Payor Responsibility for Additional Expenses & Patient Co-pays
MEDCHI, THE MARYLAND STATE MEDICAL SOCIETY
HOUSE OF DELEGATES
INTRODUCED BY: Montgomery County Medical Society
SUBJECT: Payor Responsibility for Additional Expenses & Patient Co-pays
REFERRED TO:
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- Whereas, physicians attend medical school and complete several years of residency and fellowship
- before they are allowed to practice in their chosen specialty; and
- Whereas, physicians are licensed by the Maryland Board of Physicians to practice medicine in Maryland
- and health plans are not; and
- Whereas, physicians who care for patients understand their medical issues and needs and have the
- expertise to know what treatments are in the best interest of the health care of their patients, and
- Whereas, third party payors are denying and delaying the physician-ordered care to manage “costs” not
- care; and
- Whereas, the decisions made contrary to the treating physician’s expert medical opinion may result in
- more expense including but not limited to additional office visits, hospitalization, change in medication,
- and/or different procedures for which the treating physician and patient should not be held responsible;
- therefore, be it
- RESOLVED, that MedChi will seek and/or support legislation and/or regulation which will require
- third-party payors to be responsible for approving and paying for all additional treatment costs and
- reimburse co-pays to the patient if the payor’s failure to authorize the original medical treatment
- ordered by the treating physician results in the need for these additional treatment(s).