A key Senate committee restored language in a bill Friday that would make Hawaii Medical Service Association legally responsible for deaths or other harm as a result of undue delays in testing.
HMSA on Dec. 1 began requiring all physicians in its network to go through Arizona-based National Imaging Associates Inc. to approve diagnostic imaging exams, including MRIs, CT scans and other cardiac-related procedures. Before HMSA adopted the new policy, most doctors were given a waiver that allowed them to skip the pre-authorization step.
House Bill 2740 was amended Friday by the Senate Judiciary and Labor Committee. The committee reversed an earlier decision by the Senate Commerce, Consumer Protection and Health Committee that removed HMSA’s liability for civil damages caused by any holdups for pre-authorization. The HMSA liability language is now back in the bill.
Lawmakers introduced the bill following complaints by doctors and patients that HMSA’s new policy is delaying critically needed imaging tests, resulting in harmful consequences. HMSA, the state’s largest health insurer, contends that the policy is necessary because Hawaii’s imaging costs are about
9 percent higher than the national average in commercial markets for people who have insurance through their employers. An HMSA spokeswoman didn’t respond to calls for comment Friday.
“Not having any language that deals with some aspect of liability basically made the bill flawed, and it would’ve been subject to being in violation of the constitution,” said Gilbert Keith-Agaran (D, Waihee-
Wailuku-Kahului), chairman of the Senate Judiciary and Labor Committee. “If there’s a delay in diagnosis because a test wasn’t performed, it’s a real problem for the patient. At the same time, I’m always a little leery of testing for the sake of testing. We all know that in the medical profession we have to rely on the good judgment of doctors, and any tools we can give them is worthwhile. There’s a lot of balancing of whether or not symptoms always require certain tests. We are caught in a geographic bind here because of where we’re located and where the contractor is that HMSA has picked.”
The amended bill requires preapproval requests and decisions for medical treatments or services be based on nationally accepted evidence-
based guidelines and be made public to medical providers within a health insurer’s network.
“If an insurer is inserting itself into the delivery of patient care, then it stands to reason that they should be responsible and accountable for their part if and when a patient is harmed,” said Dr. Lisa Ignacio, a Hilo interventional radiologist and president of the Hawaii Radiological Society. “As physicians we take that responsibility every day.”
