When UnitedHealthcare of New England won the state workers’ health insurance contract last fall, mental health care providers seized the opportunity to try to correct longstanding problems with the company over low pay rates, a cumbersome pre-approval system, etc.
The Rhode Island Medical Society convened a meeting with United and doctors, psychologists and social workers, and within weeks, United responded with several changes. The effort, all agree, made a real impact and will benefit patients. But money, which was at the heart of the problem, could only be discussed obliquely, says RIMS lobbyist Steven DeToy, because federal anti-trust law bars competitors from negotiating jointly.
As doctors see it, such limits put them at a disadvantage with giants like United and Blue Cross & Blue Shield of Rhode Island, who DeToy said dictate “all the rules of engagement.”
A bill introduced last month by state Rep. Peter L. Lewiss (D-Westerly) in the House and Sen. Hanna Gallo (D-Cranston) in the Senate would change that, allowing providers to negotiate jointly under supervision from the attorney general and the health insurance commissioner.
The bill, dubbed the “Health Care Fairness Act,” would “help restore the competitive balance and improve competition in the markets for health care services in this state,” Lewiss said.
Federal law allows states to make exceptions to anti-trust restrictions, DeToy said, when they’re viewed as necessary for the public good. Strict government controls have to be imposed to ensure that the negotiations don’t result in anything that hurts consumers.
A similar bill was approved last year in the House, but died in the Senate Health and Human Services Committee. DeToy said the law creating the health insurance commissioner job – which includes oversight of provider-insurer relations – was still being finalized, and there wasn’t enough time to revise the joint negotiation bill accordingly.
Along with RIMS, Lewiss said he expects to get support from the Rhode Island Dental Society, the Chiropractic Society of Rhode Island, the Optometrist Medical Society, the Podiatric Medical Society, the Rhode Island Psychological Society and the Attorney General.
