Senate passes measure requiring transparency for health insurance claim denials

The Senate gave approval to a measure Wednesday that would require insurers to provide a detailed notice to both the patient and health care provider when denying a claim.

Authored by Sen. Joe Newhouse, R-Tulsa, Senate Bill 550 would require the notification to include the reason for denial and instructions on where a person or entity could respond. Upon receiving the denial, the recipient may submit a detailed appeal in writing explaining why the claim should be approved. If the appeal is then denied, the insurer must address in writing the specific details of why it is further appealed and provide the phone number of a health plan representative.

“When dealing with health insurance companies, it’s pretty common to have some frustrations, especially when a claim has been denied and you have no clue why,” Newhouse said. “This bill is all about creating transparency and efficiency within the health care claim process by streamlining the denied claims process and improving communication between all parties.”

The measure was developed with the Oklahoma State Medical Association; Oklahoma Hospital Association; Oklahoma Association of Health Plans; Integris Health; BlueCross/BlueShield of Oklahoma; and the Oklahoma Insurance Department.

It now heads to the House of Representatives for further consideration where Rep. Marcus McEntire, R-Duncan, will carry the measure.