Unmasking Insurance Companies

New Law Unmasks Insurance Companies and Protects Vermont Pharmacies

If you want to know more about what goes on behind closed doors at our health insurance companies and how your premium money is being spent, you will appreciate a new Vermont law I introduced this year.

It sets up new, comprehensive insurance company reporting requirements and it protects Vermont pharmacists from burdensome audits by Pharmacy Benefit Managers, essentially prescription drug insurance programs.

First, it requires insurance companies to disclose every claim they deny and when those denials are overturned on appeal. As well as how much they spend on lawyers fighting their customers. Denied claims are painful and expensive. People go without care they presumed was covered. And, providers and patients spend a lot of money and time navigating a tangle of appeals, fighting to get their coverage. And, of course some give up the struggle and pay out of pocket, just what the insurance companies want.

Along with denied claims, the law requires insurance companies to report their political contributions, lobbying expenses, marketing expenses, salaries, bonuses, benefits and other compensation for corporate officers and board members and charitable contributions.

So, when it comes time to decide who to buy insurance from – as long as we have private insurance companies that is – you will have this information. It will be posted on the website of the new Vermont Health Exchange and the Vermont Department of Financial Regulation.

The law also sets out new ground rules to protect Vermont pharmacists from Pharmacy Benefit Managers (PBM) who can conduct virtually limitless audits that can end up costing pharmacies tens of thousands of dollars. Along with a lot of staff time and stress – before this new law – the Pharmacy Benefits Managers could hold pharmacists financially responsible for prescriptions they deemed problematic even though they were approved by medical providers.

The new law lays out a slew of protections defining how and when audits can be conducted and protects pharmacies from arbitrary financial penalties when they act keeping with Vermont and federal rules.

Local pharmacists say the new law is the best in the country.