Colorado Medical Society

Introduced by: Aurora-Adams County Medical Society

Subject: Medical Directors’ Responsibility in Denial of Procedures

Referred to: Reference Committee on Health Affairs

WHEREAS, physicians are patient advocates and order procedures and tests that is in the best interest of the patient, and

WHEREAS, refusal by an insurance company to pay for an ordered test or procedure may be looked upon by patients as not being in their best interest, and

WHEREAS, the majority of the denied tests and procedures are approved after the physician discusses the situation with the insurance carrier’s medical director, and

WHEREAS, the time the physician must spend getting in contact with the insurance carrier’s medical director is not in the best interest of their patients, and

WHEREAS, the delay in getting approval from the medical director is not always in the patient’s best interest, therefore be it

RESOLVED, the Colorado Medical Society take appropriate actions through its quarterly payers meetings and in discussions with the Colorado Insurance Commissioner and the legislature to require insurance companies to have their medical director call the ordering physician during regular office hours if a test or procedure is denied and not just send a denial.