Posts Tagged ‘Matheis’

Health Insurance Transparency Bill Sees Final Legislative Approval, Heads To Governor

By Sean Whaley | 1:29 pm May 31st, 2011

CARSON CITY – A bill imposing more transparency on rate increases sought by health insurance companies is now on its way to Gov. Brian Sandoval for his review.

Assembly Bill 309, sought by Assembly Speaker John Oceguera, D-Las Vegas, requires health insurance companies to publicize their rate increase requests online and allows the public to participate in rate hearings before the Nevada Division of Insurance.

One supporter of the measure said the bill was weakened with the changes made by the Senate Commerce, Labor and Energy Committee but called it a good first step. The Assembly accepted the Senate amendment on Monday.

The bill passed the Assembly on a 33-9 vote, but saw only a 12-9 vote in the Senate. Democrats in the Senate were joined by Sen. Dean Rhoads, R-Tuscarora, in supporting the bill.

“This legislation would improve health insurance transparency by requiring health insurance companies to publicize rate increases online and hold health insurance companies responsible by requiring them to publicize the information justifying rate increases,” Oceguera said. “AB309 would make Nevada the fourth state to allow its citizens to request public hearings on rate increases.”

The bill would also benefit Nevada’s health insurance consumers by allowing the state to apply for almost $4 million in additional federal funding for increased rate review and online transparency, he said.

It would require insurance companies to post rate hearing information on their websites. The Division of Insurance will be required to link to the information as well.

“I am pleased this legislation passed the Senate, and I urge the governor to sign this common sense legislation,” Oceguera said.

Larry Matheis, executive director of the Nevada State Medical Association, called the amended bill a positive step.

“But we’ll have to do much better to make the health insurance industry’s actions and decisions transparent,” he said. “If we don’t, reforms can’t work. Over the next few years this may prove to be one of the most challenging aspects of health care reform. AB309 is a small step in the right direction.”

Matheis said more needs to be done to ensure the public knows what their health insurance policy actually covers and how premiums are used by the insurance companies.

The bill was amended to allow insurance companies to withhold some information deemed to be trade secrets.

“We took a step in this session, but it will have to be followed with much more in future sessions for the public to have any confidence that they can make meaningful decisions about health plans,” Matheis said.

State Lawmaker Seeks Bill To Increase Transparency Of Health Insurance Plans For Consumers

By Sean Whaley | 4:32 pm March 18th, 2011

CARSON CITY – Assembly Speaker John Oceguera testified today in support of a bill that would expand health insurance transparency for consumers so they can shop for the best coverage.

Assembly Bill 309, reviewed by the Assembly Commerce and Labor Committee, is opposed by many companies offering health insurance in Nevada. Only one insurance representative testified against the bill at the hearing, however.

Oceguera said when other states have adopted similar measures, including Maine, Pennsylvania and Colorado, consumers saw savings and lower rate increases.

“Currently, only the Department of Insurance may inspect an insurance company’s actuarial information and assumptions used by the company to justify their rate increase and the amount spent on things other than delivering medical care,” Oceguera said.

AB309 would change that to allow consumers and businesses shopping for insurance access to the information, he said.

“It increases transparency by making information that is used to justify these rate increases readily available to the public,” Oceguera said. “It allows individual consumers and small businesses to take a more in-depth look into policies when making their decisions on what insurance to purchase.”

Assembly Speaker John Oceguera/Photo: Cathleen Allison/

The bill would allow the public to request public hearings on rate changes in excess of 10 percent or for plans that represent more than 5 percent of the market, he said. The hearings would be open to the public.

Information available now includes only price and coverage, Oceguera said. The bill would greatly expand that information to include the loss ratio for the previous year, the anticipated loss ratio for the coming year and data justifying the requested increase, he said. It would all be posted on the Insurance Division’s website and the insurance company’s website.

Jack Kim, a lobbyist representing the Nevada Association of Health Plans, spoke in opposition to the bill but said the industry would continue to work with Oceguera to resolve its concerns. The public hearing and notice provisions could result in a five- to six-month process to get a rate increase approved, which is “a very long time,” he said.

Kim said insurance companies also compete with each other and would prefer to keep some of its data confidential.

The measure was supported by Nevada Insurance Commissioner Brett Barratt, who said it will dovetail nicely with the state’s effort to set up a health insurance exchange under the federal health care law so individuals can shop for and purchase health insurance.

It will allow more scrutiny of proposed health insurance rate increases to ensure they are reasonable and justified based on real data, he said.

“It will give consumers more power and ability to shop for insurance,” Barratt said.

Nevada is moving forward under Gov. Brian Sandoval to set up the exchange even as the state continues to challenge the constitutionality of the health care law.

The bill is also supported by Nevada State Medical Association. In testifying in support of the bill today, Executive Director Larry Matheis said it isn’t only the information required to be provided to consumers in the bill that is important.

“There are too many surprises when it comes to what the benefits of coverage actually turn out to mean in reality,” he said. “Transparency regarding coverage is less about what the salesman tells you they offer than it is about what coverages don’t they offer. When do they exclude coverage.”

