Physicians, especially those entering medical practice for the first time, find themselves unable to treat privately insured patients until they have become fully credentialed by insurance companies—a lengthy and oftentimes frustrating process that creates administrative hassles and delays patient care.
Strongly supported by the Pennsylvania Medical Society (PAMED), House Bill 1551 would help streamline the physician credentialing process by requiring insurers to:
- Complete the credentialing process within 60 days of receipt of a complete application
- Notify physicians of any missing or incomplete information within five days of receiving their application
- Indicate their intent to continue processing a physician’s application
- Allow those physicians who have been notified that their credentialing process will continue to see patients 15 calendar days after their application was received
- Provide physicians with the application receipt date and meeting date of the health plan’s next credentialing review committee
There is similar bill, Senate Bill 1224, in the Senate.
Contact your legislators and ask them to vote “yes” on HB 1551 or SB 1224 when either bill comes up for a vote in their chamber. If you had a negative and frustrating experience throughout the credentialing process, please be sure to share your story in your message.
“What we currently have is a private health insurance credentialing system or process that is at best inefficient, blind to the needs of patients residing in rural and underserved areas, and unfair to newly trained physicians who simply want to begin putting into practice the skills they have learned during nearly a decade of training,” said Bruce MacLeod, MD, vice president of the Pennsylvania Medical Society (PAMED), in his testimony before the House Insurance Committee on Nov. 30, 2011.
“I should also point out that the system is no kinder to established physicians who change employers or relocate and must similarly jump through and over an insurer’s hoops and hurdles with denying care to patients in need,” said Dr. MacLeod.
In addition to easing the burden on physicians, passage of this legislation would also help ensure access to care for Pennsylvanians and reduce patients’ out-of-pocket expenses.