having
your
testimony
and
as
I
look
at
that
I'm
hearing
costs
go
up.
I
heard
this
statement
a
moment
ago.
Costs
go
up
the
question
I've
got,
who
is
paying
for
those
costs,
and
it's
still
going
back
on
now,
the
back
of
our
state
employees.
I
So
I'm
still
concerned
about
us
getting
to
a
happy
place
even
with
this
piece
of
legislation,
because
the
premiums
are
going
to
go
still
going
to
go
up
not
only
in
the
state
plan,
but
also
in
the
private
private
insurance
plans
as
well
and
the
conundrum
I
have
that
I'm
trying
to
wrap
my
mind
around.
Are
we
getting
to
the
goal
of
actually
helping
that
patient
a
lot
of
rhetorical
conversation
right
there?
I
don't
expect
any
answers.
I
A
K
I
don't
think
it
will
change
the
cost.
It
might
actually
decrease
the
cost
on
some
of
these,
because
of
the
time
that
those
individuals
that
were
on
the
phone
with
me
had
to
spend.
So
I
do
think,
there's
work
that
we
can
do
on
this
again.
How
do
we
find
that
happy
medium,
how
we
find
that
balance,
I'm
willing
to
work
whatever
we
can
do
for
these
patients?
So
thank
you.
A
A
E
Bill
huddleston
assistant,
commissioner,
with
department
of
commerce
and
insurance
welcome,
mr
chairman
and
committee
thanks
for
your
time
this
morning
and
giving
us
the
opportunity
to
come
in
and
talk
about
some
of
our
concerns
and
really
the
prior
testimony
didn't
make
me.
It
did
make
me
think
of
a
couple
of
things
that
I'm
gonna
kind
of
you
know
add
at
the
department.
As
we've
said
before,
our
goal
is
it's
consumer
protection.
E
In
some,
our
our
concern
is
the
what
chairman
hawk
spoke
about
a
moment
ago:
increased
premium
costs,
so
chairman
hawk
kind
of
stole
my
thunder
there,
but
that's
that's
our
big
concern,
I'll
kind
of
go
through
the
reasoning
just
a
little
bit,
and
it
starts
with
that.
The
the
current
standard
for
medical
necessity,
that's
in
in
chapter
56,
that
that
is
that
that
is
based
on
model
language
that
has
been
adopted
by
most
states.
E
I
think
my
last
count
was
45
states,
so
the
landscape
and
the
regulatory
environment
is
that's
from
state
to
state.
That's
that's
the
standard
for
medical
necessity
when
it's
defined
this
bill
changes
that
dramatically
and
the
the
result
that
that
we
see
could
be
instability
in
the
regulatory
environment
and
the
process
for
those
costs.
E
Health
care
costs
that
end
up
being
passed
on
in
the
form
of
increased
premium
to
consumers.
So,
while
I
agree
that
this
does
help
some
people
that
ultimately,
the
those
costs
are
paid
by
everybody,
that
is
a
policyholder-
and
I
think
that's
in
some
we're
just
concerned
about
the
increased
premiums
that
could
result.
K
K
Doctors
are
ordering
too
many
treatments
to
cover
themselves
to
so
their
malpractice
doesn't
go
up
in
many
cases
and
then
the
which
is
caused
by
the
insurance
industry,
and
then
the
insurance
industry
gets
tired
of
all
the
tr
they're
having
to
pay
all
the
treatments
to
keep
a
malpractice
down
and
cover
themselves
legally.
And
then
the
insurance
industry
comes
in
and
gets
a
doctor
who
doesn't
know
the
patient
who's,
never
seen
the
patient.
K
To
judge
that
the
doctor's
judgment
is
not
good,
because
there
are
two
too
many
treatments,
so
the
doc,
the
physician
and
the
patient's
called
in
between
and
every
time
it
seems
like.
There
is
some
type
of
reform
that
is
proposed
that
it
shut
down
and
we
keep
a
basically
a
failing
system
that
is
not
doing
the
doctor
or
the
patient
justice.
Now
what?
What?
If
not
this?
What
type
of
reform?
Because
we
talk
well,
we
need
to
reform,
but
we
never
get
reformed.
Then
every
time
we
get
a
reform,
we
shoot
it
down.
E
E
I
do
think
that
what
we
have
now
is
not
perfect,
but
it
it
does
serve
a
lot
of
people
and
the
services
that
we
do
get.
But
as
far
as
specifics
on
how
to
fix
that,
I
we
could
probably
talk
for
a
long
time
about
it
and
still
not
have
an
answer.
So
I
don't
at
this
point,
know
exactly
a
great
answer
for
you
on
that.
F
Thank
you,
mr
chairman
and
deputy
commissioner
just
two
questions
in
in
the
plans
that
you
oversee
here
in
tennessee,
whether
they're,
orisa
or
non-orissa.
