Quixotic insurance reform now seems less so

State Assemblyman Adam Bradley, D-White Plains, has been a big advocate of health- care insurance reform. That has been a somewhat lonely and frustrating position, until business started getting involved. In the past two years ago, he and other reformers in Albany have finally had success in getting some “meaningful” legislation passed.

One bill required the insurance companies to adhere to a uniform coding system of procedures. Before, each had a different code for the same procedure, resulting in a bureaucratic nightmare for health-care providers, since billing departments had to keep track of hundreds of different codes.

Another bill passed by the legislature shortened the “look back” ”“ the period of time in which an HMO can ask for money back from a provider because of overpayment by the HMO. The look-back period has been reduced from six years to 24 months, said Bradley. Yet another bill makes it more difficult for the health-care insurance companies to deny paying for a service that was pre-authorized by them.

Bradley said the legislation has “made a terrible situation just a bad situation. Tremendously more needs to be done.” The first step, he said, is to reinstate the rate regulatory authority of the state superintendent of insurance, which was in effect prior to deregulation of the HMOS in 1997.