Bill instituting appeals for denied MCO claims pass Senate committee

01/26/2016 01:23 PM

FRANKFORT – Medical providers whose claims have been denied by managed care organizations will have an opportunity to appeal those decisions under legislation which was unanimously passed by the Senate Committee on Appropriations and Revenue on Tuesday.

Senate Bill 20, sponsored by Sen. Ralph Alvarado, R-Winchester, would create an independent appeals process within the Cabinet for Human Services, where medical providers of Medicaid services, whose bill for services is denied by an MCO, can go to for $100 fee to appeal the costs of the services.

Alvarado says the appeals process is already in place in Georgia and Virginia.

The Winchester Republican, and doctor, describes denied claims as a “horrible situation” with managed care organizations in the commonwealth.

“We have certain insurance companies that are essentially bad players in the insurance market,” Alvarado said. “They’re not paying providers in a timely fashion, or they’re not paying them at all.”

Kentucky Hospital Association chair Nina Eisner, who testified in favor of the bill, said the current situation with MCOs is putting a strain on many of her organizations members.

“A medical provider gives medically necessary care and services, the MCO denies the payment for the services that have been rendered as medically necessary, and the provider is denied a necessary appeals process,” Eisner said. “It’s unreasonable to expect that Kentucky providers will provide care for free.”

Alvarado says that the bill would give medical providers an opportunity to recover costs from services that they currently do not have.

“This would create and independent appeals process within the cabinet that they can go to, for a smaller fee, and appeal that cost,” Alvarado said. “If the managed care organizations lose, they’ll cover the cost for the provider coming forward. It’s exactly what Georgia does. It’s exactly what Virginia does.”

Originally, the appeals process was to go through the attorneys’ general office but was changed to the Cabinet for Human Services.

The bill now goes to the full Senate chamber.


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