State Rep. Bryan Terry, MD (R-Murfreesboro) called on Gov. Bill Lee and the Department of Commerce and Insurance to ensure that the newly unemployed have their surgical health insurance coverage honored because of the moratorium on elective procedures. Due to an unintended consequence of banning elective procedures, many Tennessee patients may have paid premiums and had valid insurance during the ban, but then they had their surgery delayed. Now that they are unemployed, they may get stuck with the bill through no fault of their own. Terry is working to correct that.
On March 23, Lee issued Executive Order 18 which banned all elective surgeries in Tennessee to conserve personal protective equipment (PPE). Prior to and during the ban, insurers have been approving elective surgeries through a process called “prior authorization”. It is a process by which insurers agree to pay for the procedure or surgery of the insured. While Governor Lee did urge insurers to uphold their coverage commitments to Tennesseans, unfortunately, many Tennesseans have lost their job or their employers have not been able to continue paying premiums. This means that the insurance policy that was valid prior to or during the ban may no longer be valid. This situation places patients, providers, and facilities in a bind.
Explained Rep. Terry, “Through no fault of their own, we have newly unemployed individuals who needed surgery and had valid insurance, but now they are in a situation where they are at the mercy and grace of the insurers. Premiums were paid. Providers were willing to operate, but the COVID-19 pandemic halted their medical care. The state needs to ensure that these patients and providers aren’t punished by a government decision. Those commitments need to be honored.”
Many patients who were scheduled to have necessary, but elective medical or dental procedures before Gov. Bill Lee’s executive order halting all non-emergency procedures may now be left to cancel or pay out of pocket for previously approved procedures unless action is taken to address the issue. While some insurance companies are offering extensions for these prior authorizations or grace periods to catch up on premiums, there isn’t any guarantee that patients won’t receive a bill or providers won’t be reimbursed.
In a letter to Lee and Hodgen Mainda, Commissioner for the Tennessee Department of Commerce and Insurance, Terry suggested a recoupment moratorium could be put in place for surgeries approved prior to or during the halting of elective surgeries brought through Executive Order 18. Terry said this would not only help patients, but also hospitals and medical or dental practices that have experienced major financial setbacks as a result of the cancellations and postponements of elective surgical procedures.
“TennCare has frozen their termination process and they are going to honor those commitments to patients. Private insurance carriers who took the premiums should do the same,” said Terry. “I understand that Governor Lee urged a grace period and some insurers have said they will comply. But patients and practices need guarantees during these uncertain times. They do not need additional financial burdens and hardships when they are complying with Executive Orders.”
Terry said that he is working with Commissioner Mainda, Speaker Cameron Sexton (R-Crossville), and Insurance Chairman Robin Smith (R-Hixson) on the issue and has offered guidance and solutions. “With over 400,000 newly unemployed, as well as businesses that need time to catch back up after they reopen, the state doesn’t know how big of a problem that this is. With the state reopening elective surgery on May 1st, time is of the essence and this issue needs to be addressed properly and expeditiously by the state.”
Rep. Bryan Terry, MD represents District 48 which is the eastern half of Rutherford County. His office can be contacted at 615-741-2180 or Rep.Bryan.Terry@Capitol.Tn.Gov