CASAGRANDE INTRODUCES LEGISLATION TO INCREASE AWARENESS OF HEALTH INSURANCE APPEALS PROGRAM

12TH District Assemblywoman Caroline Casagrande has introduced legislation that would increase awareness by patients and doctors of an existing state program, the state Independent Health Care Appeals Program (IHCAP), designed to review health insurance coverage decisions. The program gives patients who have been denied coverage by their insurer for medically necessary treatment an opportunity to appeal that decision to a neutral arbitrator. IHCAP, which has existed in state government for over 10 years, receives only about 50 calls each month.

“When doctors recommend treatment and an insurance company denies coverage for it, patients and their families must wade through a sea of red tape to get that treatment covered, in many cases to the detriment of the health of the patient”, said Casagrande. “This independent state review board exists to help, but no one I’ve met, from doctors and nurses to patients and social workers, knows about it. My legislation would bring this resource out of the remote corners of state government, and put it to work improving the lives of New Jerseyans.”

Casagrande’s bill would create a 24 hour hotline for the program where patients, families and doctors can call to begin the process of applying to the program for arbitration. The bill would also require doctor’s offices and hospitals to post signs advertising the hotline’s toll-free number. Currently the number to reach the IHCAP is 888-393-1062. Finally, the bill would require training for appropriate hospital staff about the details of this program.

“In these economically strenuous times,” Casagrande said, it is important to alleviate stress wherever possible. By offering our citizens another avenue by which to save their hard-earned salaries, as well as time that could be better spent providing the nurturing care for loved ones, spreading awareness of this helpful program may have added benefits we haven’t even anticipated.”

This program offers patients, their families, and their doctors an excellent opportunity to have their case for coverage of medically necessary treatment made by an independent review board, not an insurance company medical director with half the patient’s file and a bias towards denial.

“There is nothing more terrifying than being told by your doctor that a treatment is medically necessary,” said Casagrande, “while simultaneously being told by your insurance company that it won’t pay for a treatment that may very well save the life of a loved one.”

In addition to introducing this legislation, Assemblywoman Casagrande has written to over 300 hospital presidents and administrators throughout the state, alerting them of this proposal, and asking for their support to promote the IHCAP among the doctors and staff at their hospital. Also, the Assemblywoman’s office has already created and distributed signs in both English and Spanish that contain the phone number to hospitals, asking that they be displayed.

“Currently, the program reviewed 250 appeals during the first six months of 2008. It’s clear from my conversations with doctors and patients that the program is being underutilized,” Casagrande’s letter states. “A goal of the legislation I have drafted and enclosed, A3543, is to raise awareness of this program among doctors and staff at our state’s medical facilities. In my own personal experience, I did not find that this program was well known or widely publicized, despite being in existence for 10 years.”