Is
there
one
single
definition,
that's
applied
throughout
all
those
plans
of
medically
necessary,
so
does
cigna
and
blue
cross
blue
shield
and
aetna
and
united
health
care?
Do
they
have
the
same
identical
definition
of
medically
necessary
or
medical
necessity.
E
Okay,
yes,
chairman
the
we,
we
do
have
no
just
to
be
clear
on
our
orisa
plans.
We
have
no
authority,
so
it
would
all
be
non-erisa
plans,
and
I
would
want
my
forms
and
policy
director
to
confirm
this,
but
the
standard
for
medical
necessity
is
is
in
statute,
but
from
carrier
to
carrier
it's
it's
left
up
to
be
defined
in
the
contract.
A
F
A
I
would
I
would
add,
to
that,
that
sharing
risk-
certainly,
as
you
said,
is
there,
but
also
at
times
from
a
working
person's
point
of
view,
is
the
expectation
that
insurance
will
pay
everything
and
that
that
is
not
understanding.
The
fact
that
insurance
is
for
events
that
are
rare
but
expensive,
not
for
every
event,
because
if
the
cost
of.
A
F
Thank
you,
mr
chairman,
and
thank
you
deputy
commissioner.
I
think
what
we're
seeing
in
this
committee,
which
is
charged
to
be
the
insurance
committee
of
the
house
of
tennessee,
is
that
we
have
a
mess
in
health
care
and
if
insurance
is
defined
as
a
financial
product
that
is
supposed
to
ensure
against
financial
ruin
and
to
manage
risk
and
yet
we're
arguing
over
how
an
insurance
company
defines
medically
necessary.
F
I
think
what
we're
seeing
is
the
convergence
of
a
lot
of
circles
that
we're
allowing
bureaucrats
that
never
touch
the
patient,
never
see
the
patient,
we're
allowing
individuals
who
never
see
a
patient
to
overrule
the
clinical
judgment.
Of
those
who
do,
and
with
that.
Mr
chairman,
I
will
stand
committed
to
take
friendly
amendments
to
put
this
particular
issue
throughout
our
code
to
be
consistent
for
the
health
of
not
just
patients
but
providers
as
well
as
insurance
companies.
But
I
think
what
we're
seeing
here
is
a
very
healthy
conflict
that
we
can.
We
can
either
choose.
F
A
You
you're
being
very
generous
in
and
open
to
suggestions,
and
I
would
also,
I
think,
we're
grateful
to
chairman
rudd
for
bringing
up
the
fact
about
the
pressures
of
liability
or
malpractice
lawsuits
that
impel
certain
times
to
overutilization
or
over
prescribing
by
physicians.
Under
that.
Thank
you,
general
wright.
Do
you
have
a
comment?
Your
name
was
called.
A
L
Thank
you,
mr
chairman.
I'm
benjamin
sanders
with
farm
bureau
health
plans.
I'd
like
to
thank
you
for
the
time
today.
I'd
also
like
to
thank
the
sponsor
for
her
time
over
the
last
few
weeks
to
discuss
this
bill.
We
often
have
different
opinions
on
policy
matters,
but
we
very
much
agree
on
open
discourse
and
open
dialogue,
even
when
it's
a
healthy
conflict,
as
was
mentioned
earlier,
so
thank
you
of
all
of
the
aspects
of
a
health
policy
benefits
coverages
networks.
L
All
these
things
that
a
health
insurance
company
does
our
members
consistently
tell
us
the
most
important
to
them
is
the
cost.
What
they
pay
out
of
pocket
is
their
highest
priority,
because
none
of
those
other
things
matter
if
they
can't
afford
the
insurance
that
we're
selling
and
when
it
comes
to
the
cost
impact
of
legislation
that
you
all
see
all
the
time
we
often
hear
companies
can
absorb
the
cost,
and
let
me
put
that
in
perspective
last
year,
the
highest
profit
margin
of
any
insurer
health
insurer
in
the
country
was
5.26
percent.
L
L
I
don't
think
any
company
would
operate
for
free,
but
consider
this
hypothetical.
If
insurance
companies
operated
at
zero
profit
operated
for
free
medical
inflation
clocks
in
at
about
six
percent
per
year.
So
even
if
a
company
operated
for
free,
we're
still
going
to
see
premium
increases
because
of
simply
the
simple
the
margin
of
medical
inflation.
L
Now
we
hear
also
on
a
number
of
pieces
of
legislation
that
it's
just
a
few
dollars
per
month.
We
hear
that
mostly
in
coverage,
mandates
that
we
discuss
about
nobody
in
this
room,
myself
included
notices
when
their
insurance
goes
up
a
few
dollars
a
month,
but
there
are
people
all
over
the
state
that
ten
dollars
makes
a
difference
between
buying
insurance
and
not
buying
insurance.
