HLS 15RS-4181 ORIGINAL
2015 Regular Session
HOUSE RESOLUTION NO. 149
BY REPRESENTATIVE ROBERT JOHNSON
INSURANCE/HEALTH: Urges the Department of Insurance to study the appeals process
and its impact on those with critical illnesses
1 A RESOLUTION
2To urge and request the Department of Insurance to study the appeals process and its impact
3 on those with critical illnesses.
4 WHEREAS, Louisiana has a statutory process by which persons who have been
5denied a medical benefit by their health insurers may appeal that decision; and
6 WHEREAS, such denials are referred to in the law as "adverse determinations"; and
7 WHEREAS, such adverse determinations are often based upon a health insurer's
8decision that a medication is not medically necessary; and
9 WHEREAS, due to such a determination, persons with critical illnesses lose access
10to medications that are indeed medically necessary, even during the appeals process; and
11 WHEREAS, such critical illnesses include but are not limited to multiple sclerosis,
12cancer, heart disease, Alzheimer's, and muscular dystrophy; and
13 WHEREAS, denying such persons access to such medications can result in
14immediate and irreversible damage to their health.
15 THEREFORE, BE IT RESOLVED that the House of Representatives of the
16Legislature of Louisiana does hereby urge and request the Department of Insurance to study
17the appeals process and its impact on those with critical illnesses.
18 BE IT FURTHER RESOLVED that the study include the following factors: how
19many adverse determinations involving medications, not based on formulary changes, are
20made during one year in this state; how many appeals are filed based on such adverse
Page 1 of 2 HLS 15RS-4181 ORIGINAL
HR NO. 149
1determinations; the average length of such an appeal; and how many of these appeals are
2upheld or overturned.
3 BE IT FURTHER RESOLVED that the study also include the following factors:
4the average notification time of such adverse determination; whether the person's physician
5is consulted prior to making the adverse determination; and what factors are considered
6when an adverse determination is made due to the health insurer finding a medication
7medically unnecessary.
8 BE IT FURTHER RESOLVED that the Department of Insurance may submit its
9findings from the study in the form of a report to the House Committee on Insurance and the
10Senate Committee on Insurance on or before January 15, 2016.
11 BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the
12commissioner of insurance.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HR 149 Original 2015 Regular Session Robert Johnson
Urges and requests the Department of Insurance to study the appeals process and its impact
on those with critical illnesses and to report findings and recommendations to the House
Committee on Insurance on or before Jan. 15, 2016.
Specifies that the following factors be included in the study: how many adverse
determinations, not based on formulary changes, are made during one year in this state; how
many appeals are filed based on such adverse determinations; the average length of such an
appeal; how many of these appeals are upheld or overturned; the average notification time
of the adverse decision; whether the person's physician is consulted prior to making the
adverse determination; and what factors are considered when an adverse determination is
made due to the health insurer finding a medication medically unnecessary.
Page 2 of 2