AMCNO views Prior Authorization Legislation (SB 129) as a Victory for Physicians and Patients

Ohio has joined a growing list of states to make substantial changes in how a patient’s insurance carrier will cover needed medical services.  SB 129 – Prior Authorization (PA) legislation is headed to Gov. John Kasich’s office for signature in the near future.  The AMCNO was part of a statewide coalition backing SB 129, and we consider passage of this bill as a major victory for physicians and patients. 

Prior authorization is a process that requires physician offices to ask for permission from a patient’s insurance company before prescribing certain medications or performing medical treatment. The problem with this process has been that many times insurance carriers would not cover the services even if prior authorization had already been provided for a medical service. 

SB 129 will:   

  • Ensure that PA requirements or restrictions are listed on the health insurer’s website; 
  • Allow providers and patients to obtain PAs through a web-based system; 
  • Ensure that any new or future PA requirements are disclosed prior to the new requirement being implemented; 
  • Guarantee that once a PA has been approved, the insurer will not retroactively deny the service based upon previously approved medical necessity or coverage criteria; and,
  • Guarantee a faster turnaround on PA requests and a streamlined appeals process in the event a prior authorization is denied.

To learn more about SB 129, click here.

The Pollen Line is now closed. See you in the spring!

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