Peer Review

8 Feb 2010
MSV is actively supporting HB 11, which would establish a requirement for a peer-to-peer reviews following a health plan or HMO's denial of coverage for a health care service. Presently, a health plan may use advisors or panels that are not specialist in the treating provider's field to make determinations on claims. HB 11 will be heard by the full House HWI Committee on Tuesday, February 9. The Virginia Association of Health Plans opposes the bill and has proposed new language favorable to its members.

MSV Position

• MSV supports HB 11 as introduced. HB 11 would specify that upon receiving an adverse decision, a treating physician may request reconsideration by a physician peer rather than by physician advisors (nurses) or panels of other health care providers.
• HB 11 retains the current requirement that a health plan or HMO respond within 10 days to a reconsideration of an adverse decision.
• This bill provides patients with a timely response and reduces the uncertainty in receiving physician recommended treatment.
• The bill enhances treating physicians’ ability to have a reconsideration conducted by a physician peer, to best ensure quality health care services can be delivered to their patients.