Committee advances substitute for insurer ‘takebacks,’ shortens look‑back and extends provider appeal window
Get AI-powered insights, summaries, and transcripts
Sign Up Free
Summary
The committee approved substitute Senate Bill 162 as a working document; the substitute shortens insurer claim ‘takebacks’ look‑back from 24 to 12 months, extends provider appeal rights from 30 to 60 days, and allows agreed electronic notification between insurers and providers, sponsors and the Ohio State Medical Association said.
The Financial Institutions, Insurance and Technology Committee on the motion of Senator Blessing approved a substitute for Senate Bill 162 as the working document and heard proponent testimony.
Senator Blessing said the substitute is the product of negotiations between the Ohio Association of Health Plans and the Ohio State Medical Association. "The substitute bill promotes fairness and transparency," he said, and the language narrows the time frame for insurer takebacks while lengthening the provider appeal window.
Monica Hickle, vice president of advocacy for the Ohio State Medical Association, told the committee the current 24‑month look‑back for insurer recoupments is "really hard fiscally for practices." She said a 12‑month window would allow providers to close their fiscal year and complete audits without being subject to a two‑year clawback. "This gives it a 12 month time period so we'll wrap up finances within the current fiscal year," Hickle said.
The substitute also increases the provider appeal period from 30 to 60 days; Hickle and the sponsor said that extension is intended to address delays caused when providers receive hard‑copy clawback notices after claims were processed electronically. The bill requires electronic notice if the insurer and provider typically communicate electronically.
Committee members were told the draft reflects feedback from the Department of Insurance and health plans. The sponsor and proponent described the change as applicable to all health‑care providers, not only physicians, and said it had broad stakeholder support.
The committee concluded the bill's third hearing and accepted written testimony into the record. No formal roll‑call vote on passage was taken; the substitute was made the working document for further consideration.
Next steps: the committee closed the hearing on the substitute and will carry the working document forward for additional committee action and potential future hearings.