L
Now,
most
people
are
not
on
the
brink
of
affordability,
just
to
be
honest,
but
that
doesn't
mean
they're
immune
from
the
economic
reality
most
families
when
they
see
rising
premiums.
They'll
sacrifice
other
spending
for
their
families
and
their
kids
in
their
retirement
to
continue
that
health
coverage
or
businesses
when
they
see
in
premiums
increase
they
evaluate
whether
they
should
keep
offering
coverage
to
their
employees
or
just
drop
that
coverage
and
invest
in
other
parts
of
the
business.
L
Dr
kumar
mentioned
a
balance
and
I
think
that's
a
great
definition
of
what
we're
talking
about.
Personally,
I'm
proud
of
how
the
insurance
industry,
how
my
industry
maintains
the
critical
balance
of
access
to
care
and
managing
costs,
and
it's
a
balance
too
much
management.
If
you
will
and
we
limit
care,
as
has
been
discussed
and
too
little
though,
and
we
limit
affordability,
we
use
tools
all
be
them
on
popular
tools
like
medical
policies,
step
therapy,
prior
authorization,
prior
certification
and
utilization
review,
to
manage
those
costs.
L
Nobody
gets
it
right
all
the
time,
which
is
why
all
of
the
tools
that
companies
use
are
underpinned
with
consumer
safeguards
and
sound
medical
policy,
and
that
policy
I
want
to
know
is
not
developed
internally
by
a
company.
We
look
to
medical
professionals
themselves,
national
boards,
research
institutions,
literature
to
make
sure
that
our
medical
policy
is
developed
by
those
on
the
forefront
in
that
area
of
healthcare.
L
Now,
when
it
comes
to
these
tools,
if
you
will
there's
a
I'd,
thought
earlier,
representative
smith
of
the
phrase
healthy
tension,
but
healthy
conflict,
I
think
is
also
a
good
phrase.
There's
a
healthy
conflict,
a
healthy
tension
between
companies
and
healthcare
providers
and
that
tension,
I
will
say,
helps
maintain
that
balance
that
critical
balance
between
care
and
affordability,
everyone
needs
checks
and
balances
and
push
and
pull.
L
Now
I
recognize
that
these
tools
can
be
frustrating
at
times
and
that's
probably
an
understatement,
but
the
reality
is
that
approximately
95
of
all
covered
claims
are
paid
without
question.
That
doesn't
mean
we
should
ignore
that
5.
But
let
me
say
that
again,
approximately
95
percent
of
claims
are
paid
without
question.
L
I'm
proud
of
how
our
industry
strategically
uses
these
tools
on
a
small
number
of
claims
to
maintain
that
balance,
and
we
believe
respectfully
that
reversing
the
burden
of
care
has
the
very
real
potential
to
upset
this
balance.
Mr
chairman,
we
appreciate
your
indulgence
to
let
someone
from
the
carriers
and
the
insurance
community
speak.
We
very
much
appreciate
the
sponsor
and
her
dialogue
and
discourse
on
this
bill.
I'm
happy
to
answer
any
questions.
A
C
C
I
don't
know
all
the
answers
to
insurance
trust
me.
I
I'm
trying
to
learn
here.
As
I
go,
the
thing
that's
frustrating
to
me
is
I
keep
hearing
money,
money,
money,
money.
Okay,
tell
me
about
the
care.
How
do
we
get
to
a
healthy
conflict
or
a
healthy?
Whatever
you
want
to
call
it
a
happy
place
that
we
can
take
care
of
people
that
is
fair
and
equitable
to
the
insurance
companies
and
provide
the
necessary
care
for
the
patient.
I
keep
hearing
money.
Stop
talking
about
money.
A
L
L
We
can't
tell
a
doctor
or
any
health
care
provider
what
or
how
they
can
practice
or
what
they
can
prescribe,
and
we
can't
tell
a
patient
what
treatment
they
can
get.
All
we
can
do
is
talk
about
what
we're
going
to
pay
for
now.
I
understand
that's
divorcing
the
reality
of
affordability
from
out
of
pocket
cost
with
health
care,
but
we're
only
talking
about
the
insurance
coverage
on
it.
L
We
look
at.
I
look
at
insurance
as
a
fiduciary,
so
when
we
are
paying
for
someone's
claim
we're
paying
for
it
with
everyone
else's
premiums,
it's
incumbent
on
us
to
find
that
balance
to
make
sure
that
what
we
are
paying
for
with
other
people's
premiums
is
not
just
cost-effective
but
medically
appropriate.
As
well
and
I'll
say
again,
it's
a
balance.
Nobody
gets
it
right
all
the
time,
but
then
the
third
thing
that
I
will
note
is
that
it's
in
a
company's
best
interest
for
someone
to
get
better
and
to
get
well.
