HOUSE CONCURRENT RESOLUTION NO. 125

(By Delegates Perry, Hall, Moore, Reynolds, Cann,

Ferns, Frazier, Hartman, Iaquinta, Mahan, Manchin,

Michael, Shaver, Stowers, Ashley, Walters,

 Carmichael, Nelson, and O’Neal)

(Originating in the Committee on Banking and Insurance)

(March 3, 2011)

Requesting the Joint Committee on Government and Finance study issues related to requiring direct payment by health insurance companies and health maintenance organizations to out-of-network health care providers upon an assignment of benefits by a covered patient to the provider.

    Whereas, Currently, state law does not regulate the direct payment by health insurance companies and health maintenance organizations to an out-of-network health care provider if a patient has made an assignment of benefits to the health care provider; and

    Whereas, Health insurance companies and health maintenance organizations currently exercise the election to either directly pay health care providers or pay the patient for covered treatment or procedures, regardless of whether the patient/insured has assigned his or her benefits to the provider; and

    WHEREAS, House Bill 3052, introduced in the West Virginia House of Delegates in the 2011 Regular Session, sets forth various requirements upon group accident and sickness insurers relating to the assignment of benefits by an insured patient to a provider; and

    Whereas, Proponents of H.B. 3052 assert that requiring insurers and other benefit providers honor the assignment of benefits by patient/insureds directly to providers as provided in the proposed legislation would ease the administrative and financial burden placed on the patient consumer and would remove potential barriers to access to healthcare by insured patients needing healthcare from an out of network providers; and

    Whereas, Proponents of H.B. 3052 also assert that the legislation would provide a more efficient and cost effective method for providers to receive payment for healthcare services rendered, thereby contributing to a reduction in the cost of healthcare; and

    WHEREAS, Questions have been raised by health insurers as to whether the requirements in H. B. 3052 would tend to be a disincentive for providers to enter into network provider agreements with insurers at reduced rates for insured patients and therefore may result in increasing the cost of accident and sickness insurance; and

    WHEREAS, Representatives of the health care insurance industry also assert that such legislation may also promote the increased practice of balance billing by out of network providers, thereby increasing the cost of healthcare to patient insureds; and

     WHEREAS, other states have adopted legislation addressing the assignment of health insurance benefits by insured patients to health care providers; therefore, be it

    Resolved by the Legislature of West Virginia:

    That the Joint Committee on Government and Finance is hereby requested to study issues related to requiring direct payment by health insurance companies and health maintenance organizations to out-of-network health care providers upon an assignment of benefits by a covered patient to the provider; and, be it

    Further Resolved, That the Joint Committee on Government and Finance report to the Legislature, on the first day of the regular session, 2012, on its findings, conclusions and recommendations, together with drafts of legislation necessary to effectuate its recommendations; and, be it

    Further Resolved, That the expense necessary to conduct this study, to prepare a report and to draft necessary legislation be paid from legislative appropriations to the Joint Committee on Government and Finance.