ENROLLED
2015 Regular Session
HOUSE RESOLUTION NO. 149
BY REPRESENTATIVE ROBERT JOHNSON
A RESOLUTION
To urge and request the Department of Insurance to study the appeals process and its impact
on those with critical illnesses.
WHEREAS, Louisiana has a statutory process by which persons who have been
denied a medical benefit by their health insurers may appeal that decision; and
WHEREAS, such denials are referred to in the law as "adverse determinations"; and
WHEREAS, such adverse determinations are often based upon a health insurer's
decision that a medication is not medically necessary; and
WHEREAS, due to such a determination, persons with critical illnesses lose access
to medications that are indeed medically necessary, even during the appeals process; and
WHEREAS, such critical illnesses include but are not limited to multiple sclerosis,
cancer, heart disease, Alzheimer's, and muscular dystrophy; and
WHEREAS, denying such persons access to such medications can result in
immediate and irreversible damage to their health.
THEREFORE, BE IT RESOLVED that the House of Representatives of the
Legislature of Louisiana does hereby urge and request the Department of Insurance to study
the appeals process and its impact on those with critical illnesses.
BE IT FURTHER RESOLVED that the study include the following factors: how
many adverse determinations involving medications, 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; and how many of these appeals are
upheld or overturned.
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BE IT FURTHER RESOLVED that the study also include the following factors: the
average notification time of such adverse determination; 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.
BE IT FURTHER RESOLVED that the Department of Insurance may submit its
findings from the study in the form of a report to the House Committee on Insurance and the
Senate Committee on Insurance on or before January 15, 2016.
BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the
commissioner of insurance.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
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