Audio clips:

Assembly Speaker John Oceguera says his bill would open up insurance company information to the public:

031811Oceguera1 :15 delivering medical care.”

Oceguera says opening up the information will create an informed public:

031811Oceguera2 :18 insurance to purchase.”

Oceguera says the bill will help consumers actively participate in evaluating their insurance policies:

031811Oceguera3 :09 reviewing their policies.”

Larry Matheis of the Nevada State Medical Association says there are too many surprises now in what is covered by an insurance policy:

031811Matheis1 :06 mean in reality.”

Matheis says transparency about health insurance has to include information about medical conditions not covered by a policy:

031811Matheis2 :11 they exclude coverage.”

Nevada State Medical Association To Seek Health Insurance Transparency

By Sean Whaley | 3:29 pm December 7th, 2010

CARSON CITY – The Nevada State Medical Association believes consumers should have access to clear and understandable information about the cost and coverage provided under health care insurance policies before they sign on the dotted line.

Executive Director Larry Matheis  said the association will pursue legislation next year to require companies offering health insurance policies to post such information on the Nevada state website to provide transparency for such critical health care decisions.

“It is essential that people have an understanding of what they’re getting with this package called health insurance,” he said.

There are many anecdotal examples of people purchasing health insurance policies only to find out that illnesses such as cancer were excluded, Matheis said.

“So all of those kinds of issues are what we want to see a much more open demonstration of the information that people need,” he said. “They (insurance companies) can make decisions about what they will and won’t cover, but it has to be then very clearly explained to people at the front end, not the back end. You don’t want to be shocked after you’ve had care to find out that the insurer has decided, not that you didn’t need it, but that they’re not going to pay for it.”

Making health insurance decisions more transparent by providing the information up front to consumers is even more important as the federal health care law begins to take effect, Matheis said.

Transparency efforts are moving forward in Nevada in the areas of reporting key hospital and physician data, he said. But the same cannot be said for the health insurance policies offered by the insurance industry.

“How does the health insurance industry deal with things like coverage,” Matheis said. “What does coverage mean? When do they exclude something. When do they exclude somebody. How much of the premium dollar goes for health care. How much goes for other things. Just a range of issues.

“People don’t need to have the unpleasant surprise when they or their family are going through serious illness and medical care decision making,” he said. “That is not the time to find out what your insurer does and doesn’t cover.”

The association plans to work with lawmakers to require such information to be posted by the state on its official website. Matheis says he hopes to win the support of the state Insurance Commissioner and Gov.-elect Brian Sandoval in the effort, which has no significant fiscal issues associated with it.

State Sen. Sheila Leslie, D-Reno, said she has not talked with Matheis about his proposal but that it is an idea she would support. Standardizing such information would be of great benefit to consumers, she said.

“Of course we should be educating ourselves but reading an insurance policy is like trying to find a needle in a haystack,” Leslie said. “You can never find the answer to the question you have without a lot of work.”

Assemblyman David Bobzien, D-Reno, proposed a similar measure in the 2009 session that would have required health insurance policies to identify certain medical conditions not covered by the policy. It also would have required posting on the state website. Assembly Bill 438 did not make it out of the Assembly Commerce and Labor Committee, however.

Las Vegas attorney Jim Wadhams, a lobbyist who represents Anthem Blue Cross and Blue Shield in the Nevada Legislature, said the industry would not likely have any issue with the idea of providing helpful health insurance information to consumers on the state’s official website.

But he did suggest that if the Legislature wants to move ahead with such an idea, it should include all health insurance providers, including those operated by private companies for their employees and those operated by such organizations as the Culinary Union.

“I don’t think the industry would have a particular problem with it,” he said. “But if we are going to have transparency let’s have it for all.”

Individuals seeking health insurance can already do some comparison shopping on the internet through a couple of different brokerages, and, Wadhams said.

“So the concept is not particularly radical,” he said.

 Matheis said the association agrees that all plans should be included. But he said the special need is going to be for those buying individual or small group plans, particularly if the health insurance exchanges are to function under the new Patient Protection and Affordable Care Act.

Matheis said that while some opposition could emerge to the idea from the health insurance industry, it will be hard to oppose the idea of providing more information and information people need when they make their critical health care choices.

The idea is not to create new regulation or mandates, but to provide more sunshine on the issue of health care insurance coverage, he said.

“More front end information makes for fewer unpleasant surprises at the back end,” Matheis said. “If we do it right, that is what transparency brings to the health care system.”

Audio clips:

Larry Matheis of the Nevada Medical Association says people need to know what their health insurance plan covers before they need care:

120310Matheis1 :17 does not cover.”

Matheis says health insurance industry needs to make insurance information more transparent:

120310Matheis3 :13 that people need.”

Matheis says the public needs the information before purchasing health insurance:

120310Matheis4 :19 pay for it.”

Matheis says more information at the front end will eliminate unpleasant surprises at the back end:

120310Matheis5 :14 health care system.”

State Sen. Sheila Leslie says transparency in health insurance plans would be helpful to consumers:

120710Leslie1 :24 should participate in.”

Leslie says any way to help consumers understand policy coverages is important:

120710Leslie2 :15 is very important.”