Colorado Medical Society

Introduced by: Arapahoe-Douglas-Elbert Medical Society

Subject: Preexisting Conditions at Time of Service

Referred to: Reference Committee on Health Affairs

WHEREAS, many employers and/or insurers are tailoring health benefit plans in order to place more financial obligation on the patient, and

WHEREAS, exclusionary clauses placed in benefit plans often do not give insured patients coverage for certain diagnoses, and

WHEREAS, physicians are not aware of these exclusionary criteria at time of service, and

WHEREAS, payors send paperwork to physicians to fill out regarding preexisting condition diagnosis/treatment, before processing a claim, if they will pay for a claim at all, and

WHEREAS, collecting payment after time of service is inefficient, involves excessive staff time and resources, and often is unsuccessful, therefore, be it

RESOLVED, that CMS seek legislative relief for physicians to be notified at time of service, either through website access/ and/or information on the insurance ID card, by insurers/payors, what pre-existing conditions will not be covered at the time of service, so that physicians can inform patients of their financial responsibilities, and get appropriately and promptly paid for services rendered at the time of service.

FISCAL IMPACT: None