Insurance Claims on Interim Agenda


The Interim Public Health, Behavioral Health and Human Services Committee conducted its final hearing in late October. The only topic of debate was the preliminary draft language that was offered by the chair, Sen. Patricia Miller (R-Indianapolis). The committee also prepared its final report for the Indiana General Assembly.

Senator Miller’s proposal addressed problems that she believes are occurring related to the handling and denial of health insurance claims. Her proposal would require the Department of Insurance to post on its web site information concerning internal and external grievance procedures for health insurance contracts. Examples include the process that a consumer should follow in filing a grievance along with a contact phone number of the department for the consumer. These provisions were generally accepted as reasonable provisions of the draft.

Controversy arose over the quarterly requirements that will be imposed on insurers regarding the denial of claims and additional burdens placed on them. The Indiana Department of Insurance testified that there really isn’t a problem regarding health claim denial in Indiana and while there have been problems among property and casualty insurers, that has not been the case with health insurers. Further testimony reflected that the department has the ability to do market conducts (on the distribution and sale of insurance), which determine problems with carriers.

Furthermore, the department conducts financial audits once every five years on every Indiana domestic insurer to make certain of insurer solvency and the ability to pay claims. Representative Matt Lehman (R-Berne) commented that the claim problem was .0004 of one percent – implying that there really isn’t any need to impose further requirements. The language passed the committee, with Sen. Jean Breaux (D-Indianapolis) and Rep. Lehman voting against the draft.

Look for Sen. Miller to draft legislation in the 2016 session similar to the language proposed in the draft. A bill may even move through the Senate, but may find more difficulty getting traction in its current form in the House. Still, there will be a fairly good chance that the grievance procedures and the web site information will find their way through the legislative process. The Chamber will be involved in the debate during the upcoming legislative session.

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