L
I
hear
what
you're
saying
and
some
of
your
colleagues
have
said
about
care.
Sir.
We
want
people
to
get
well
too.
I
never
thought,
mr
chairman,
I
can't
believe
I'm
going
to
say
this.
I
never
thought
I
would
quote
senator
nicely
in
a
committee,
but
he
made
a
good
point
recently
when
he
said
insurance
companies
make
money
when
you're
healthy
others
make
money
when
you're
sick.
So
we
want
people
to
get
healthy,
there's
a
vested
interest
to
take
care
of
our
policy
policyholders.
Sir.
C
I
appreciate
that
answer.
I
don't
know
if
it
was
the
answer
to
my
question,
but
it
was.
It
was
an
answer
to
a
question.
You
know
one
of
the
things
that
is
more
of
a
statement.
Mr
sanders.
One
of
the
things
I
struggle
with
all
the
time
is,
you
know
we
get
all
these
different
opinions
from
people
coming
up
here.
C
Health
department,
commerce,
experts,
chairman
smith,
does
her
trust
me.
I
know
she
does
her
homework,
I'm
going
to
be
frank
with
everybody
here.
I
do
not
like
that.
10
care
was
taken
out.
I
do
not
like
that.
10
cares
sitting
here
behind
you,
mr
sanders.
They
know
I
have
an
adversarial
relationship
with
them,
but
it's
a
healthy
adversary
relationship.
Sometimes
I
win
sometimes
tenncare
wins,
but
to
unilaterally
take
them
out
of
this
bill
I
think,
is
wrong.
That
was
not
what
I
voted
on
in
subcommittee.
C
I
voted
to
leave
them
all
in.
So
that's
my
first
problem.
Second
problem
is:
when
you
shift
something
all
to
one
side,
do
you
get
the
best
results
when
there's
not
the
proper
checks
and
balances,
the
healthy
adversarial
relationship?
And
let's
face
it?
It's
an
adversarial
relationship
between
insurance
companies
and
providers.
That's
the
system
that
works.
C
I
think
we
get
the
best
care
for
our
for
our
citizens,
because
I
can
tell
you
this
in
my
travels
and
sports,
I've
played
in
other
in
other
s
in
other
countries
as
bad
as
people
may
think.
Our
health
care
system
here
is
in
the
in
the
united
states.
It
by
far
leads
the
world
and
that's
why
people
come
here
for
our
medicine.
C
F
And
thank
you
from
the
chairman,
because
I
do
my
homework
and
I
also
want
to
thank
my
colleague
mr
sanders,
because
I
do
know
that
you
prioritize
your
members
and
patients,
one
of
the
things
that
I
want
everyone
to
hear
as
active
members
that
are
engaged
on
this
committee.
You
know
moving
tenncare
cover,
tennessee
workers.
Comp
came
out
at
the
request
of
those
departments
to
save
this
bill
and
and
I'm
happy
to
roll
it
to
the
end
of
this
calendar
happy
even
to
have
have
further
discussions.
F
F
But
I
think
that
my
colleague
mr
sapiki
nailed
it.
We
have
to
have
a
balance.
It
has
to
be
transparent
and
it
has,
we
have
to
agree.
Profits
are
not
ugly,
I
mean
you
do
understand
that
most
of
us
are
republicans
right.
Okay,
profits
are
not
ugly,
but
what
I
would
tell
you
is
patients
are
the
key
of
health
care
and
without
patients
and
without
providers
there
are
no
there's
no
need
for
insurance
companies.
A
Members
are
there
any
questions
for
our
mr
sanders,
seeing
none
mr
sanders.
Thank
you.
You
bring
good
thoughts
and
we
appreciate
it.
Thank
you.
Members
we'll
go
back
into
the
session.
We
are
back
on
the
bill
itself.
It
has
been
certainly
a
thought
provoking
discussion.
It's
been
therapy
for
chairman
speaking.
A
But
the
only
question
I
have
one
more
have
for
chairman
smith
is
that,
as
we
are
looking
through
the
summary
of
the
bill
itself
and
various
provisions
are
listed,
we
are
not
touching
on
provisions
in
surgery
and
other
things.
Are
you
comfortable
with
the
way
the
current
practice
exists
in
that
regard
or
the
definition
of
medical
necessity?
F
Thank
you,
mr
chairman,
and
working
with
legal
and
the
various
departments
we
went
through
and
pulled
where
medical
necessity
was
listed
in
code,
and
so
the
the
references
that
you
find
are
those
that
are
in
code
and
so
how
that
may
be
addressed
with
the
application
of
the
insurance
plans
and
policies
it
may
vary,
but
relative
to
our
jurisdiction
as
lawmakers.
We
only
identified
the
areas
in
the
the
green
books
or
tennessee
code
annotated.
Yes,
sir.