Colorado Medical Society

WHEREAS, health insurance companies in Colorado have extraordinary market power in comparison to physicians with whom they negotiate contracts for health care services, and

WHEREAS, patients are relatively uninvolved in the negotiations that go on between insurance companies and employers regarding health care coverage, and often lack details which would be helpful in their choosing health care coverage, and

WHEREAS, methods of creating group bargaining power for physicians have been unsuccessful in other states and generally run afoul of antitrust law, therefore be it

RESOLVED, that the Colorado Medical Society should study ways in which the health insurance market in Colorado can be regulated so as to create a more fair and equal bargaining environment for physicians dealing with health insurance companies, to include such requirements as a set time of the year for contract renewals, defined methods of contact between physicians and companies, posting of complete fee schedules, default cost of living increases in physician reimbursement when negotiations have not been concluded, methods of publicly posting insurance reimbursement levels and other appropriate legal efforts to facilitate physician-insurance company negotiations in a free and open market, and be it further

RESOLVED, that the Colorado Medical Society should study ways in which insurance companies can be required to post a reliable physician roster for network plans and a schedule of benefits for all patients seeking care from "any competent physician" practicing medicine in Colorado, to provide a limit on requirements for pre-authorization, a method of appeal to an independent body when insurers deny coverage and other safeguards for appropriate patient care, and be it further

RESOLVED, that the Colorado Medical Society, through its Board of Directors should seek legislation and regulatory reforms in order to effect the safeguards envisioned by this resolutions.

FISCAL IMPACT: $3,208